DSpace Collection:

Determinants of utilization of skilled birth attendants in maternal and neonatal health centres of excellence in Kibish Subcounty, Turkana County

2026-10-05T07:23:59Z

Title: Determinants of utilization of skilled birth attendants in maternal and neonatal health centres of excellence in Kibish Subcounty, Turkana County Authors: Lopodo, Gabriel Ekal Abstract: Background: Skilled birth attendance (SBA) is an important intervention for reducing preventable maternal and neonatal morbidity and mortality. It enables timely identification and management of complications during childbirth and referral for advanced care when required. However, utilisation of SBA remains uneven, particularly in remote and underserved settings. In Kenya, SBA was 89% nationally in 2022, compared with 53% in Turkana County. Despite the establishment of Maternal and Newborn Health Centres of Excellence (MNH CoEs) to improve access to quality maternal and newborn services, there is limited evidence on utilisation of SBA in Kibish Sub-County. This study therefore assessed utilisation of SBA and factors influencing its utilisation among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County. Objectives: The broad objective of the study was to assess the determinants influencing the utilisation of SBA among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County. The specific objectives were to assess socio-demographic characteristics associated with utilisation of SBA; to assess obstetric factors associated with utilisation of SBA; to determine the influence of health facility accessibility on utilisation of SBA; and to explore perceived cultural factors influencing utilisation of SBA among women of reproductive age in MNH CoEs. Methods: The study employed a cross-sectional mixed-methods design using a convergent parallel approach. The study involved 369 participants aged 15–49 years who had at least one delivery in the preceding two years and had lived in Kibish Sub-County for at least two years before the study. Quantitative data were collected through structured questionnaires, and qualitative data were collected through eight FGDs conducted in each of the catchment villages and four KIIs involving County and Sub-County RH coordinators and in-charges of the two health facilities. Quantitative data were entered into SPSS v20 and analysed using statistical tests such as frequencies, Prevalence, and Logistic regression, as applicable. Qualitative data were translated, transcribed, and thematically analysed both manually and with NVivo. Ethical approval was obtained from MTRH /Moi University IREC (Approval no: 0003543) and NACOSTI (License No. NACOSTI/P/20/5223). Findings: Most of the respondents were aged 25-34 years (65.0%, n=240), had no formal education (93.2%, n=344), and lived within 5 km of a healthcare facility (59.9%, n=221). Hospital delivery was reported by 58.0% (n=214) of participants; 213 (57.7%) reported being attended by a skilled health professional at their last birth; 55.3% (n=204) had parity of ≥4, and 93.1% (n=344) had at least one ANC visit. Reduced utilization of SBA was associated with husbands who were herdsmen [95% CI: 2.35-20.91; p=0.001, AOR = 7.01], parity ≥5 [AOR = 8.86; 95% CI: 2.77–28.33; p<0.001], and transport cost ≥500 [AOR = 9.30; 95% CI: 3.08–28.09; p<0.001], while having ≥4 ANC visits [AOR = 0.092; 95% CI: 0.019–0.451; p=0.003] increased utilization of SBA. Six main themes emerged from the FGDs and five from the KIIs: highlighting cultural practices related to placenta disposal, umbilical cord care, preferred birthing position, gender of the birth attendant, domestic responsibilities, breastfeeding and naming practices, and the roles of husbands and mothers-in-law in childbirth decisions. Conclusion: SBA utilisation in Kibish Sub-County was suboptimal. Higher parity, having a husband who was a herdsman, and higher transport costs were associated with increased likelihood of home delivery, while attending four or more ANC visits was associated with reduced likelihood of home delivery. Qualitative findings indicated that cultural practices, family decision-making, and challenges in accessing and using health facilities influenced childbirth decisions. Interventions to improve SBA utilisation should therefore address transport-related barriers, strengthen ANC engagement, and incorporate culturally responsive approaches to maternal and newborn care. Recommendations: The findings highlight the need for community-based interventions to improve access to maternal and newborn health services in remote areas through strengthened health infrastructure, transport systems, and community-based ANC outreach. There is also a need to invest in operationalising and optimizing the use of Maternity Waiting Homes (MWHs) for expectant women residing away from health facilities. Culturally responsive and respectful maternity care should also be strengthened through community engagement and promotion of practices that do not compromise maternal and newborn safety.

Determinants of cervical cancer screening among women of reproductive age in Bomachoge Chache Sub County, Kisii County

