MST-Department of Population and Reproductive Health

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Determinants of utilization of health facility during child birth by women aged 15-49 years in Matinyani sub-county in Kitui County, Kenya
(2014-08-27) Maingi, Nancy
A demographic health survey done in Kenya in the year 2009 revealed that 54% of births in Eastern Province are conducted at home by TBAs and relatives and obstetric care services are unavailable in most of the rural health facilities. A report by Kitui District Development Plan 2008-2012 indicates that despite 20% of women delivering in a health facility, over 80% deliver at home with 70% of the deliveries being assisted by TBAs. Across the County, the majority of maternal death and disabilities occur from preventable causes that can be averted through skilled attendance at birth, backed up with emergency care. This precisely indicate that the uptake of the health services of skilled attendance at birth is low; this also posed a lot of questions as to why 93% of women in Eastern province would seek ANC services yet 70% deliver in the hands of unskilled attendants. This study was aimed at identifying the determinants of utilization of health facility during childbirth by women aged 15-49 years in Matinyani Sub county, in Kitui county. It was a facility- based study conducted in Matinyani Sub county where 376 women and 6 health facilities were included. It was a descriptive cross-sectional study. The variables tested were utilization of health facility during child birth, client related factors, provider related factors and health facility related factors. Data collection was done using focused group discussions guide, interview schedule guide, observation and analysis was done using SPSS version 17. Chi test was used to show association between the variables Majority of the respondents 138 (36.7 %) were between 25-30 years, 125 (33.2 %) betweenZfl-Zfiyears, 58 (15.4 %) between 30-35 years, 31 (8.2%) between 15-20 years and 24 (6.4%) above 35 years. At least 66.2%(n=249) of the respondents highest level of education was primary school,30.3% (n=114) had secondary education and only 3.5%(n=13) had tertiary education.Fifty eight percent (n=218) of the respondents deliver at home,while 42% (n=158) deliver in health facilities. About 33.8% (n=127) of the respondents deliver under TBAs, 18% (n=68) are assisted by relatives, 6% (n=23) are unassisted. Some of the major reasons for home delivery included distance to health facility, travel cost and weak referral systems. There was a significant relationship between marital status and utilization of health facility during child birth (x2=0.040 1; df=2; p<0.05). There was a significant relationship between religion and utilization of health facility during child birth (x2=0.0401; df=l; p<0.05).At least 99% (n=373) of the respondents attended antenatal clinic during pregnancy but only 53% (n=202) managed to attend the four recommended visits. Eighty six percent (n=324) had health education on maternal-health. Only 43% (n=164) of the respondents made own decision on where and who to assist them during delivery. The proportion of women not utilizing SBA were58%, with 33.8% being assisted by traditional birth attendant. Ninety nine percent attended ANC but only 53.7% made the recommended four visits. Majority of health workers were trained on FANC but not trained on comprehensive RH. Despite availability of some essential drugs for management of obstetric complications, in majority of the facilities they were expired. From the study findings it is recommended that community to be health educated on importance of hospital delivery, dangers associated with home delivery by the government. All health workers to be educated on drug storage to avoid expiry hence wastage of drugs. The government and the community should strengthen the referral systems in the sub county.
Occurrence and management of puerperal sepsis amongst women of reproductive age (15-49) attending two hospitals in Nandi county, Kenya.
