High Parity and Low Education are Predictors of Late Antenatal Care initiation among Women in Maternal and Child Health Clinics in Kwale County, Kenya

Background: Timely initiation of antenatal care (ANC) clinic attendance during pregnancy helps identify and reduce risk factors in pregnancy.  The World Health Organization (WHO) recommends at least four ANC visits during pregnancy with the first being in the first trimester. In most developing countries including Kenya, the first visit occurs late in some mothers. Aim: This study describes ANC attendance by mothers at clinics in Kwale County. It was conducted with the aim of determining factors affecting ANC attendance in two dispensaries in Kwale County. Design: A cross-sectional study using quantitative research methods was adopted. Results: Two hundred and eighty pregnant women at a gestational age of 20 weeks and above were recruited and interviewed. All the mothers made at least one ANC visit with 19.6% starting in the first trimester. About a quarter of the mothers (24.0 %) came for the first time at nine months gestational age.  There was a significant relationship between late ANC initiation and low or no formal education (p = 0.001) as well as higher parity (p = 0.0001). Mothers with no formal education were four times more likely to initiate ANC clinics late  compared to those with secondary or tertiary education (OR = 4.687; CI 1.765 – 12.447). The likelihood of mothers whose husbands had no formal education initiating ANC later was almost three times more likely as compared to those who had secondary or tertiary education (OR = 2.775; CI 1.107 – 6.960).  Multiparous women were more likely to initiate ANC clinics earlier compared to grand multiparous women (OR = 0.513; CI 0.223 – 1.183). Conclusion: Timely initiation and appropriate ANC attendance was low in Kwale. Low education level and high parity had a significant negative association with timely ANC initiation. There is need for community mobilization and enlightening on the importance of timely ANC attendance for mothers to reap the full benefits of maternal and child health care. Keywords: Maternal, Antenatal, Child, Health, Parity, Multiparous, Grand multiparous.

ケニア沿岸部における新たな地域密着型栄養教育プログラムによる食事の多様性と推奨される給餌方法に対する態度の向上-介入研究

長崎大学学位論文 [学位記番号]博（医歯薬）甲第1342号 [学位授与年月日]令和3年3月22

Water, Sanitation and Hygiene Indicator Levels Eight Years Post Community-Led Total Sanitation Implementation in Kajiado County, Kenya

Background: The United Nations Sustainable Development Goal (SDG) 3 and 6 aim to improve people's health and wellbeing, as well as expand universal access to safe water and sanitation by 2030. The government of Kenya adopted Community-Led Total Sanitation (CLTS) as an approach to meet these goals. We assessed Water Sanitation and Hygiene (WASH) levels eight years post-CLTS implementation in Kajiado County, inhabited by pastoralists with higher WASH needs in Kenya where two sub-locations were selected. Materials and  Methods: Through systematic random sampling, we selected 259 household heads from which we collected quantitative data. We collected qualitative data from 16 focus group discussions (FGDs) with the communities. While we analyzed quantitative data using STATA version 15.1 using logistic regression analyses, QSR NVivo version12 analyzed qualitative data. Household latrine ownership was low at 30%. Results: Only 9% of these latrines contained a handwashing station, of which 86% were functional with water. Over half (50.8%) of the households practised open defecation. A majority (61.4%) of the households fetched water for household use from improved sources. While only 17.4% of households treated their water before drinking mainly through boiling, our water bacteriological analysis detected widespread contamination. We reported a 45.1% prevalence of diarrhoea cases among under-five-year-old children at the time of the study, predominantly from Namelok sub-location. Independent significant factors increasing the risk of diarrhoea included the use of unimproved water sources (p=0.032) and taking between half to one hour to access a water source (p=0.008). However, significant protective factors included households in Rombo sub-location (p=0.001), household water treatment (p=0.006), and covering water containers (p=0.013). Conclusion: CLTS approach has not helped households achieve high WASH levels in the study area with the potential for sustaining high diarrhoea prevalence. This highlights the need to focus on increased WASH education and promotion through positive cultural contribution while enhancing access to safe and improved water sources