Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities.

Background: Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility. Objective: To determine satisfaction level of mothers with the free maternal services in selected Kenyan public health facilities after the implementation of the free maternal healthcare policy. Methods: Data was collected through a quantitative exit survey questionnaire. The respondents were mothers who had delivered in the health facilities and were waiting to leave the health facilities after discharge. The sample included 2,216 mothers in 77 public health facilities across 14 counties in Kenya under tier 3 and tier 4 categories. The number of respondents to be interviewed was proportionately arrived at based on each health facility's bed capacity. Results: The study established a satisfaction rate of 54.5% among the beneficiaries of the free maternal healthcare services in the country. Mothers benefiting from the free delivery services were satisfied with communication by the healthcare workers, staff availability in the delivery rooms, availability of staff in the wards, and drug and supplies availability (>56%) but unsatisfied with consultation time, cleanliness, and privacy in the wards (<56%). High education levels and lengthy stay in healthcare facilities were negatively associated with the satisfaction with the free delivery services (P < 0.05). Conclusion: There is a high satisfaction with the free maternal healthcare services in Kenya. However, the implementation of the free maternal healthcare policy was associated with low privacy, poor hygiene, and low consultation time in the health facilities. Therefore there is need to address these service gaps so as to attract more mothers to deliver in public health facilities.

The effect of Kenya's free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities.

BACKGROUND: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy's effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities. METHODS: A time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya. RESULTS: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality. CONCLUSION: The findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths.

Quality of record keeping in the intrapartum period at the Provincial General Hospital, Kakamega, Kenya.

OBJECTIVE: To assess the quality of recording critical events in the intrapartum period in Kakamega Provincial General Hospital (PGHK). DESIGN: Retrospective comparative study. SETTING: Provincial General Hospital, Kakamega, the referral hospital for Western Province, Kenya. PARTICIPANTS: Two hundred women admitted at the labour ward during the six-month period between 1st September 2000 and 28th February 2001 were compared to two hundred women admitted between 1st July 2001 and 31st December 2001. INTERVENTION: The Safe Motherhood Demonstration Project (SMDP) was introduced in four districts of Western Province, Kenya, in which PGHK is located. It included on job training in Safe Motherhood which emphasised, among others, collection and utilisation of maternal health care services data. MAIN OUTCOME MEASURES: Comprehensiveness of recording of biodata, history taking and examination findings were assessed for women in labour before and during the implementation of the SMDP. The proportion of cases in labour managed by use of partograph and its appropriate use were also determined. RESULTS: Retrieval rate of patients' notes was 86.9% and 89.6% before and during SMDP respectively. Information on sociodemographic characteristics, history taking, general and obstetric examination had a near universal recording in both groups but data on alcohol consumption, smoking, menarche, previous pregnancies and contraceptive use was poorly recorded. There was a significant improvement in recording of diagnosis and plan of management during the SMDP (p = 0.037). The partograph was used in only 11% of patients before SMDP as compared to 85% during SMDP (p = 0.000). Record on foetal condition and progress of labour were significantly improved during the SMDP (p = 0.000). Records on summary of labour likewise significantly improved during the SMDP (p = 0.02). CONCLUSION: The quality of record keeping in the intrapartum period at the PGHK greatly improved during the implementation of the SMDP. It would be worthwhile to assess the sustainability of quality of intrapartum records and care a year or so after the SMDP ended.

Socio-demographic characteristics of patients admitted with gynaecological emergency conditions at the provincial general hospital, Kakamega, Kenya.

OBJECTIVE: To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK). DESIGN: Retrospective cross-sectional study. SETTING: Provincial General Hospital Kakamega, the referral hospital for Western Province, Kenya. SUBJECTS: Four hundred patients admitted at the gynaecological wards during the period 1st January 2002 to 31st December 2002. RESULTS: In this study 80% of gynaecological patients admitted at PGH Kakamega were of an emergency nature with 45% being teenagers. The mean age was 17 +/- 3 (mean +/- SD). The majority had primary level of education or below (69%), unemployed (87%) and were rural residents (71%). Patients with abortion formed about 43% of the study group while those with inflammatory disease, pelvic abscess and ectopic pregnancy formed about 24%, 10% and 8% respectively. CONCLUSION: Most gynaecological admissions in PGH Kakamega are of acute nature, with abortion being the most common diagnosis. Hence, trained staff, equipment, supplies and drugs for management of acute gynaecological conditions should be available in hospitals in Western Kenya.

Knowledge, attitudes, and practices regarding emergency contraception among nurses and nursing students in two hospitals in Nairobi, Kenya.

A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students.

PIP: A descriptive research study on knowledge, attitudes and practices with regard to emergency contraception (EC) was conducted using a questionnaire among 167 nurses and 63 nursing students in Nairobi, Kenya. Results revealed that 95% recorded at least one regular contraceptive method. About 48% of the respondents had heard about EC, but only 2.6% had used it. More nursing students than qualified nurses were aware of EC. There was poor knowledge about the types, applications and side effects of EC. Some 49% of the subjects regarded EC as an abortifacient. About 77% of those knowledgeable about EC approved its use for rape victims and 21% for adolescents and schoolgirls. Only about 3.5% had personally used it. Some 23% of those aware of EC intended to use it in the future. About 53% planned to provide or promote it. The perception that EC is abortifacient affected the decision whether to use or provide it. The data imply that there is potential for effective promotion of EC among nurses and nursing students in Kenya.

