Factors influencing high prevalence of Fresh Still Births in Mbagathi County Hospital, Nairobi - Kenya

Background: The annual global burden of stillbirths is approximately 2.6 million, 98% of which occur in Sub Saharan Africa. In 2016, approximately 24 still births per month occurred in Mbagathi County Hospital (MCH) representing a 33.3% increase from 2015. A third of these were Fresh Still Births (FSBs). Objectives: To establish factors influencing increase in FSB among women delivering at MCH. Methodology: The study was conducted at MCH postnatal ward. A descriptive cross sectional study design was employed. Forty three respondents with FSBs were consecutively sampled. Clearance to conduct the study was sought from Ethics Review Committee, MCH and respondents. Researcher administered questionnaires were used for data collection over two months. Descriptive data involved calculation of measures of central tendency. Findings were presented in tables, graphs and narrative. Results: A majority of the respondents were less than 20 years old, had low education level and were unemployed. Also the biggest proportion had preterm deliveries; prolonged premature rupture of membranes, had medical conditions and attended antenatal care less than four times. Most of the FSBs had complications and were delivered preterm. The facility had inadequate staffing, lacked prompt triaging equipment, and rarely used partograph to monitor labor. Conclusion: Maternal, fetal and hospital related factors influenced high prevalence of FSB. Recommendations: Improve uptake of focused antenatal care among women. Need for girl child empowerment in line with Sustainable Development Goal 5. Improve midwife to patient ratio, develop protocol regarding triaging and labor monitoring. Avail hospital equipment for proper maternity care

Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya

Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. Findings: The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Conclusion: Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya

Experiences in Care Given During Child Birth at a Referral Hospital in Kenya

The fifth Millennium development Goal (MDG) calls for a reduction in the maternal mortality ratio (MMR) by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel, (United Nations, 2007). In Kenya the MMR is 400 and has made insufficient progress towards improving maternal health, (UNICEF, WHO, World Bank, 2013). According to KDHS (2014), the proportion of skilled birth attendance is 46.5%, while in Kenya it is 62% against an MDG target of 90%. According to Zaers S., et al., (2008), prior experience in delivery care by skilled attendants affects their subsequent use of these services. In Africa little research has been carried out on the experiences of mothers in facility-based delivery care. This study was therefore set to describe the experiences of women during labour and delivery at a referral hospital in Kenya This was a cross sectional descriptive study that focused on experiences of delivery care by postnatal mothers at a referral hospital in Kenya. Systematic random sampling from a sampling frame of 327 was employed to recruit post-natal mothers who delivered in labour ward and four postnatal wards. A total of 109 participants were recruited into the study. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartum experience. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to determine the statistical significance of the results obtained. Most participants (87.7%) agreed that they were treated with respect, accorded privacy and asked to consent, prior to the initiation of the procedures. A single aspect of communication, namely health provider explanation of health status with understandable terms was poorly rated (mean 1.8 to 2.2) as was the level of genuine interest in patient well-being (mean = 1.7 to 2.0) which was significant in the study. Most participant (n = 102(93.6%) said they would recommend delivery services at KNH to friends or family, although 6% of them said they would not recommend. Majority of the participants had a positive experience of quality in delivery care. This was evidenced by the fact that majority of then stated that they would come to deliver in the same institution again or recommend a relative or friend. Aspects of care such as health providers communicating to clients in understandable terms and showing genuine interest in patients wellbeing was rated poorly. Institutional factors such as inadequate space and shortage of staff were also noted to be significantly contributing to negative experience of delivery care in the study

The healthcare system and client failures contributing to maternal mortality in rural Kenya

Background The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. Methods An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. Results Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence. Conclusion In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.Health Studie

High-impact low-cost interventions implemented to enhance the quality of care given to preterm babies in Kilifi County, Kenya

