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51. Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya

Author

Carol Wanjira, Carol Wanjira, Evans Mathenge, Gabriel Mbugua, Moses Mwangi, Carol Wanjira, Carol Wanjira, Evans Mathenge, Gabriel Mbugua, and Moses Mwangi

Abstract

Background: A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care. Methods: A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice. Results: Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have

Published
2011

53. Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality

Author

Anselimo Makokha, Elizabeth Echoka, Moses Mwangi, Bjørg Evjen-Olsen, Jens Byskov, Yeri Kombe, Øystein Evjen Olsen, Dominique Dubourg, and Richard Mutisya

Subjects
Program evaluation, medicine.medical_specialty, Emergency Medical Services, Quality Assurance, Health Care, Population, Health informatics, Health Services Accessibility, Health administration, Environmental health, Surveys and Questionnaires, Health care, medicine, Emergency medical services, Health Status Indicators, Humans, Maternal Health Services, education, education.field_of_study, business.industry, Cesarean Section, Health Priorities, Public health, Nursing research, Health Policy, Ownership, Delivery, Obstetric, Kenya, Cross-Sectional Studies, Emergency obstetric care, Geographic Information Systems, Female, Maternal health, Health Facilities, Rural Health Services, Life-saving, business, Research Article
Abstract

Background: The knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both at national and lower levels of the health system. In a country with a high maternal mortality burden, the implication is that decision makers are unaware of the extent of need for life-saving care and, therefore, where to intervene. The objective of the study was to assess the actual existence and functionality of EmOC services at district level. Methods: This was a facility-based cross-sectional study. Data were collected from 40 health facilities offering delivery services in Malindi District, Kenya. Data presented are part of the “Response to accountable priority setting for trust in health systems” (REACT) study, in which EmOC was one of the service areas selected to assess fairness and legitimacy of priority setting in health care. The main outcome measures in this study were the number of facilities providing EmOC, their geographical distribution, and caesarean section rates in relation to World Health Organization (WHO) recommendations. Results: Among the 40 facilities assessed, 29 were government owned, seven were private and four were voluntary organisations. The ratio of EmOC facilities to population size was met (6.2/500,000), compared to the recommended 5/500,000. However, using the strict WHO definition, none of the facilities met the EmOC requirements, since assisted delivery, by vacuum or forceps was not provided in any facility. Rural–urban inequities in geographical distribution of facilities were observed. The facilities were not providing sufficient life-saving care as measured by caesarean section rates, which were below recommended levels (3.7% in 2008 and 4.5% in 2009). The rates were lower in the rural than in urban areas (2.1% vs. 6.8%; p < 0.001 ) in 2008 and (2.7% vs. 7.7%; p < 0.001) in 2009. Conclusions: The gaps in existence and functionality of EmOC services revealed in this study may point to the health system conditions contributing to lack of improvements in maternal survival in Kenya. As such, the findings bear considerable implications for policy and local priority setting. publishedVersion

Published
2013

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