Browsing by Author "Kabo, Jane"

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Experiences and associated factors in quality of delivery care at the Kenyatta National Hospital
(KIBU, 2013-08) Kabo, Jane
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.
Experiences in Care Given During Child Birth at a Referral Hospital in Kenya
(KIBU, 2016-01) Kabo, Jane; Karani, A; Oyieke, J; Wakoli, B. A.; Cheruiyot, B
The fifth Millennium development Goal (MDG) calls for a reduction in the maternal mortality ratio (MMR) 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 Kenya the MMR is 400 and has made insufficient progress towards improving maternal health, (UNICEF, WHO, World Bank, 2013). According to KDHS (2014), the proportion of skilled birth attendance is 46.5%, while in Kenya it is 62% against an MDG target of 90%. According to Zaers S., et al., (2008), prior experience in delivery care by skilled attendants affects their subsequent use of these services. In Africa little research has been carried out on the experiences of mothers in facility-based delivery care. This study was therefore set to describe the experiences of women during labour and delivery at a referral hospital in Kenya This was a cross sectional descriptive study that focused on experiences of delivery care by postnatal mothers at a referral hospital in Kenya. Systematic random sampling from a sampling frame of 327 was employed to recruit post-natal mothers who delivered in labour ward and four postnatal wards. A total of 109 participants were recruited into the study. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartum experience. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to determine the statistical significance of the results obtained. Most participants (87.7%) agreed that they were treated with respect, accorded privacy and asked to consent, prior to the initiation of the procedures. A single aspect of communication, namely health provider explanation of health status with understandable terms was poorly rated (mean 1.8 to 2.2) as was the level of genuine interest in patient well-being (mean = 1.7 to 2.0) which was significant in the study. Most participant (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. Majority of the participants had a positive experience of quality in delivery care. This was evidenced by the fact that majority of then stated that they would come to deliver in the same institution again or recommend a relative or friend. Aspects of care such as health providers communicating to clients in understandable terms and showing genuine interest in patients wellbeing was rated poorly. Institutional factors such as inadequate space and shortage of staff were also noted to be significantly contributing to negative experience of delivery care in the study
Factors influencing high prevalence of Fresh Still Births in Mbagathi County Hospital, Nairobi - Kenya
(KIBU, 2018-01) Kabo, Jane; Ongeso, Abednego; Lukorito, Magdalene
The annual global burden of stillbirths is approximately 2.6 million, 98% of which occur in Sub Saharan Africa. In 2016, approximately 24 still births per month occurred in Mbagathi County Hospital (MCH) representing a 33.3% increase from 2015. A third of these were Fresh Still Births (FSBs).
High-Impact Low-Cost Interventions Implemented to Enhance the Quality of Care Given to Preterm Babies in Kilifi County, Kenya
(KIBU, 2019-02-24) Kabo, Jane
The main objective of this study was to explore and describe the implementation of national policies/guidelines regarding low-cost high-impact interventions to enhance health outcomes for preterm babies among health professionals in Kilifi County. A mixed method approach, with a convergent parallel design was used. Seventeen public health facilities were chosen purposively for the study. Census sampling for the nurses and midwives was utilized with a sampling frame of 146 nurses and midwives. Data was collected using semi structured questionnaires to the nurses and midwives (n=102); A health facility assessment tool with facility leaders (n=16); focus group discussions were held among with nurses and midwives (n=7); in-depth interviews with key informants n=seven and unstructured observation. Analysis of quantitative data was done using the Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics (i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables) and inferential statistics were used to answer the research questions. Qualitative data was coded and analysed thematically. The results provided rich information from several data sources highlighting a need to improve the implementation of four evidence-based practices that would enhance health outcomes for preterm babies. Guidelines/policies, important equipment and medications were not always available, which caused frustration among healthcare workers in their efforts to provide care for preterm babies. Despite common recognition of their key function, guidelines are not always adhered to, as shown in this study. Inadequate use of guidelines reflects the omission of beneficial treatments, possible avoidable harms, and suboptimal patient care. This study also established that there were associations between participants’ gender and percentage scores for knowledge and practice and implementation. The study also highlights barriers and enablers to implementation of clinical guidelines and possible strategies to effective implementation.
Knowledge, Understanding and Utilisation of High-impact Low-cost Evidenced-based Interventions for Preterm Carein Rural Kenya
(KIBU, 2019-07-25) Kabo, Jane
Approximately 25% of 4 million neonatal deaths globally are due to prematurity (WHO 2015; Gondwe et al 2017). A majority of the preterm babies deaths occurs within the the first week of life (Penfold et al 2013). 60% of the preterm births occur in sub-Saharan Africa (Baker et al 2017). Preterm birth rate in Kenya is 12.3% with some rural counties having higher rates (KDHS, 2014). International consensus exists on effectiveness of high-impact low-cost evidence-based interventions to improve preterm outcomes (WHO 2016). • Kenya has adopted and contextualised the following preterm care guidelines: – Immediate and exclusive breastfeeding – Thermal protection of the new-born: a practical guide – Kangaroo Mother Care: Clinical Implementation Guidelines – Basic paediatric protocols (Resuscitation) – Use of chlorhexidine for new-born umbilical cord care • Despite development of these guidelines, there is paucity of literature on availability and effective implementation by health professionals
Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya
(KIBU, 2019-08-05) Kabo, Jane; Holroyd, Eleanor; Edwards, Grace; Sarki, Ahmed
Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. Findings: The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Conclusion: Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya.