Okumbe, Mukolwe Gaudencia2011-08-102011-08-102011-08-10http://ir-library.ku.ac.ke/handle/123456789/671RG 530.3.K4O38The evident disparities in maternal morbidity and mortality between developed and developing countries are of concern. These stem from the fact that developed countries have achieved very low rates of 9 maternal deaths per 100,000 live births, while developing countries have very high rates of 900 maternal deaths per 100,000 live births. In the developing world, 533,000 women lose their lives as a result of complications of pregnancy and delivery, unlike the developed world where there are only 6,000 deaths. The persistence of high maternal mortality ratios in developing countries despite the Safe Motherhood Initiative and efforts by the Inter Agency Group has led to prioritisation of maternal mortality reduction one of the UN's Millennium Development Goals. In Kenya, the maternal mortality ratios between different regions have displayed similar disparities with some regions in Central and Rift Valley Provinces having very low rates while some regions in the Coast, Western and Nyanza Provinces have very high rates, hence the problem of the study. The choice of Bondo District was based on the fact that the District is in one of the regions with a high maternal mortality rate of 620 deaths per 100,000 live births and a high number of health problems. The main objectives of the study were to estimate the maternal morbidity and mortality rates for Bondo District; determine environmental factors that impact on maternal morbidity and mortality; ascertain the extent to which each of these factors impacts on these phenomena in the District; and to assess progress made towards lowering maternal mortality rate in the District. The literature review covered several issues perceived to impact on maternal morbidity and mortality. The perspectives were founded on population theories, such as the demographic transition theory. This was followed by a review of maternal morbidity and mortality studies conducted worldwide. The Mosley and Chen's conceptual model (1984) of factors affecting mortality was adapted for this study. The methodology addressed the study site, the study design, methods of data analysis and their limitations. The study was conducted in five divisions of the District. A random sample of 50 enumeration areas was drawn from a total of 686 enumeration areas in the District. From each of the enumeration areas, 20 households were systematically sampled in proportion to the size of each enumeration area. From each household, a female of reproductive age 15-49 was selected for interview. A total of 1,000 female respondents were thus selected. Descriptive statistics and logistic regression analysis were applied in data analysis, using the statistical package for social sciences (SPSS). Common morbidities were malaria, during pregnancy and fever n postpartum period, while the least illness suffered was sexually transmitted disease (STD). The maternal mortality rate for the District was estimated at 477 deaths per 100,000 live births. The logistic regression analysis showed that environmental factors such as demographic attributes of age, socio-economic attributes of occupation, income and health attributes of family planning increased risks of maternal morbidity. The study confirmed increased risk of haemorrhage during pregnancy among women aged 3539, increased risks of postpartum haemorrhage in the age group 25-29 and 30-34, but reduced risks of haemorrhage in pregnancy among low income Age was also found to be a risk in some maternal morbidity areas such as cough, anaemia, and fever. The study recommends mandatory delivery in health facilities and attendance of postpartum care. It also recommends empowerment of women economically and educationally as a means to better healthcare. The study emphasizes the need for further study on causes of postpartum haemorrhage in adolescents and the link between the injectable and Norplant methods of contraception and anaemiaenThesis