(Kenyatta University, 2015) Chepchirchir, Maritim Violet; Margaret Keraka; Jackim Nyamari
Puerperal sepsis is a major cause of maternal morbidity and mortality and is usually within the first 42 days after child birth/pregnancy termination. It is a common pregnancy-related condition, which could eventually lead to obstetric shock or even death. Studies have shown that puerperal sepsis is the second cause of maternal morbidity and mortality in the resource poor countries. One‘s susceptibility to developing an infection is related to such factors as cesarean section, extended labor, obesity, anemia and poor prenatal nutrition, socio economic status, geographical factors amongst others. The aim of this study was to evaluate the occurrence of Puerperal Sepsis among women in Nandi County and establish the relationships that exist between the associated factors with puerperal sepsis. Moreover, the study examined the strategies that were put in place to control the infection and identify the challenges being faced in executing them. This study employed a descriptive, cross sectional study design with a sample size of 215 of Puerperal Sepsis patients of the age group 15-49 years from two selected Hospitals in Nandi County. The hospitals included Nandi Hills and Kapsabet District Hospitals. Purposive sampling was used in selection of the study respondents. Data was collected using a structured interview guides for patients on exit. Additional data on patient‘s health seeking behavior and management challenges were obtained from a key informant using an open ended guide. Data collected was analyzed using SPSS version 20. Data was presented in form of percentages, frequencies through tables, graphs and charts. Qualitative data was grouped into categories, themes developed and presented in text form. The demographic data showed that women aged 20-29 years (57.2%), were the most affected while above 40 years (2.8%) were the least affected. It was found that majority (50.2%) of the respondents had attained primary school education and 62.8% were married. Most (56.2%) of the respondents were of lower parity level, 66.5% had spontaneous deliveries and 46% had experience multiple vaginal examinations 28.4% of the respondents had procured unsafe abortions. There was a high significant relation between ANC attendance and labour duration, (OR=5, 95%CI, 1.8-14.28), indicating ANC visits had a positive impact on duration of labour that a woman will experience. Proper nutrition also showed significant relationship with duration of labour,( OR=0.35, 95% CI, 0.15-0.08). Women who had balanced nutrition were more likely to experience short labour durations. Further, results indicated that there was lack of knowledge on the etiology of infection in the area, 81.9% of the respondents did not have knowledge on Puerperal Sepsis. Facilities lacked adequate prerequisites to perform PS awareness both in the facility and in the community. Reports indicated that there were issues of understaffing in the study facilities, in addition; patients had a poor health seeking behavior. These factors underscore the need for the Ministry of health to provide funds that will develop an enabling environment for awareness creation and hygiene education in this area. Policy makers and planners should also consider integrating Hygiene education and Puerperal sepsis awareness into ANC services as a strategy to prevent and control the infection.
Sexual Violence against Adolescent Girls in Mixed-Day Secondary Schools in Limuru Sub-County, Kiambu County, Kenya
(Kenyatta University, 2015) Kimani, Eunice W.
Sexual violence against adolescent girls (SV AG) is a global concern due to its adverse effects on the overall health of these girls. In Kenya, cases of sexual violence in this age group are reported to be at 33%. The study explored sexual violence among adolescent girls (15-19 years) in the nine (9) mixed day secondary schools of Limuru Sub-county, Kiambu County, Kenya. The broad objective of the study was: to assess the status of SVAG in mixed day school in Limuru Sub-county, Kiambu County. The specific objectives were: To establish the proportion of adolescent girls in mixed day schools in Limuru Sub-county affected by SVAG, to determine the perpetrators of SVAG in mixed day schools in Limuru Sub-county, to determine the factors that increase vulnerability of adolescent girls in mixed day schools in Limuru Sub-county to sexual violence, and to determine the factors that affect disclosure levels on sexual violence matters among adolescent girls in mixed day schools in Limuru Sub-county. The study was cross sectional in nature and collected qualitative and quantitative data. The research instruments that were employed in gathering data included selfadministered questionnaires with the 301 sampled girls. The number of girls sampled in every school was proportionate to the number of adolescent girls in that school. Systematic sampling was then used to select the individual girls to participate in every school. Girls who were aged 15-19 years, who were in any mixed day secondary school in Limuru Sub-county, those that had been in the school for three terms and those who consented to participate in the study were illegible. Those who were excluded were girls who failed to consent to participate in the study as well as those who were absent from school during sampling. Three Focus Group Discussions (FGDs) were conducted; one in each educational zone of the Sub-county to enrich the data collected using the questionnaires. Key informant interviews were conducted with two officials in the Children's Sub-county office, two medical officers, as well as with two police officers stationed in Limuru Sub-county and two school heads selected at random. 32.6% of the respondents were affected by SVAG. Of these cases, 85% had experienced forced touching, 51% had experienced attempted sex and 15% had experienced forced sex. In all the three forms of SVAG, male perpetrators constituted more than 96%. Boyfriends (32%) were the commonest perpetrators of sexual violence. About 49% of the perpetrators were reported to have been under the influence of psychoactive substances when committing the sexual violence. Most of the SVAG (40%) was done in the perpetrator's home. Factors that showed a significant association with vulnerability to SVAG were: alcohol use (OR=3.4 p=O.OOI), forced sex at debut (OR=62.4 p=O.OOO)and family. connectedness (p=O.OOI OR=10.6). Social economic status and age of adolescent girl did not show any significant association with vulnerability to SVAG. Disclosure levels were low: forced sex (7%), attempted sex (12%) and forced touch (15%). Factors that showed significant association with disclosure levels were: level of knowledge on sexual violence (OR=I.8 p=0.03), level of knowledge on service availability (OR=7.9 p=O.OI) and family connectedness (OR=2.29 p=0.02). Age of the girl did not show any significant association with disclosure levels.
