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\begin{document}

\title{Risk Factors for Maternal Death in an Urban Tertiary Hospital in Kenya:
A Case-Cohort Study}



\author[1]{Moses Ndiritu}%
\author[1]{Magoma Mwancha-Kwasa}%
\author[1]{Rashida Admani}%
\author[1]{Margaret Mbugua}%
\author[1]{Patrick Nyaga}%
\author[1]{Prabhjot Juttla}%
\author[1]{Teresia Njoki Kimani}%
\author[1]{Ryan Gitau}%
\author[2]{Alfred Owino Odongo}%
\author[1]{Mary Maina}%
\affil[1]{Kenya Ministry of Health}%
\affil[2]{Mount Kenya University}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\begin{abstract}
\textbf{Objective:} To evaluate the risk of maternal death following the
intensification of Maternal and Perinatal Death Surveillance (MPDSR)
activities and the substitution of dinoprostone for misoprostol for
labour induction. \textbf{Design:} Case-cohort \textbf{Setting:} Kiambu
County Referral Hospital(KCRH), Kiambu County, Kenya \textbf{Population
or Sample:} Mothers delivering at KCRH during January 2018 - December
2021 \textbf{Methods:} We recruited all 58 mothers who died between
January 2018 and December 2021 as cases. A random subcohort of 232
mothers who did not die was selected from a retrospective cohort study
of 411 mothers as controls. Multiple logistic regression was used to
model the determinants of maternal mortality adjusted for intensified
MPDSR activities and labour induction agents. \textbf{Main Outcome
Measures:} Adjusted odds ratio of maternal mortality for mothers induced
with misoprostol versus dinoprostone and for delivery prior to and after
the intensification of MPDSR activities. \textbf{Results:} Factors
associated with increased risk maternal mortality included: unemployment
(AOR 1.83; 95\% C.I.: 0.52 -- 7.50), singlehood (AOR 3.47; 95\% C.I.:
0.59 -- 17.9), labour induction with misoprostol (AOR 7.17; 95\% C.I.:
0.72 - 182), multiparity (AOR 3.11; 95\% C.I.: 1.37 -- 6.98, p = 0.006),
or being pre-term (AOR 4.79; 95\% C.I.: 1.56 -- 15.7, p = 0.007).
\textbf{Conclusions:} The risk of maternal mortality did not decrease
with the intensification of MPDSR activities but increased with the use
of misoprostol to induce labour. \textbf{Funding:} Ministry of Health
(Kenya), Transforming Health for Universal Health Coverage%
\end{abstract}%



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\textbf{Hosted file}

\verb`Case-Control V3.0-BJOG.docx`  available at \url{https://authorea.com/users/632433/articles/651220-risk-factors-for-maternal-death-in-an-urban-tertiary-hospital-in-kenya-a-case-cohort-study}

\textbf{Hosted file}

\verb`Case-Control-V3.0-BJOG-Tables.docx`  available at \url{https://authorea.com/users/632433/articles/651220-risk-factors-for-maternal-death-in-an-urban-tertiary-hospital-in-kenya-a-case-cohort-study}

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