Factors Contributing to Adverse Pregnancy Outcomes in Public Health Facilities in Keiyo District, Kenya.
Cheptum, Joyce Jebet
MetadataShow full item record
Addressing poor pregnancy and childbirth outcomes such as still births, preterm births and neonatal deaths have continued to be a major global challenge. Nations and organizations have invested much effort and resources to promote safe pregnancy and childbirth. Despite this, maternal and perinatal mortalities and morbidities remain high. Though several risk factors predisposing women and their infants to adverse outcomes during pregnancy have been documented, little is known on the factors contributing to poor pregnancy outcomes in Keiyo District of Kenya. This was a descriptive cross-sectional study targeting women of reproductive age (15 – 49 years) utilizing maternal and child health services in public health facilities in Keiyo district of Kenya, to identify factors contributing to adverse pregnancy outcomes. Data collection tools employing both qualitative and quantitative parameters were used in the study. A multistage sampling approach was used. The district hospital was purposively selected while the sub-district hospital and health centre were randomly selected considering the levels of care provision in Kenya. Data was obtained from a total of 384 women using interviewer-administered questionnaire. Key informant interviews on health facility in-charges were used to provide additional information. Data was presented using tables, graphs and cross tabulations, while association between variables was assessed using Chi-square statistics and Odds Ratio. Thematic analysis was done on qualitative data. Findings showed that low education level significantly affected pregnancy outcome, none schooling [Unadjusted OR 5.63, 95% CI (1.34, 23.66), p=0.018] and primary school level [(Unadjusted OR 2.09, 95% CI (1.828, 5.004) p=0.029]. Low gestational age at birth was associated with poor pregnancy outcome, (20-28 weeks [(unadjusted OR 50.6, 95% CI (11.3, 225.6) p<0.0001) and 28-37 weeks (Unadjusted OR 4.6, 95% CI (2.72, 7.83), p<0.0001]. Pre-existing medical conditions were associated with poor pregnancy outcomes [Unadjusted OR 4.48, 95% CI (2.653, 7.571) p<0.0001), adjusted OR 3.97, 95% CI (2.653, 7.571), p= 0.023]. Illnesses occurring during pregnancy also showed association with poor pregnancy outcome [Unadjusted OR 3.025, 95% CI (1.828, 5.004), p<0.0001]. Obstetric emergencies were significantly associated with poor pregnancy outcome [Unadjusted OR=2.982, 95% CI (1.751, 5.0791), p<0.0001]. Those who attended the health centre facility for care had significantly poor pregnancy outcomes compared to those who attended the hospital [Unadjusted OR 0.314, 95% CI (0.216, 0.683) p=0.001]. There is need to address health facility factors that contribute to delays in obtaining care, and putting in place a well defined referral system to enable early identification and timely care for women at risk. Findings from this study will be used by the policy makers in focusing interventions aimed at improving maternal and child health, ultimately contributing to attainment of the millennium development goals