RÉSUMÉ
Background: This study sought to determine the health facility-related factors and social factors associated with the accessibility of reproductive health services (RHS) among women living in the informal settlements of Mathare slums, Nairobi City County, Kenya. Methods: This cross-sectional study focused on Nairobi County, Kenya, specifically targeting Mathare slums, known for poor reproductive health (PRH) indicators among women. Three hundred women were randomly recruited from four villages (Mathare 3B, Mathare 4A, Kosovo, and Mathare village 2). Results: The majority of respondents were aged 18-29 years (48.7%), had primary education (61.7%), were married (58.7%), and unemployed (69.3%). Significant associations were observed between accessibility and the woman's age (?2=83.013, df=1, p<0.001), education level (p<0.001), marital status (p<0.001), and employment status (?p<0.001). Significant health facility barriers to accessibility encompassed long distances to health facilities (p<0.001), transportation cost constraints (p<0.001), difficult terrain (p<0.001), cost of services (p<0.001), services provided by health facilities (p<0.001), and availability of required medications (p<0.001). Discouragement by friends or family (p<0.001), the perceived influence of age on RHS accessibility (p<0.001), the perceived influence of education level on RHS choices (p=0.014), and the perceived role of a spouse in influencing RHS (p=0.002) were all significant social factors associated with accessibility to RHS. Conclusions: Health facilities and social factors presented complex challenges, including geographical barriers, transportation costs, and medication availability, while spouse involvement, education's influence, and familial discussions positively impacted accessibility.
RÉSUMÉ
Background: Maternal knowledge and maternal self-efficacy (MSE) are crucial for the adoption of health-promoting evidence-based postnatal practices. Short hospital stay after normal deliveries curtails delivery of pre-discharge postnatal education thus inadequate knowledge and poor MSE. This is accentuated among low-income primiparas thus a need for post-discharge follow-up. Aim was to determine the effect of self-efficacy theory-based post-discharge postnatal education on low-income primiparas’ MSE. Methods: A Quasi-experimental study on low-income primiparas residing in selected slums in Nairobi, Kenya. The control and experimental sites had 118 primiparas each conveniently recruited on early discharge after normal delivery from health facilities serving the slums. An interviewer-administered entry questionnaire was applied to collect facility and demographic data. The intervention group received post-discharge PNE intervention and routine PNC while the control group received routine PNC only. Perceived maternal parental self-efficacy scale was used to measure MSE at 6 weeks. Focus group discussions were conducted for qualitative data. IBM SPSS was used to analyze data. Independent sample t-tests and multiple linear regression were derived. Results: There was a significant (t=12.322, p=0.000) difference in MSE between experimental and control groups. The intervention was a significant predictor of MSE (?=0.59, p=0.00). Respondents appreciated the multi-pronged learning methods, especially the community health volunteers. COVID-19 pandemic challenges such as loss of livelihood and disruption of social connectedness were highlighted. Conclusions: Self-efficacy theory-based follow-up PNE intervention improves MSE among low-income primiparas thus a valuable complement to routine care.