| dc.description.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. | en_US |
