Determinants of high neonatal mortality rates in Migori County Referral Hospital in Kenya

The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, poor 1st Apgar score, low birth weight and neonates with intrapartum complications. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Other determinants were gender, rural residence, lowly educated and informally employed mothers. To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care, reduce preterm birth incidences, and empower mothers socio-economically.Health StudiesM.A. (Nursing Science

A strategy for reducing maternal mortality in Migori, Kenya

The aim of the study was to investigate the determinants of maternal mortality and develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. The objectives of the study were to describe the causes and the socio-economic determinants of maternal mortality, analyse the existing strategies that aim at reducing MMR, and develop a strategy to reduce MMR in Migori, Kenya. A sequential explanatory mixed methods study design was used to conduct the study. A checklist and in-depth interview guides were employed to collect the data. The quantitative data was analysed using the Statistical Package for Social Science (SPSS) version 23 and simple descriptive statistics. Thematic analysis was employed to analyse the qualitative data. The study revealed that the leading causes of maternal mortalities are haemorrhage (34.7%), eclampsia (20.8%) and sepsis (15.8%). Moreover, social and system factors which largely determined the deaths of mothers were found to be timely provision of and lack of drugs and blood, rural residence, and maternal ignorance of danger signs. The above-mentioned factors were exacerbated by the delays in accessing appropriate healthcare that could have saved the lives of mothers. Identified delays were theatre delays, resuscitation delays, competent care delays, referral delays, and the delays in decision-making by the mothers themselves. The study further established that the existing maternal improvement interventions such as the free maternal service policy, the haemorrhage prevention programmes, and family planning were poorly implemented with low coverage. The findings informed development of an alternative strategy that would reduce MMR in Migori, Kenya. The proposed strategy targets maternal care delays, which the study found to contribute to the persisting high levels of maternal deaths in Migori, Kenya. Increased focus on the identified determinants of maternal deaths by policy makers is recommended. The study further alerts stakeholders that hospital systems as well as community empowerment programmes are in dire need of quality improvement initiatives. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy

Neonatal Survival in Sub-Sahara: A Review of Kenya and South Africa

Introduction: The majority (99%) of the children who die during the first 4 weeks of life do so in the poorer parts of the world, especially in sub-Saharan Africa and South Asia. In 2018, sub-Saharan Africa had a neonatal mortality rate of 28 deaths per 1000 live births. The purpose of the review was to explore and describe the trends of neonatal mortality within the two sub-Saharan countries. Methods: We did a literature search in biomedical databases of data published, in English, between Jan 1, 1975, and November 30, 2019. The databases included Scopus, Web of Science, Science Direct, Cochrane Library, PUBMED, OVID and Google scholar. The keywords used in the search: “Neonatal Survival”, “Sub-Sahara”, “Kenya” and “South Africa”. Results: The search generated 2209 articles of which only 27 met the inclusion criteria. The present study qualitatively analysed data. Data were presented and organized under two thematic domains: 1) trends of national neonatal mortality rates in South Africa and Kenya and 2) causes of neonatal mortality. Conclusion: The current review results noted that in 2018, the neonatal mortality rate for Kenya was 19.6 deaths per 1000 live births. The neonatal mortality rate has fallen gradually from 35.4 deaths per 1000 live births in 1975. On the other hand, South Africa has had its neonatal mortality rate fall from 27.9 deaths per 1000 live births in 1975 to 10.7 deaths per 1000 live births in 2018. Most neonatal deaths resulted in preterm birth complications followed by intrapartum-related events for the two countries. Within the sub-Saharan region, disparities exist as neonates born in South Africa are more likely to survive during the neonatal period compared to Kenya.Health Studie

Determinants of High Neonatal Mortality Rates in Migori County Referral Hospital in Kenya

Background: Neonatal mortality is a significant public health problem worldwide. In Kenya, neonatal mortality rates are unacceptably high within the sub-Saharan region. In 2017 the country had 20.9 deaths per 1000 live births above the WHO target of 12 deaths per 1000 live births. Purpose: The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. Method: A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. Results: The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, low birth weight, neonates with intrapartum complications and poor 1st Apgar score. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Conclusions: To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care and reduce preterm birth incidences in Migori County.Health Studie

Barriers to and Opportunities for Male Partner Involvement in Antenatal Care in Efforts to Eliminate Mother-to-child Transmission of Human Immuno-deficiency Virus in Kenya: Systematic Review

