Factors Associated with Woman in Child Bearing Age Not Wanting to Deliver in a Health Facility Despite Antenatal Care Attendance, in Kakamega Central Sub-County

Background Despite a large proportion of women attending ANC during pregnancy, a significant percentage still avoid delivering at the health facility thus increasing the risk of adverse pregnancy outcomes and death. Knowledge of factors associated with the women`s decision against health facility delivery is limited. The main objective of this study is to examine factors associated with women`s decision against health facility delivery despite ANC attendance in Kakamega Central Sub-County, Kakamega county, Kenya. Methodology Design: A community based cross sectional study. Sample size: 302 women who attended ANC but did not deliver in a health facility. Sampling. Simple random sampling Analysis. Analyzed using SPSS V19. The statistical significance level was set at p<0.05. Descriptive statistics and associations-using chi-square was utilized. Results: Significant associations between education level of the women and poor staff availability and unfriendliness (P=0.049), Marital status and high cost of delivery (p=0.050), parity with poor preparatory service (p=0.000), long distance (p=0.000), high cost of delivery (p=0.000) and poor staff availability and unfriendliness (p=0.000) and other costs and health facility delivery (p=0.0063) were found to be some of the factors discouraging women from Kakamega Central sub-county from delivering in a healthy facility. Conclusion and recommendation Women need to be empowered economically, mentally and socially in order for them to make sound decisions when it comes to delivery. Keywords: Antenatal care attendance, Health facility delivery, Kakamega Central Sub-County

Evaluation of Implementation Level of Community Health Strategy and Its Influence on Uptake of Skilled Delivery in Lurambi Sub County- Kenya

Background: Despite the widespread application of the community health strategy (CHS) in Kenya and evidence of its effectiveness in reducing health outcomes at the household level, data from Kakamega County, of which Lurambi sub-county is part of, still showed that skilled birth delivery was at 47% against the national estimateof 62% and a target of 90%. However, there was limited evidence on the level of CHS implementation and its association with the uptake of skilled delivery.Methods: The study employed a cross-sectional analytic design. A structured validated community unit (CU) scorecard and a household questionnaire were used to collect quantitative data from the CUs through Community Health Extension Workers (CHEWs) and at the household level through mothers with children below 1 year. A random sample of 436 mothers from all the 38 Community Units (CUs) was included. CU functionality was assessed using 17 binary indicators (scored as 1 for a positive response, 0 otherwise) and total scores were expressed as percentages. Fully functional CUs scored ≥80% and semi-functional CU scored >50 to <80%. No CU was non-functional (scored ≤50%). Data from the CUs were merged with data at the household level. Association between CU functionality and skilled delivery was assessed using multivariable binary logistic regression controlling for socio-demographic variables. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) are reported.Results: A total of 38 CUs were assessed and of these, 26(68.6%) were fully functional and 12(31.4%) were semi-functional, 18(47.4%) had both household registers (MOH 513) and service delivery logbooks (MOH 514). Overall, 387(80.0%) of mothers had skilled birth deliveries, 263(68%) were from functional CUs and 124(32%) were from semi-functional CUs. Pregnant women were more likely to have skilled deliveries in fully functional CUs than semi-functional CUs (OR=1.3; 95% CI=1.1-2.4; p-value<.001). Other factors significantly associated with uptake of skilled delivery included receiving health education(OR=2.9;95%CI=1.4-6.1,p=.005), being visited at least twice by Community Health Volunteers, CHVs(OR=1.9;95%CI=1.1-3.5,p=.045), attending antenatal care clinics, ANC (OR=3.4;95%CI=1.3-3.5,p=.012), receiving advice where to deliver (OR=4.1;95%CI=1.8-9.4,p=.001).Conclusion: 2 out of 3 community units were fully functional, and functionality was associated with increased uptake of skilled delivery. In a fully functional CUs, Community Health Volunteers provided health education through regular visits and they were able to provide a referral to health facilities for the pregnant women. To achieve national targets for skilled deliveries and universal health coverage, there is a need to ensure CUs are fully functional

Factors determining anti-malarial drug use in a peri-urban population from malaria holoendemic region of western kenya

<p>Abstract</p> <p>Background</p> <p>Interventions to reverse trends in malaria-related morbidity and mortality in Kenya focus on preventive strategies and drug efficacy. However, the pattern of use of anti-malarials in malaria-endemic populations, such as in western Kenya, is still poorly understood. It is critical to understand the patterns of anti-malarial drug use to ascertain that the currently applied new combination therapy to malaria treatment, will achieve sustained cure rates and protection against parasite resistance. Therefore, this cross-sectional study was designed to determine the patterns of use of anti-malarial drugs in households (n = 397) in peri-urban location of Manyatta-B sub-location in Kisumu in western Kenya.</p> <p>Methods</p> <p>Household factors, associated with the pattern of anti-malarials use, were evaluated. Using clusters, questionnaire was administered to a particular household member who had the most recent malaria episode (within <2 weeks) and used an anti-malarial for cure. Mothers/caretakers provided information for children aged <13 years.</p> <p>Results</p> <p>Stratification of the type of anti-malarial drugs taken revealed that 37.0% used sulphadoxine/pyrimethamine (SP), 32.0% artemisinin-based combined therapy (ACT), 11.1% anti-pyretics, 7.3% chloroquine (CQ), 7.1% quinine, 2.5% amodiaquine (AQ), while 3.0% used others which were perceived as anti-malarials (cough syrups and antibiotics). In a regression model, it was demonstrated that age (<it>P </it>= 0.050), household size (<it>P </it>= 0.047), household head (<it>P </it>= 0.049), household source of income (<it>P </it>= 0.015), monthly income (<it>P </it>= 0.020), duration of use (<it>P </it>= 0.029), dosage of drugs taken (<it>P </it>= 0.036), and source of drugs (<it>P </it>= 0.005) significantly influenced anti-malarial drug use. Overall, 38.8% of respondents used drugs as recommended by the Ministry of Health.</p> <p>Conclusion</p> <p>This study demonstrates that consumers require access to correct and comprehensible information associated with use of drugs, including self-prescription. There is potential need by the Kenyan government to improve malaria care and decrease malaria-related morbidity and mortality by increasing drug affordability, ensuring that the recommended anti-malarial drugs are easily available in all government approved drug outlets and educates the local shopkeepers on the symptoms and appropriate treatment of malaria. Following a switch to ACT in national drug policy, education on awareness and behaviour change is recommended, since the efficacy of ACT alone is not sufficient to reduce morbidity and mortality due to malaria.</p