Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions.

BackgroundThis study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension.MethodsWe used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors.ResultsThe average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33).ConclusionQuality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities

Assessment of Risk Predisposition to Human Papilloma Virus through Cervical Infections Screening of Women Attending an Outpatient Health Facility in Nairobi, Kenya

There is limited data on comparative disposition to cervical cancer among HPV infected women in Kenya. We aimed to determine the distribution of HPV infection, cervical abnormalities and infections commonly reported on cervical pap smears among both HIV positive and HIV negative women attending a reproductive health clinic at the largest national hospital in Kenya. A total of 187 women aged 18 to 50 years attending the reproductive clinic at Kenyatta National Referral Hospital in Nairobi were recruited into the study. All consenting subjects were screened for HIV by serology and their cervical smears taken and immediately fixed on slides for Papanicolaou (Pap) staining. A second endocervical swab was collected in the same sitting for HPV DNA extraction and PCR amplification of the HPV LI region.  Of the 187 women studied, 27 (14.4 %) were positive for HIV and 90 (48.1%) had one or more infection associated with bacterial vaginosis, candidiasis, cervicitis or inflammation of the cervix of unknown cause.  Eight (4.3%) women had abnormal cervix, 3/8 being of high grade squamous intraepithelial lesions (HSIL), 1/8 of low grade squamous intraepithelial lesions (LSIL), 1/8 had adenocarcinoma while the remaining 3 had atypical squamous cells of undetermined significance (ASC-US). The remaining 89/187 (47.6%) women had normal smears with no infection. Of the 89 women with normal smears, 82 (92.1%) were HIV negative.  A total of 66 (35.3%) women were positive for HPV L1 DNA by PCR and included 30 of the 89 women with normal cytology. Of the 27 HIV positive women, 14 (51.9%) were also positive for HPV LI DNA. 52 of the 160 (32.5%) HIV negative women were positive for HPV L1 DNA. We report more cases of cervical intraepithelial lesions among HIV positive than HIV negative women. Similarly, the other infections commonly found on Pap smear tests were higher among HIV negative than HIV positive women. HPV prevalence among these clinic-attending women was higher in those with normal cytology, indicating an increased underlying risk of cervical cancer in a setting where routine diagnostic screening is limited or non-existent. Keywords: cervical cancer, HIV, HPV, cervical cytolog

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey

Background:Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. Methods:For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. Results:The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13–5.34) and hallucination (OR, 2.08; 95% C.I, 1.06–4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). Conclusions:Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality

What makes or mars the facility-based childbirth experience: thematic analysis of women’s childbirth experiences in western Kenya

Abstract Background Sub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women’s facility–based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience. Methods Data are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis. Results The findings suggest four factors influence women’s perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment. Conclusions This study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication

Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya

Abstract Background Research suggests that birth companionship, and in particular, continuous support during labor and delivery, can improve women’s childbirth experience and birth outcomes. Yet, little is known about the extent to which birth companionship is practiced, as well as women and providers’ perceptions of it in low-resource settings. This study aimed to assess the prevalence and determinants of birth companionship, and women and providers’ perceptions of it in health facilities in a rural County in Western Kenya. Methods We used quantitative and qualitative data from 3 sources: surveys with 877 women, 8 focus group discussions with 58 women, and in-depth interviews with 49 maternity providers in the County. Eligible women were 15 to 49 years old and delivered in the 9 weeks preceding the study. Results About 88% of women were accompanied by someone from their social network to the health facility during their childbirth, with 29% accompanied by a male partner. Sixty-seven percent were allowed continuous support during labor, but only 29% were allowed continuous support during delivery. Eighteen percent did not desire companionship during labor and 63% did not desire it during delivery. Literate, wealthy, and employed women, as well as women who delivered in health centers and did not experience birth complications, were more likely to be allowed continuous support during labor. Most women desired a companion during labor to attend to their needs. Reasons for not desiring companions included embarrassment and fear of gossip and abuse. Most providers recommended birth companionship, but stated that it is often not possible due to privacy concerns and other reasons mainly related to distrust of companions. Providers perceive companions’ roles more in terms of assisting them with non-clinical tasks than providing emotional support to women. Conclusion Although many women desire birth companionship, their desires differ across the labor and delivery continuum, with most desiring companionship during labor but not at the time of delivery. Most, however, don’t get continuous support during labor and delivery. Interventions with women, companions, and providers, as well as structural and health system interventions, are needed to promote continuous support during labor and delivery

Additional file 1: of Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya

Interview guides. (DOCX 95 kb

Additional file 4: of Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya

Multivariate regression of desire for labor companionship and male companions on potential predictors. (DOCX 105 kb

Additional file 3: of Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya

COREQ checklist. (PDF 66 kb