Effectiveness of mobile phone text message reminder on birth preparedness in a rural community in Kenya

Background: Birth preparedness is a strategy that has been found effective in preventing obstetric delays. Use of mobile technology can enable access and efficiency of health messages delivered during antenatal care. The mobile technology can be more effective in conveying health messages owing to its accessibility and enables follow up. Materials and Methods: This was a randomized control trial carried out among pregnant women attending public health antenatal clinics in Migori County. Four health facilities were randomized. Two facilities each were randomly picked for the study and control groups respectively. A total of 379 participants were recruited into the study. The study group participants received a verbal message on birth preparedness and a mobile phone text message reminder one month to their expected date of delivery. Follow up was done to both groups through their mobile phone contacts. Data was collected using an interviewer‑administered questionnaire and analyzed using Stata version 11. Proportion tests were done to compare the groups. Results: The success rate of the study was 90.5% (n = 343). Most of the participants (73%) were aged between 20 and 34 years. Majority of them were married (79.2%) and most of them had primary level of education. Protestant was the predominant religion (55.2%). Housewives and businesswomen constituted 34.2% and 27%, respectively. The respondents in the study group who were birth prepared were 74.3% (n = 136) while those in the control group were 48.1% (n = 77).Conclusion: The use of mobile phone text message reminder in addition to verbal messages is more effective. Key words: Antenatal; birth preparedness; delivery; message reminder; mobile phon

An Analysis of Bachelor of Science Nursing Students’ Attitudes on Nursing Profession at the end of their Basic Training: Case of Public Universities, Kenyan.

Background information: Attitudes are learned predispositions to respond in a consistently favorable or unfavorable manner with respect to a given object. Thus they cannot be observed directly.  Their dimension on a particular aspect determines the end result of that activity.  Nurses are responsible for caring for patients and are directly involved in decisions regarding a patient’s care. Nurse’s attitudes are also influential on other health care providers. Today’s nursing students and future nurses make up the backbone of the health care forces in every country and a positive attitude is essential in provision of health care services. Methodology and objective This study investigated the attitude of BScN as they finish their training. Study subjects involved 46 final year Bachelor of Science in Nursing (BScN) students, randomly selected from purposefully selected Kenyan public universities which included, Kenyatta University, Moi University and University of Nairobi. Data was collected using self administered questionnaire and attitude scales. Statistical package of social studies version 17 was used for data analysis. Results and discussions: Most respondents had a positive attitude toward the nursing profession because their main reason for joining nurse training was to help and care for the sick (70%). This was supported by the fact that 45.7 % of them viewed nursing as a noble profession. However, 52.2% of the respondents had not made a definite choice to remain in the nursing profession. This was mainly associated to lack of recognition for the work performed by nurses and poor financial motivation. Conclusions and recommendations: Majority of the nursing students have a positive attitude toward the nursing profession but certain aspects in this noble profession tend to diminish the proportion of those who would like to take it up as a lifelong career. Therefore, effort to motivate nurses financially, improve the working schedules and recognize the work done by the nurses should be encouraged in order to increase the number of the students who would prefer to remain in the nursing profession in future. Key words: Bachelor of Science Nursing Students,               Attitudes on Nursing Profession, Public Universities in Kenya

Role of Men in Birth Preparedness: A Qualitative Study of Women Attending Antenatal Clinics in Migori County, Kenya

Background & aim: Male involvement is evidently an effective strategy for enhancing maternal health outcomes. Although childbirth has traditionally targeted women, the key roles of men in decision-making and financial support cannot be ignored. This study aimed to analyze women’s perception of men in birth preparedness in Migori County, Kenya. Methods: This qualitative study was conducted on 32 pregnant women attending selected public health facilities in Migori County from January to March, 2016, using conventional content analysis. The study population was selected through purposive sampling technique. Data collection was performed by means of focus group discussions (FGD) organized in four high-volume health facilities. Discussions were recorded based on FGD guidelines. Subsequently, the recorded data were transcribed and reduced into themes. The thematic analysis of the results was reported in the form of narration. Results: The analysis of the data led to the identification of some important themes, including decision making for labor and delivery, financial support, birth companionship, house caretaking in the absence of women, and non-involvement of men in birth preparedness. Conclusion: Men play a key role in birth preparedness in terms of economic and emotional support. Although some cultures prohibit men from participating in the process of birth preparedness, there is a need to educate men in this regard.It is recommended to make more efforts to encourage men’s participation through community education, which can effectively modify prohibitive cultural practices

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

Background: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? Methods: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients. Results: We recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms. Conclusions: We conclude that the formal health system is not responsive to women’s needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women’s treatment pathways

Contributing Factors to Late Age Pregnancy and its Outcome Among Elderly Primigravidas in Kakamega County,Kenya