Introduction: Men’s involvement in antenatal care (ANC) is intended to encourage husbands to support women’s care and associated interventions, including prevention of mother-to-child transmission from pregnancy to delivery, and throughout the postnatal period. The present study aimed to systematically review the barriers and opportunities for male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus (HIV) in Kenya. Methods: A systematic search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID, and Google scholar. The reference list of included studies was manually searched for possible additional eligible articles. The searches were conducted from May 2019 to April 2020. Qualitative analysis was done and data were presented in thematic domains. Results: The search generated 2208 articles, of which only 19 met the inclusion criteria. The major findings were discussed under two thematic domains: 1) Barriers: Knowledge, Social-cultural/economic factors, Institutional factors, and Age. 2) Opportunities: Skilled Birth Attendant, Human Immunodeficiency virus-free infant and Human Immunodeficiency virus testing. Conclusion: The review notes that the main barriers to male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus in Kenya include; socio-cultural factors, the low maternal-child health education by the male partner, and institutional factors. It further provides insight on the opportunities associated with male partner involvement in antenatal care/prevention of mother-to-child transmission, which includes; having Human Immunodeficiency virus-free infants and increased, skilled birth deliveries. The review strongly calls out for sustainable initiatives to incorporate males into the antenatal care/prevention of mother to child transmission programs.Health Studie

Experiences of Former Markers of Undergraduate Assignments and Examinations at A University: A Case Study

Purpose The present study explored experiences of former markers of undergraduate assignments and examinations at the University of South Africa (Unisa). Methodology Qualitative method of research was used to gather data. Colaizzi’s method (1978) was used to analyze and interpret data. The article’s frame of reference was informed by Mezirow’s transformative learning theory which is aligned to critical theory (Mezirow 2009). Findings Findings were based on the following: Demographic information, markers’ experiences in marking assignments and exam books, content knowledge, markers’ meetings, duration of marking assignments and examination books as well as students support, and suggestions are the themes that emerged from the data that was gathered. Originality It is recommended that the university must develop a policy for external markers for marking assignments and examinations of undergraduate program. All E-tutors must be trained to support students after the official closure of registration and before examinations are set. All markers must be trained - through a markers’ guide - to mark assignments and examination books.Teacher Educatio

Effects of Positive HIV Status Disclosure on Sexual Behaviour Change

Introduction: Disclosure of HIV serostatus is critical to controlling the spread of HIV, and understanding the experience for disclosure enhances the development of prevention interventions and ultimately leads to better control of the spread of the disease. The present narrative review aimed to synthesize literature on the effects of positive HIV status disclosure on sexual behaviour change. Method: A narrative review design was utilized. Literature search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID and Google scholar. The searches were conducted from August 2019 to June 2020. The qualitative analysis was used to presented data into themes. Results: The main findings were discussed under four thematic domains: 1) disclosure, 2) number of sexual partners, 3) type of sexual partners and 4) use condoms. Conclusion: The narrative review presents evidence on; how patients revealing their HIV positive status to their sexual partner(s), family members, or others in their social circle are associated to better, less risky sexual behaviors. This finding implies that when people living with HIV disclose their status, they are most likely to; 1) have less sexual partners, 2) use condoms and 3) minimize casual/temporary sex. The behavior change brought by the positive HIV status disclosure can significantly reduce the transmission of HIV within the society.College of Human Science

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

A Strategy for Reducing Maternal Mortality in Rural Kenya

Background: Migori County is categorized among regions with worst maternal survival rates in Kenya. The county’s current maternal mortality ratio (MMR) is 673 deaths per 100 000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. Methods: An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. Results: The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. Conclusion: The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.Health Studie

Free Maternal Health Care Policy in Kenya; Level of Utilization and Barriers

Please access the full-text of the article via the doi link at the top of this record.Objectives: The present study aimed to explore the level of utilization and barriers to the free maternal service (FMS) policy, introduced in 2013 in Kenya. Methods: Literature search was on biomedical databases of the most recent available electronic data published, in English. That is between January 2014 and April 2020. The populations for eligible studies were health care providers, stake holders and mothers who sought maternal care in the specified hospitals. All studies eligible were strictly those conducted in Kenya. Results: The search generated 20,638 articles of which only 27 articles met the inclusion criteria. Qualitative analysis was done. The findings and discussion were presented and organized under thematic domains. Conclusion: The major findings of this review show that free maternal services has increased utilisation of the skilled birth attendant among the women who dwell close to the hospitals and who could not afford for the services initially. However there still exists a challenge to the utilization of FMS among the poor women in remote areas. To further improve the efficiency and utilization of FMS, it is recommended 1) more funding to the program, 2) putting in place adequate material/infrastructure and human resources, 3) improving road network in the remote areas and providing incentives to the rural poor women.Health Studie