Comparison of postpartum family planning uptake between primiparous and multiparous women in Webuye County Hospital, Kenya.

BACKGROUND: Postpartum family planning (PPFP) is associated with health, social and economic benefits to a woman and her family. Its uptake, particularly of the more effective, long-acting reversible contraceptives (LARCs), is low. The role of parity in PPFP uptake is inconclusive. The aim of this study was to compare the uptake of PPFP and LARCs between primiparous and multiparous women accompanying their children for the first measles vaccine, which is at 9 months after delivery, in Webuye County Hospital, Kenya. METHODS: This was a cross-sectional study. Study participants were recruited using a systematic random sampling method and data were collected using a pretested, structured, interviewer-administered questionnaire. The collected data were analysed using an independent t-test to compare PPFP uptake between primiparous and multiparous women, whereas chi-square tests (for categorical data) and independent t-tests (for numerical data) were used to compare the various socio-demographic characteristics and occurrence of various predictors of PPFP uptake between the two groups of postpartum women. Factors that were significantly different between the two groups were controlled for using logistic regression. RESULTS: There was a significant difference on PPFP uptake (22.0%; 95% CI: 11.8-32.3; p 0.001), but none on LARC use (OR = 0.88; 95% CI: 0.46-1.66) between the two groups of women. The unadjusted and adjusted OR for the effect of parity on FP uptake was 3.48 (95% CI: 1.88-6.42) and 2.32 (95% CI: 1.15-4.67), respectively. CONCLUSION: There is a significant difference in the uptake of PPFP, but not LARCs, between primiparous women and multiparous women accompanying their children for the 9-month measles vaccine in Webuye County Hospital. Primiparous women are less likely to initiate the use of PPFP compared to their multiparous counterparts.

The differential effect of the free maternity services policy in Kenya.

BACKGROUND: The Government of Kenya introduced the free maternity services (FMS) policy to enable mothers deliver at a health facility and thus improve maternal health indicators. AIM: The aim of this study was to determine if there was a differential effect of the policy by region (sub-county) and by facility type (hospitals vs. primary healthcare facilities [PHCFs]). SETTING: The study was conducted in Nyamira County in western Kenya. METHODS: This was an interrupted time series study where 42 data sets (24 pre- and 18 post-intervention) were collected for each observation. Monthly data were abstracted from the District Health Information System-2, verified, keyed into and analysed by using IBM-Statistical Package for the Social Sciences (SPSS-17). RESULTS: The relative effect of the policy on facility deliveries in the county was an increase of 22.5%, significant up to the 12th month (p < 0.05). The effect of the policy on deliveries by region was highest in Nyamira North and Masaba North (p < 0.001 up to the 18th month). The effect was larger (46.5% vs. 18.3%) and lasted longer (18 months vs. 6 months) in the hospitals than in the PHCFs. The increase in hospital deliveries was most significant in Nyamira North (61%; p < 0.001). There was a medium-term effect on hospital deliveries in Borabu (up to 9 months) and an effect that started in the sixth month in Manga. The relative effect of the policy on facility deliveries in PHCFs was only significant in Nyamira North and Masaba North (p < 0.001). CONCLUSION: The effect of the FMS policy was varied by region (sub-county) and by facility type.

Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya.

INTRODUCTION: The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya. METHODS: An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed. RESULTS: During the study period, there was a significant increase in births attended by skilled attendants up to the 12th month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12th and 18th months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1st to the 18th month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6th month (p<0.05). CONCLUSIONS: The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.

The differential effect of the free maternity services policy in Kenya

Background: The Government of Kenya introduced the free maternity services (FMS) policy to enable mothers deliver at a health facility and thus improve maternal health indicators. Aim: The aim of this study was to determine if there was a differential effect of the policy by region (sub-county) and by facility type (hospitals vs. primary healthcare facilities [PHCFs]). Setting: The study was conducted in Nyamira County in western Kenya. Methods: This was an interrupted time series study where 42 data sets (24 pre- and 18 post-intervention) were collected for each observation. Monthly data were abstracted from the District Health Information System-2, verified, keyed into and analysed by using IBM-Statistical Package for the Social Sciences (SPSS-17). Results: The relative effect of thepolicy on facility deliveries in the county was an increase of 22.5%, significant up to the 12th month (p < 0.05). The effect of the policy on deliveries by region was highest in Nyamira North and Masaba North (p < 0.001 up to the 18th month). The effect was larger (46.5% vs. 18.3%) and lasted longer (18 months vs. 6 months) in the hospitals than in the PHCFs. The increase in hospital deliveries was most significant in Nyamira North (61%; p < 0.001). There was a medium-term effect on hospital deliveries in Borabu (up to 9months) and an effect that started in the sixth month in Manga. The relative effect of the policy on facility deliveries in PHCFs was only significant in Nyamira North and Masaba North (p < 0.001). Conclusion: The effect of the FMS policy was varied by region (sub-county) and by facility type

Predictors of post-partum family planning uptake in Webuye Hospital, western Kenya.

BACKGROUND:  A short inter-pregnancy interval increases the risk for maternal and neonatal deaths in addition to other pregnancy complications including: preterm delivery, low birth weight, anaemia and premature rupture of membranes. However, only one half of Kenyan women, who have no desire to conceive immediately after birth, are using contraception one year after delivery. Aim: The aim of this study was to determine the predictors of uptake of post-partum family planning (PPFP). Setting: The study was conducted among post-partum women accompanying their children for their first measles vaccination at Webuye County Hospital (WCH), in western Kenya. Methods: This was a cross-sectional study involving 259 randomly sampled post-partum women, accompanying their children for their first measles vaccination. A structured, interviewer-administered questionnaire was used to collect data. Logistic regression was used to identify correlates of PPFP uptake. Results: The uptake of PPFP among women at 9 months post-partum at WCH was found to be 78.4% ± 5.0%. The odds of PPFP uptake among women living with their sexual partners was 88.2% less than among those not living with their partners with the true population effect between 97% and 51% (OR = 0.118; 95% CI: 0.028-0.494; p = 0.003). Conclusions: Not living with her sexual partner in the same house is the key predictor of a woman's PPFP uptake in WCH. This study recommends that any programme aimed at improving post-partum contraceptive use in WCH should target women who live with their partners in the same house.