Diagnostic Errors and their Impact on Obstetric Outcomes among Post-Natal Women at Level Five Teaching and Referral Hospitals in Bungoma County, Kenya

Abstract

Diagnostic errors are a global problem. Kenya has a high annual maternal mortality prevalence ratio of 362/100,000 live births. Bungoma County has a higher prevalence of diagnostic errors of 382/100,000 live births annually which exceeds the national average. Maternal and neonatal mortality arises from morbidity caused by diagnostic errors in Bungoma County. Thus, this study investigated the relationship between diagnostic errors and obstetric outcomes among post-natal women at level five hospitals in Bungoma County. Swiss Model guided this study. The study used a cross-sectional research design which was hospital-based (Bungoma and Webuye hospitals). Systematic sampling was used to obtain 327 respondents after proportionate allocation to each hospital, and purposive sampling to select 8 healthcare workers as key informants. Data was collected using a structured questionnaire and an interview guide. The pre-test was done with validity established through crosschecking and reliability calculated using the Cronbach method (0.891). Using a statistical package for social sciences version 25, descriptive and inferential statistics were run where chi-square and odds ratio were used to determine the relationship between diagnostic errors and obstetric outcomes. The findings showed that diagnostic errors on average constituted 68.7% at the antenatal care clinics. Individual diagnostic errors were delayed diagnosis (56.9%), missed diagnosis (61.2%), absent diagnosis (72.5%), wrong diagnosis (65.1%), misinterpretation of tests (75.8%) and unnecessary investigation (80.7%). The safe obstetric outcome from the diagnostic errors was 77.4% and the unsafe obstetric outcome was 22.6%. The computed Odds Ratio (OR) indicated that delayed diagnosis (OR=1.661, p < 0.001), missed diagnosis (OR=1.587, p < 0.001), absent diagnosis (OR=1.454, p < 0.001), wrong diagnosis (OR=1.532, p < 0.001), misinterpretation of tests (OR=1.425, p < 0.001) and unnecessary investigation (OR=1.389, p < 0.001) were more likely to result in a safe obstetric outcome especially when matched at the final diagnosis. The matched diagnosis was 5.625 times more likely to result in a safe obstetric outcome as compared to an unmatched diagnosis. In conclusion, diagnostic errors from the matched diagnosis were 5.625 times more likely to prevent adverse obstetric outcomes as compared to diagnostic errors from the unmatched diagnoses. This study recommends that there should be continuous monitoring and evaluation of the antenatal care units to ascertain the diagnosis and history of the pregnant women to cushion against diagnostic errors that may result in adverse obstetric outcomes.