Characteristics, Outcomes and experiences of pregnant women with cardiac disease at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya

Abstract

Cardiac disease in pregnancy is a cause of indirect maternal morbidity and death worldwide. It places an excessive burden on low- and middle-income regions. In Western Kenya, there is a high prevalence of clinically significant heart lesions. However, many women remain undiagnosed until decompensation occurs. At JOOTRH, a lack of integrated regional data on disease burden, sociodemographic profiles, and patients' lived experiences hinders the development of evidence-based cardio-obstetric protocols. The broad objective of this study was to investigate the characteristics, outcomes, and lived experiences of pregnant women with cardiac disease managed at JOOTRH between 2022 and 2026. Specifically, the study aimed to describe the sociodemographic and clinical profiles and determine maternal, cardiac, and neonatal outcomes. Concurrently, the study explored the biological, psychological, and social experiences of these patients. The research adopted a convergent parallel mixed-methods design to understand the disease burden. A retrospective, analytical cross-sectional review of 27 patient files was conducted. The files had been identified through census sampling. Simultaneously, a cross-sectional phenomenological design was used, comprising nine indepth interviews selected through purposive sampling. Quantitative data comprising patients' characteristics (sociodemographic factors, obstetric history, and clinical features) and outcomes (cardiac, obstetric, and foetal) were extracted using a pre-tested data abstraction form and analysed in R. Fisher's exact tests were used to assess bivariate associations between categorical clinical markers and binary materno-foetal outcomes. Firth’s penalised logistic regression was employed for multivariable analysis to calculate stable, adjusted odds ratios despite small-sample data separation. The quantitative analysis revealed rheumatic heart disease as the main cause of morbidity. The composite cardio-obstetric Major Adverse Cardiovascular Event rate was 63.0%, driven predominantly by heart failure and pulmonary oedema, with a maternal mortality rate of 14.8%. Bivariate and multivariable analyses identified New York Heart Association functional class III/IV at entry as the sole significant adjusted predictor of MACE. Qualitative data were managed using NVivo. The narratives contextualised the results by describing biological experiences, including “diagnostic odysseys”, symptom normalisation, and traumatic peripartum crises. The Psychological Experiences included fear of death, ambivalence about pregnancy termination, and maladaptive coping strategies. The Socio-Structural Experience included stigma, financial stress, and institutional failures. The study determined that poor outcomes are not solely attributable to the biological severity of cardiac lesions but result from cumulative failures in systemic recognition and access to health services. It is recommended that JOOTRH develop and institutionalise cardio-obstetric protocols and establish a Pregnancy Heart Team. Additionally, early first-trimester NYHA functional status screening, shared decision-making, and a maternal health financial subsidy should be implemented to reduce barriers to specialist care.