Utilization of Contraceptives among Secondary School Adolescent Girls in Karuri, Kiambaa Sub-County, Kiambu County
(Kenyatta University, 2015) Murigi, Mary W.
Despite high sexual activity among adolescent girls in Kenya, contraceptive uptake is very low with only about 26 percent sexually active adolescent girls currently using a contraceptive method. This exposes them to HIV infections and unplanned pregnancies which consequently lead to school dropouts, unsafe abortions, and lack of employment opportunities. The study aimed at assessing the utilization of contraceptives among secondary school adolescent girls in Karuri Town Council, Kiambu County. The specific objectives were to establish the level of contraceptive uptake and factors influencing contraceptive utilization amongst secondary school adolescent girls in Karuri Town Council, Kiambu County. This was a cross-sectional study, employing stratified random sampling technique. The research instruments were self-administered semi-structured questionnaires and Focused Group Discussions (FGDs). Quantitative data from questionnaires was checked daily for completeness and coded for appropriate computer entry. Quantitative data analysis was conducted using IBM SPSS® 21.0 and involved univariate and bivariate analysis. Chi- square values were used to test the significance of the association between the dependent and independent variables. Qualitative data from FGDs was transcribed and analyzed by thematic content analysis technique. Overall, 421 girls aged between 13.0 to 19.0 years (mean age: 16.3±1.4 years) took part in the study. Findings showed that despite majority (77.5%) of the adolescent girls having had sexual debut by the age of 15 years, contraceptive utilization was low (43%) with majority of this (83.6%) using the Emergency pill. Age, knowledge on contraceptives, Accessibility and perception were cited as the major factors influencing utilization. Other factors identified included transactional sex, culture, unplanned sexual activity and sexual violence. The results revealed that age of the adolescent, knowledge of contraceptives, perception and accessibility had positive significant effect on contraceptive utilization. Adolescents aged 18 years and above were more likely to utilize contraceptives as compared to those of a lesser age (p=<0.001; OR: 9.870 (95% CI: 3.781-25.763)). Those with knowledge on contraceptives were OR 3.2 times more likely to use contraceptives p=0.025 similarly, accessibility was significantly associated with increased contraceptive utilization (p=0.34, 95% CI: 1.054-4.187). Adolescents who perceived use of contraceptives as wise were more likely to use a contraceptive than those of a divergent opinion (OR: 2.053, (95% CI: 1.024-4.115): p=0.041). Despite a high level of knowledge (90.1%) and an early age at sexual debut among secondary school adolescent girls; the study depicted that contraceptive utilization among secondary school adolescent girls remains low (43%). There exists a gap between contraceptive knowledge and practice among secondary school adolescent girls, indicating that knowledge does not always amount to practice. There is therefore need to develop age specific reproductive health messages to guide school education curriculum as well as parent or guardian - child communication. Developing adolescent friendly health services will improve adolescent’s sexual and reproductive health which will subsequently improve contraceptive utilization.
Intrauterine device uptake among women seeking family planning services at Mbagathi and mama Lucy Kibaki hospitals in Nairobi county, Kenya
(Kenyatta University, 2015-04) Mbuthia, Florence Wangari; Gaundencia Okumbe; Jonathan Monda
Intrauterine Device is a method of contraception, which is underutilized in Sub Saharan African countries including Kenya despite the method being safe, long acting, reversible and effective in preventing unintended pregnancies. The main objective of this study was to determine the uptake of Intrauterine Device among women seeking Family Planning services at Mbagathi and Mama Lucy Kibaki hospitals in Nairobi County. The specific objectives were to establish the level of Intra Uterine Device uptake among women seeking Family Planning services and to determine drivers and barriers to Intrauterine Device uptake among the study population. This was a descriptive cross sectional facility based study involving women of reproductive ages 15-49 years seeking family planning services at the two level four Government Hospitals in Nairobi County. Systematic sampling method was used to select respondent and 380 women who were distributed proportionately in the two facilities were interviewed. Data was collected using both quantitative and qualitative approaches where an interviewer administered questionnaires, focus group discussions and key informant interviews were used as the data collection tools. Descriptive statistics were used to describe the variables while chi square tests assessed associations. Logistic regression was performed for variables that were significant at bivariate analysis. The uptake of IUD among respondent was 7.9%. The uptake of IUD increased with age with those above 30 years using the device more than those below 30 years. Parity was significant in uptake of the method with those having more than two children using the method more compared to those who had one or two children (p<0.0001). Majority of women (84.6%) were able to identify what an IUD is and how it is used. Awareness of the fact that the facility was providing the IUD significantly influenced the uptake. Myths, rumours and misconception were mentioned by 71.3% of women but having heard them was not associated with uptake of IUD (p=0.167), however they were cited to be barrier to IUD uptake by key informant .The main myths, rumours and misconception that were mentioned included; One can conceive with IUD and give birth to a baby with device embedded in the body (35.8%), IUD can travel to other parts of the body (26.6%) and spread infections to other parts of the body (19.6%). Fear and conceptual concern were also cited as barrier to IUD uptake. Eighty three percent of the IUD users were satisfied with the device and 97% of the users would recommend the method to others. FP providers influenced IUD uptake by either recommending or advising against it. In conclusion the uptake of IUD was 7.9%. Parity, awareness of IUD availability and a favourable perception were the main drivers to IUD uptake. Myths, rumours and misconceptions largely persist in the region. The study recommends to the ministry of health a need to increase IUD uptake and Family planning programmes a need to focus more on young women and those of lower parity to increase the uptake of IUD. Health providers need to dispel myths, rumours and misconceptions and allay fears and concern about IUD. The study recommends further study to find out health provider’s influence on IUD uptake as well as a similar or comparative study in rural areas to find out IUD uptake and for ease of generalization.