2025-02-07T07:23:58Z

Title: Determinants of cervical cancer screening among women of reproductive age in Bomachoge Chache Sub County, Kisii County Authors: Osoro, Benson Sibota Abstract: Introduction: cervical cancer, the second most prevalent cancer after breast cancer in Kenya but the leading cause of cancer deaths, has had an increasing incidence. Between 2020 and 2021 the prevalence stood at 28.7% with a mortality rate of 50% of the cases diagnosed in 2020. In spite of the possible prevention with early detection through screening, only 4% of reproductive age women in Kisii Sub-County were screened for cervical cancer in the year 2017 against the national target of 75%. Objectives: to examine the determinants of cervical cancer screening among women of reproductive age in Bomachoge Chache Sub County, Kisii County, Kenya. Methods: the study utilized mixed methods applying convergent parallel design. A total of 394 participants from seven health facilities were selected for the study through stratified random sampling. Quantitative data was gathered using questionnaires while qualitative data was obtained via focused group discussions. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 27. Chi-square test was used to determine predictors of cervical cancer screening prevalence and bivariate regression analysis determined the association between determinants of cervical cancer screening and screening practices. A p-value of less than 0.05 (typically ≤ 0.05) was considered statistically significant. Qualitative data was analyzed thematically. Data was presented in tables and pie charts,k and narratives for qualitative data. Results: 206 (57.5%) of the participants were aged between 16 to 19 years, 190 (53%) were married with over 67% of them having at least secondary school education. Notably, although 248(69.2%) of the participants were aware of cervical cancer only 104 (41.9%) were screened. Cervical cancer screening was positively associated with feeling of being at risk of cervical cancer (p <.0001), not being afraid of screening procedures (p <.0001), preference of being attended by a female (p <.0001), a distance of <1km from the nearest screening center (p < .0007). Participants perceived cervical cancer to be caused by witchcraft, curses and sexual immorality. They also had misconceptions such as prayers being a cure to cervical cancer. Further, delay in service delivery was attributed to shortage of health care professionals and inadequate hospital infrastructure. Conclusions: study participants were aware of cervical cancer, risk factors, and warning signs. Screening practices were positively associated with knowledge on cervical cancer, source and monthly income and level of education. Participants perceived that they were not at risk of cervical cancer and believed that witchcraft and sexual immorality were causes of cervical cancer and prayers perceived as the cure.

Assessment of the referral process for emergency obstetric care in basic facilities in Bungoma County, Kenya

2025-02-07T07:13:34Z

Title: Assessment of the referral process for emergency obstetric care in basic facilities in Bungoma County, Kenya Authors: Nekesa, Jacquelyne Wamalwa Abstract: Background: Emergency Obstetric Care (EmOC) refers to a package of essential healthcare services that should be available to all women during pregnancy, labour and after birth. Women who develop obstetric complications should access timely and appropriate care, including referral so as to prevent pregnancy-related morbidities and mortalities, which has largely been attributed to delays and poor management in the healthcare referral system. The World Health Organization highlights that any inability in the referral system to securely transport pregnant women to an appropriate level of care with competent personnel when complications arise can have adverse effects on maternal and fetal outcomes. Objectives: The study objectives included: to determine the influence of communication and transport on the emergency obstetric referral process; to assess the perceived competence on the use of emergency obstetric signal functions among healthcare workers; to determine the availability of supplies and equipment in the provision of EmOC; and to assess client satisfaction with obstetric emergency referral care from level 3 and 4 facilities in Bungoma County. Methods: A cross-sectional design was adopted. The study was conducted in Bungoma County from August 2022 to December 2022. Multistage sampling was used, comprising of stratified random sampling (for levels of healthcare - levels 3 and 4 facilities) and simple random sampling (for healthcare workers and women participants). The study participants included healthcare workers (n=161) in Level 3 and 4 obstetric units, and women (n=379) with obstetric emergencies referred from these facilities. Data was collected using questionnaires and observation checklist. Data was analyzed using descriptive statistics, including measures of central tendency and inferential statistics as applicable, and presented in summary tables. Results: Effective communication and transport was strongly associated with quality EmOC during referral process (linear regression coefficient, T=3.24, p=0.001); healthcare workers' perceived competence on the use of signal functions was statistically associated with the provision of quality EmOC (linear regression coefficient, T=7.15, p=0.003); the availability of supplies and equipment was also strongly associated with the quality of EmOC services (Chi-square value=240.05, p=0.002); Clients’ overall satisfaction with the referral process had a significant relationship with the quality of EmOC services (logistic coefficient value=0.088, p=0.002). Overall, the findings were statistically significant, highlighting a significant association between the study variables and the quality of EmOC services during obstetric referral process. Conclusion: Effective communication and transport, healthcare workers’ perceived competence on EmOC signal functions, and the availability of supplies and equipment have a direct influence on the referral process of emergency obstetric care, and the overall client satisfaction. Clients’ (women) satisfaction was positively associated with Quality EmOC services during referral process. Recommendations: The study recommends that the county ensures effective communication and transport mechanisms and constant availability of supplies and functional equipment for obstetric referrals; ensure regular support supervision and continuous professional development to enhance HCWs competence on EmOC signal functions; and to improve the overall emergency obstetric referral care in basic facilities so as to meet clients’ expectations/satisfaction. A qualitative study is also warranted to provide in-depth understanding of clients’ experiences and/or salient issues on satisfaction.

Education model for building health care capacity in protracted refugee contexts : policy brief

2023-09-21T06:27:55Z

Title: Education model for building health care capacity in protracted refugee contexts : policy brief Authors: Pilkington, F. Beryl; Mbai, Isabella; Judith, Mangeni; Abuelaish, Izzeldin Abstract: Reliance on humanitarian NGOs for health care in protracted displacement situations like Dadaab is not sustainable. Refugees need to be equipped to play a greater role in providing primary health care for their communities. Findings of project research clearly indicated overwhelming support for the development of a health-related degree, with most prospective students and community health workers expressing interest in taking the degree. As a result, a BSc degree in Community Health Education has been developed and ready for implementation. This policy brief highlights the importance of developing education models aimed at addressing health and higher education equity issues in protracted refugee situations.