Delayed childbearing is becoming apparent in developing countries especially among the upper and middle class women as they become increasingly empowered. The objective of this study was to determine the pre-disposing factors to late age pregnancy among childbearing women. A cross sectional survey of childbearing women aged between 18 and 40 years and hospital personnel, in 3 selected hospitals and tertiary institutions in Kakamega County, Kenya was carried out. Purposive and stratified sampling strategies were employed. The findings revealed that although the majority age of primigravidas lies between 26 to 30 years, an increasing number of women at the age of 31 to 40 years were still having their first borns. Primigravidas at such ages were found to be more vulnerable to birth complications. It emerged that prolonged education, financial stability, career development, lifestyle, drug and substance abuse and lack of awareness were the leading contributing factors to delayed pregnancy among child bearing women.

Women's Experiences of Care after Stillbirth and Obstetric Fistula: A Phenomenological Study in Kenya

Background Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula. Aim To explore the lived experiences of women following stillbirth and fistula. Methods Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach. Results Three main themes summarised participants' experiences: ‘Treated like an alien’ reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in ‘Shattered dreams’. The impact of beliefs and practices of women and those around them were encapsulated in ‘It was not written on my forehead.’ Conclusion The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked understanding of the pathophysiology and identification of fistula, and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences

‘There is trauma all round’: A qualitative study of health workers’ experiences of caring for parents after stillbirth in Kenya and Uganda

Background: Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents’ needs. However, very few studies have explored health worker’s experiences in these settings. Aim: To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda. Methods: Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen’s reflexive approach. Results: Three main themes summarised participants’ experiences: ‘In the mud and you learn to swim in it’ reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in ‘It’s bad, it’s a sad experience’. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks ‘how are you doing?’. Conclusion: Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes

Advancing care and support for women and families after stillbirth or neonatal death in Kenya and Uganda: A feasibility study

Background Approximately every 16 seconds a baby dies, before, during or shortly after birth globally. Over 98% of stillbirths and neonatal deaths occur in low- and middle-income countries, with over 75% in sub-Saharan Africa and South Asia. Alongside prevention, providing respectful and appropriate bereavement support to parents is a key global priority for equitable care and outcomes. Previous studies in sub-Saharan Africa, including Kenya and Uganda, demonstrate limited bereavement support in facilities and stigma surrounding perinatal death in communities. There is an urgent need for context-appropriate interventions to improve emotional and psychological support for bereaved parents in these settings. Objectives To assess the feasibility of implementation, and a full-scale effectiveness evaluation of a co-produced multicomponent intervention to improve perinatal bereavement support in Kenya and Uganda. Design A prospective, observational, mixed-methods feasibility study, using a pre- and post-cohort design. Community engagement and involvement was embedded throughout the research process. Setting Two tertiary urban maternity facilities and surrounding communities in Kenya and Uganda. Participants Postnatal women experiencing stillbirth or early neonatal death in the included facilities. Intervention Two components including (1) introduction of trained health worker ‘bereavement champions’ in facilities, focused on developing care for bereaved women and families through individual and collective action and (2) access to telephone peer support for women, post discharge, from trained peers in communities. Main outcome measures The primary feasibility outcome measures were recruitment and retention of women. Secondary outcomes included acceptability of the intervention and research processes, feasibility of data collection, characteristics of the proposed evaluation trial primary outcome measure and quality of implementation. Results Over the study period, November 2019 to December 2020, a total of 501 women experienced stillbirth or early neonatal death in the included facilities, 208 women consented to be contacted for participation in the study and 107 were recruited; 56 women experiencing usual postnatal care and 51 offered the study intervention. Despite the COVID-19 pandemic, recruitment was 89% of the target and 85% of participants completed the study. The intervention was implemented largely as planned and was generally acceptable to women, families, health workers and others involved. Key learning points included the need for education for a wider group of health workers to increase understanding of principles of effective bereavement support and involving more clinical leaders as bereavement champions, to add leverage for change in practice. Research processes and data collection tools, including the selected psychological measures, were also acceptable. Women and families welcomed the opportunity to participate in research to improve care. Limitations This study was impacted by COVID-19, which disrupted aspects of recruitment, intervention implementation and data collection. The focus on urban settings in both countries is a potential limitation to transferability of findings. Conclusions This study demonstrated the feasibility of implementation and of a larger-scale effectiveness evaluation of the co-produced multicomponent intervention. Learning from this feasibility study will be used to refine the intervention to improve context-appropriateness. Future work A pragmatic stepped-wedge cluster-randomised controlled trial, with parallel economic and process evaluations is proposed to assess the clinical and cost effectiveness of the intervention and explore future scale-up and sustainability