Experiences and associated factors in quality of delivery care at the Kenyatta National Hospital

Abstract

The fifth Millennium Development Goal calls for a reduction in the maternal mortality ratio by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel (United Nations 2007). In Sub-Saharan Africa approximately 40% of women deliver with a skilled attendant. In Sub-Saharan Africa, little research has been carried out on the experience of quality in facility-based delivery care and factors associated with delivery care. This was a cross sectional descriptive study that focuses on experience and associated factors of delivery care by postnatal mothers in the Kenyatta National Referral Hospital in Nairobi, Kenya. The main objective was to describe the experience of quality in delivery care among women who delivered in the health facility; and their perception of the care. Systematic sampling was employed to recruit post-natal mothers who delivered in KNH labour ward and four postnatal wards. A total of 109 participants were recruited into the study, postnatal wards were purposely selected. Training of research assistant was done before data collection. Data was collected using structured and semi-structured questionnaires to respondents within 48 hours after delivery. Qualitative data was collected by use of case studies and key informant interviews. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to calculate the statistical significance of the results obtained The average age of the participants was 26 years (SD 4.5), close to thirty eight percent (37.6%) of the participants had a parity of three. Most (95.4%) of the deliveries were uncomplicated and five (4.6%) participants had complicated births. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartum experience. The participants attending KNH for second delivery viewed providers as respectful (p = 0.043), effective in explaining labor and delivery (p = 0.019) and seeking patient consent before procedures (p = 0.008). Most participants (87.7%) agreed that they were treated respectfully, accorded privacy and asked to consent to procedures, prior to the initiation of these procedures. Ninety percent of participants agreed that the health providers explained what to expect during labor, listened to participants concerns and clearly explained to clients their condition. However 8% of the respondents disagreed with this statement. Most participants (n = 102, 93.6%) said they would recommend delivery services at KNH to friends or family, although 6% of them said they would not recommend. In conclusion, the study showed majority of the participants rated most of the delivery care aspects highly and therefore had a good experience of delivery care though few aspects were rated poorly. There is need for the hospital management to increase the staff patient ratios in labour ward to care for women in labour especially with the increase in numbers of mothers delivering in the institution following provision of free maternity services by the government. The management also needs to plan on increasing the number of beds in labour rooms and also delivery rooms as well provision of privacy in these rooms.