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Quality of Health Care Provided to Mothers During Immediate Postpartum Period at Health Facilities in Kakamega County, Kenya

Obulemire Edriey Ronniey1*, James Ogutu2, Gilbert Munyoki3, Monicah Wambugu4

Health care workers have an important role in reducing the high maternal and infant mortality rates in Kenya. Of concern is that majority of the deaths occur during the immediate postpartum period and thus need to study quality of care provided during this delicate period. Kakamega County in Kenya was selected because it ranked the third countrywide according to the Kenya Demographic Health Survey report with infant mortality rates of 65 per a thousand live births and 319 maternal mortality rates per a hundred thousand (UNFPA / UNICEF/ WHO /World Bank, 2015).Socio-demographic factors, knowledge and health services provided during the immediate postpartum period were evaluated from a the recipient of health care service perspective, in this case the mothers. A crosssectional descriptive study design to collect quantitative data was adopted. Self-administered questionnaires were utilized to collect data. The study participants were 257 postnatal mothers who were systematically sampled from facilities within Kakamega County. Quantitative data was analyzed using SPSS version 21.0. Descriptive statistics were used to present quantitative data in frequency tables, charts and graphs. Inferential statics were done using ChiSquare tests at a 95% confidence interval (p<0.05). The results revealed that socio-demographic factors such as age (p=0.014), education (p=0.001), and parity (p=0.029) were associated with the perceived quality of postpartum care. Availability of family planning (p=0.050), immunization (p=0.001), and nutritional counseling services (p=0.012), was associated with a positive perception of the quality of postpartum care health care. Several gaps in service provision were identified such as a significant population of mothers could not recognize maternal danger signs, infant danger signs, and safe cord care practices at 41.5%, 38.2% and 48.1% respectively. Blood pressure monitoring, lochia monitoring, breast examination, health education on safe cord care practices and nutritional counseling in the immediate postpartum period were not provided in a substantial population of the mothers. A significant portion of the mothers could not correctly recognize maternal postpartum danger signs (41.5%) and newborn danger signs (38.2%) within 24 hours. In addition knowledge on cord care management (48.1%) and demonstration of how to breastfeed the newborn (24.5%) was found to be low in significant population of the mothers.

In conclusion, immediate postpartum care services such as blood pressure monitoring, lochia monitoring, nutritional counseling, health education on cord care, maternal and infants’ danger signs recognition need to be strengthened in the immediate postpartum period to avert the high maternal and infant mortality rates associated with postpartum hemorrhage, neonatal sepsis, birth asphyxia and malnutrition.