MST-School of Architecture and the Built Environment

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Browsing MST-School of Architecture and the Built Environment by Author "Sakuny, Raymond Tanui"

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    Determinants of Informed Consent Process for Cesarean Section in Kiambu County, Kenya
    (Kenyatta University, 2025-10) Sakuny, Raymond Tanui
    Cesarean section (CS) is the most commonly undertaken operation in women that is associated with significant mortality and morbidity compared to normal vaginal delivery. Informed consent (IC) respects the patient's autonomy, offers collaborative care. Consenting for CS in sub-Sahara Africa is suboptimal since women receive limited, vague or no information on what the CS entails. The elements of IC process were infrequently considered at AIC Kijabe Hospital. The study sought to determine how the patient-related factors, communication related factors, information-related factors influence consenting as well strategies for ethical decision-making on consenting for CS as highlighted by patients post-delivery and clinicians. The mixed-method cross-sectional study design sought to assess IC for CS among women who delivered between periods of 12 to 72 hours in two tertiary level government facilities in Kiambu County, Kenya. The investigator applied a systematic random sampling technique to select (N= 159) post-natal women to participate in the study. Closed and open-ended questionnaires were incorporated to obtain the required information as well as findings of focused group discussion of clinicians. Data was analyzed using a computer software statistical package for social sciences (SPSS) and Microsoft Excel and presented in descriptive statistics. Primigravidas were the majority participants with percentage of 37.7%. Most of the CS conducted in Kiambu County were emergencies at 69.9%. The findings indicated that as age and parity increase, the decision to have elective CS increases, going for elective CS was influenced by parity (18.7%) and age (8.3%) respectively. Patients with higher parity are more likely to understand the information given. Birth companion helped reduce the chances of experiencing emotional overwhelm particularly those who underwent emergency CS [r(156) =-0.230 p=0.004]. . Bivariate analysis showed the following factors were significantly associated with consenting process; active participation and information given on the consenting [r(158)=-0.345, p<0.001], companion and experiencing emotional overwhelm [r(156) =-0.230 p=0.004],parity and the ability to understand the information given [r(159)=0.162, p=0.041), Labor pain and active participation [r(111)=-.210, p=0.027). Active participation of the participant in consenting process contributed to better collaboration between clinician in making the decision for CS [r(83)=0.443, p<0.001]. The results demonstrated information given to participants was not balanced. The information given largely focuses on diagnoses and indication and less on benefits, risk, alternatives or the consequences of declining treatment. Antenatal consent was considered as a helpful strategy to consent for CS by 64.9% of the participants. The study found birth companion helpful in consenting; disclosure of information was partial, brief consenting time thus existing consent process has significant gaps but can be mitigated by antenatal consent. The study recommends clinicians to provide their clients with full information that focuses on diagnosis, available alternative treatment including benefits and risk. Clinicians should be trained on proper counselling to facilitate exchange of information for the patient or surrogate to make autonomous decisions. Antenatal visits are the appropriate time to engage the client about the possibility of CS delivery through integration within FANC program education as key component of birth preparedness