The main objective of this study was to explore and describe the implementation of national policies/guidelines regarding low-cost high-impact interventions to enhance health outcomes for preterm babies among health professionals in Kilifi County. A mixed method approach, with a convergent parallel design was used. Seventeen public health facilities were chosen purposively for the study. Census sampling for the nurses and midwives was utilized with a sampling frame of 146 nurses and midwives. Data was collected using semi structured questionnaires to the nurses and midwives (n=102); A health facility assessment tool with facility leaders (n=16); focus group discussions were held among with nurses and midwives (n=7); in-depth interviews with key informants n=seven and unstructured observation. Analysis of quantitative data was done using the Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics (i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables) and inferential statistics were used to answer the research questions. Qualitative data was coded and analysed thematically. The results provided rich information from several data sources highlighting a need to improve the implementation of four evidence-based practices that would enhance health outcomes for preterm babies. Guidelines/policies, important equipment and medications were not always available, which caused frustration among healthcare workers in their efforts to provide care for preterm babies. Despite common recognition of their key function, guidelines are not always adhered to, as shown in this study. Inadequate use of guidelines reflects the omission of beneficial treatments, possible avoidable harms, and suboptimal patient care. This study also established that there were associations between participants’ gender and percentage scores for knowledge and practice and implementation. The study also highlights barriers and enablers to implementation of clinical guidelines and possible strategies to effective implementation.Lengo la utafiti huu lilikuwa ni kuchunguza na kuelezea utekelezaji wa sera za taifa/miongozo kuhusu gharama nafuu hatua juu ya athari ya kuimarisha matokeo ya afya, kwa ajili ya watoto njiti kati ya wataalamu wa afya katika kata la Kilifi. Mchanganyiko njia mbinu, na muunganiko sambamba kubuni ilitumika. Vituo vya afya vya umma Kumi na saba vilichaguliwa makusudi kwa ajili ya utafiti. Sensa sampuli kwa wauguzi na wakunga ulitumiwa kwa sampuli hii ya wauguzi na wakunga mia moja arobaini na sita. Takwimu zilikusanywa kwa kutumia nusu ya muundo dodoso za wauguzi na wakunga (nambari= mia moja na mbili); vituo vya afya tathmini chombo na viongozi kituo (Nambari= kumi na sita), majadiliano ya vikundi kati ya wauguzi na wakunga (nambari=saba); mahojiano ya kina na watoa habari wakuu (nambari=saba) na uchunguzi haujatengenezwa. Data ya ubora ilikuwa kuchambuliwa kwa kutumia SPSS toleo la ishirini na tatu. Takwimu maelezo (yaani maana na kiwango kupotoka kwa vigezo endelevu, masafa na asilimia kwa vigezo vya kipekee) na takwimu sisizo na mapendeleo zilitumika kujibu maswali ya utafiti. Data ya ubora ilikuwa kutolewa na kuchambuliwa kwa makusudi. Matokeo kutoa habari tajiri na vyanzo kadhaa data kuonyesha haja ya kuboresha utekelezaji wa shughuli nne ushahidi wa msingi ambayo kuongeza matokeo ya afya kwa ajili ya watoto njiti. Miongozo / sera, vifaa muhimu na dawa zilikuwa hazipatikani kila wakati, ambazo zilisababisha kuchanganyikiwa miongoni mwa wafanyakazi wa afya katika juhudi zao za kutoa huduma kwa ajili ya watoto njiti. Pamoja na kutambua kawaida ya kazi yao muhimu, miongozo si daima kuzingatiwa na, kama inavyoonekana katika utafiti huu. Matumizi duni ya miongozo huonyesha upungufu wa matibabu ya manufaa, madhara yanayoweza kuepukwa, na huduma ya afya ya watoto njiti ya chini.Utafiti huu pia ulibaini kwamba kulikuwa na uhusiano kati ya jinsia ya washiriki na asilimia alama kwa maarifa na mazoezi na utekelezaji. Utafiti huo pia unaonyesha vikwazo na wawezeshaji na utekelezaji wa miongozo ya kliniki na mikakati inawezekana utekelezaji.Health StudiesD. Litt. et Phil. (Health Studies

Drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period: A systematic review

The present study aimed to explore the drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period. A systematic review design was adopted. The major online databases utilized were PubMed, Google Scholar, Uganda and Kenya Ministry of Health repositories, ScienceDirect, and Scopus. Studies that were originating from Kenya and Uganda that were publicly available in electronic format published from March 2020 to March 2022 were used. The thematic analysis identified major concepts that were drivers to the present research problem which were as follows: (1) school closure and (2) loss of income by parents. The COVID-19 containment measures introduced in the two countries were noted as major contributing factors. During the pandemic, lockdown led to school closures which meant the teenagers being idle at home with an increased opportunity to indulge in sexual risk behaviors. Schools have been noted to be a safe place protecting this vulnerable population. However, with their prolonged closure, the teenagers were exposed to sexual predators. Parents lost income, and this might have contributed to early marriages and teenagers' dependency on their sexual partners. Based on the reviewed evidence, the present study furthers the advocacy for the reduction of early marriages and teenage pregnancy, especially in the current COVID-19 pandemic era. The study calls upon the governments to intensify efforts toward the present research problem as the COVID-19 pandemic is eroding the earlier gains made within the regionHealth Studie