Unmet need for family planning among women of reproductive age living in Makadara division, Nairobi County, Kenya.
(Kenyatta University, 2015-06) Mukhongo, Aliongo Raymond
Throughout the whole world, the unmet need for family planning data has become a very useful tool in measuring and predicting the contraceptive needs of a population. Access to family planning services and awareness has improved greatly, but the unmet need for family planning continues to remain high. Kenya is one of the fastest growing countries in population worldwide mainly due to low contraceptive use and high unmet need for family planning. In this study, the proportion of unmet needs for family planning and the factors responsible for this unmet need for family planning among women of reproductive age in Makadara Division, Nairobi County, Kenya were determined. Few research studies have been done to investigate the unmet need for family planning for the past years creating a need for investigation with the aim of informing health services interventions. In the study, a community-based cross sectional household survey was conducted. A total of 196 study participants of women of reproductive age (15- 49years) from Makadara Division were selected through cluster sampling. All participants were interviewed using a pre tested structured questionnaire modeled on KDHS. The data collected was analysed using SPSS version 20. The Westoff model revealed that the total unmet need for family planning was 17%; 12% for birth spacing and 5% for birth limiting. Multivariate regression revealed that the unmet need was significantly associated with age, region of residence, experience of child loss, education level, partner’s education level and knowledge level on contraceptives (p < 0.05). The unmet need for family planning was still quite high among the respondents and associated with various determinants that should be considered while planning for scaling-up healthcare program. To address this current high level of unmet need for family planning in urban regions, the county government should focus on promoting level of education beyond primary level, improve maternal and child healthcare, and adopt region and age specific programmatic actions in order to reduce unmet need to an acceptable level.
Intimate Partner Violence in Pregnancy Among Antenatal Attendees at Health Facilities in West Pokot County, Kenya
(Kenyatta University, 2015-10) Owaka, Isaac Ogweno
Violence against women perpetuated by intimate partners is worldwide and an important public health concern as well as human rights issue. Intimate partner violence in pregnancy has drawn attention due to its prevalence, detrimental health consequences and intervention potential. In Kenya, the 2014 Kenya Demographic and Health Survey report estimates that 38 % of ever-married women age 15-49 have ever experienced Intimate Partner Violence. There is scanty information on the prevalence and associated risk factors of intimate partner violence in pregnancy in West Pokot County. The objective of this study was to investigate factors contributing to intimate partner violence in pregnancy among antenatal attendees at the health facilities in West Pokot Sub-County. The study was done in 11 health facilities in West Pokot Sub-County. Using cross sectional study design, a total of 238 antenatal attendees who were proportionately and systematically selected from a sample frame of 622 were interviewed for experience of various forms of intimate partner violence in their current pregnancy. This was followed by qualitative research comprising of 4 Focused Group Discussions with 48 community health workers and key informant interviews with 20 health workers. The qualitative study explored community level risk factors on intimate partner violence in pregnancy and the quality of care offered to antenatal attendee experiencing intimate partner violence in pregnancy. Quantitative data was managed using the statistical package for social scientist (SPSS) while Qualitative data was consolidated into various themes. Bivariate and logistic regression analysis was done to determine factors associated with experience of IPV in the index of pregnancy with P :s 0.05 being considered significant. Informed consent was sought from the participants. Confidentiality and privacy was maintained throughout the study. Ethical clearance was obtained from Kenyatta University Ethics Review Committee, and a research permit from National Council for Science, Technology and Innovation. The study found prevalence of overall, physical, psychological and sexual IPV in pregnancy to be 66.9%, 29.9%, 55.8% and 39.2% respectively. After adjusting for confounders, Overall IPV in pregnancy was significantly associated with Alcohol intake by partner (OR 2.116, 95% Cl 1.950-2.260, P 0.000) and partner's level of education (OR 1.265, 95% Cl 1.079-1.487, P 0.031), while psychological and sexual IPV was significantly associated with age of partner (OR 2.292, 95% Cl 2.123-2.722, P 0.007) and age of pregnant women (OR 1.174,95% Cl 1.001- 1.397 P 0.049) respectively. The care offered to antenatal attendees experiencing IPV is not in line with WHO guidelines and standard on handling gender based violence cases. The study findings indicates that IPV in pregnancy among antenatal attendees in West Pokot is very high. This unearths the weaknesses and gaps on gender based violence interventions both in health facilities and community level. Based on this study there is need for the national government, County government of West Pokot to integrate screening of fPV with maternal and child health services.