Antimicrobial prophylaxis in pregnancy: a randomized, placebo-controlled trial with cefetamet-pivoxil in pregnant women with a poor obstetric history.

OBJECTIVE: This study was undertaken to measure the impact of a single oral dose of cefetamet-pivoxil on pregnancy outcome in a population with substantial rates of low birth weight and high prevalence rates of maternal infections. STUDY DESIGN: A total of 320 pregnant women with a poor obstetric history, defined as a history of low birth weight or stillbirth, were randomized to receive a single oral dose of 2 gm of cefetamet-pivoxil or a placebo at a gestational age between 28 and 32 weeks. Patients were assessed at delivery and 1 week post partum for pregnancy outcome, postpartum endometritis, human immunodeficiency virus-1 and gonococcal infections. RESULTS: A total of 253 (79%) women gave birth at the maternity hospital, of whom 210 (83%) attended the follow-up clinic. Overall, 18.1% of these pregnant women were human immunodeficiency virus-1 seropositive, whereas 9.5% had antibodies against Treponema pallidum. There was a significant difference between cefetamet-pivoxil- and placebo-treated women in infant birth weight (2927 gm vs 2772 gm, p = 0.03) and low birth weight (< 2500 gm) rates (18.7% vs 32.8%, p = 0.01, odds ratio 2.1, 95% confidence interval 1.2 to 3.8). The stillbirth rate was 2.2% in the cefetamet-pivoxil group and 4.2% in the placebo group (not significant). Postpartum endometritis was found in 17.3% in the intervention arm versus 31.6% in the placebo group (p = 0.03, odds ratio 2.2, 95% confidence interval 1.1 to 7.6). Neisseria gonorrhoeae was isolated from the cervix in 5 of 103 (4.9%) women in the intervention and in 14 of 101 (13.9%) in the placebo group (p = 0.04, odds ratio 3.2, 95% confidence interval 1.1 to 10.5). CONCLUSION: A single oral dose of cefetamet-pivoxil administered to pregnant women with a poor obstetric history seemed to improve pregnancy outcome in this population with high rates of maternal infections. Larger studies should be carried out to examine the public health impact, the feasibility, and the overall cost/benefit ratio of this intervention.

Pregnancy outcome and placental weights: their relationship to HIV-1 infection.

The relationship between placental characteristics, including weight and inflammation, and pregnancy outcome was examined as part of a case control study looking into the impact of maternal HIV-1 infection on pregnancy outcome. Cases defined as low birth weight (< 2500g) or stillbirth deliveries, were compared to controls defined as mothers who delivered a live born neonate weighing 2500g or more. The mean placental weight and the mean foetal/placental weight ratio were significantly lower in cases (n = 253) than in controls (n = 216) (p < .05). Placental inflammation (chorioamnionitis) was significantly associated with prematurity (p < .001) and with stillbirth (p < .05), maternal HIV-1 antibody being a risk factor for chorioamnionitis in the preterm group. These data support a correlation between placental weight and pregnancy outcome, and suggest that maternal HIV-1 infection is a risk factor for chorioamnionitis in HIV-1 seropositive preterm deliveries.

PIP: In 1988, researchers compared data on 796 low birth weight (LBW) (500-2500 gm) infants and stillborns (cases) with data on 71 live-born infants weighing more than 2500 gm (controls) to examine the effect maternal HIV-1 infection has on the association between maternal placental characteristics and pregnancy outcome. 3.1% of control mothers of preterm infants, 7.7% in infants small for gestational age (SGA), and 11.7% for mothers of stillborns were HIV-1 seropositive. HIV-1 antibody status was linked independently with preterm birth (odds ratio [OR] = 2.1), SGA infants (OR = 2.3), and fetal death (OR = 2.7). the mean and standard deviation of gestational age and fetal and placental weight and the fetal/placental weight (F/P) ratio were much lower in LBW infants and stillborns (p .001). Mean placental weight in SGA infants born to HIV-1 seropositive mothers was significantly higher than that of SGA infants born to HIV-1 negative controls (487 gm vs. 443 gm; p .05), resulting in a lower F/P ratio among SGA infants of HIV-1 seropositive mothers (4.8 vs. 5.2; p .05). Moderate to severe chorioamnionitis, villitis, and funisitis (all signs of placental inflammation) were associated with prematurity (p .001) and stillbirths (p .05). HIV-1 infection was strongly linked to moderate to severe chorioamnionitis (31% vs. 14%; p .05; OR = 6.1). among preterm infants. These findings strengthen the belief that cumulative immunosuppressive effects of HIV-1 infection and pregnancy assist increasing infection, resulting in chorioamnionitis and possible subsequent prematurity or stillbirth.