Determinants of Contraceptive Choices among HIV Positive Women of Reproductive Age Attending Comprehensive Care Centre at Kitale County Referral Hospital, Kenya
(Kenyatta University, 2016-03) Cheruiyot, Edward Kiplagat
Family planning is an important aspect of primary health care. In order to improve the efficacy of available contraceptive methods, it is of importance to identify factors influencing women’s choice of contraception. In Kenya, like many other sub-Saharan countries, prevention of unintended pregnancies among HIV positive women as a strategy for PMTCT has been neglected. This has resulted in a large population of HIV positive women who have a substantial degree of unmet need for family planning, estimated at 60% in the 2007 Kenya Aids Indicator Survey. This study focused on exploring the various determinants of contraceptive choices among HIV positive women of reproductive age seeking services at comprehensive care centre, Kitale County Referral hospital, Trans Nzoia County. The specific objectives for this study were to determine the knowledge levels, to determine the types of modern contraception used and to assess the factors that influence contraceptive choices among HIV positive women of reproductive age attending comprehensive care centre at Kitale County Referral Hospital. This was a cross-sectional descriptive study of 357 randomly selected HIV positive women where both quantitative and qualitative information was collected. The research instruments used were a questionnaire, key informant interview guide and a focus group discussion guide. The data was analyzed using Statistical Package for Social Sciences (SPSS V.20). Statistical techniques including Chi square, and logistic regression were used in the analysis. P<0.05 was considered significant. The findings showed that more than half of HIV positive women 182 (52.1%) were using hormonal modern contraceptives. Controlling for occupation, age, religion, access to contraceptives and facing challenges were significant determinants of contraceptive choice (p<0.05). Those below 30 years were less likely to choose non-hormonal contraceptives compared to those 30 years and above (OR; 95%CI: 0.341; 0.195-0.598). Those affiliated with catholic religion were 2 times more likely to choose non hormonal contraceptives compared to Protestants (OR; 95%CI: 2.226; 1.192-4.158). Those accessing contraceptive at the CCC were 11 times more likely to choose non-hormonal contraceptives compare to those accessing from other places (OR; 95%CI: 11.265; 2.914-43.551). Those experiencing challenges in accessing contraceptives were 6 times more likely to choose non-hormonal contraceptives compared to those not (OR; 95%CI: 6.246; 1.410-27.673).In conclusion,choice of contraceptive was strongly related to age, religion, access and challenges. There is need for the Governmental and nongovernmental organizations, health facilities and other stakeholders to ensure availability, accessibility and sustained advocacy for use of appropriate contraceptive methods. This will guarantee contraceptive commodity security and sustained demand for contraception among HIV positive women of reproductive age. There is also need for researchers to investigate husbands’ perception and acceptance towards contraceptive use by their partners
Women’s persistent utilization of unskilled birth attendance: a study of mothers in Kakamega County, Kenya
(2016-06) Namusonge, Lucy Natecho
Minority of births in Sub-Saharan Africa are conducted by Skilled Birth Attendants (SBAs). Having the highest world maternal mortality ratios and most deaths being associated with lack of trained supervision at delivery, changing delivery practices is a major priority in this region. Utilization of Skilled Birth Attendants (SBAs) may contribute to reducing Maternal Mortality Rate (MMR). While approximately 95.5% of women giving birth receive some antenatal care, 39% of Kenyan women deliver at home especially in rural areas. Kakamega County has low facility deliveries at 48.6% compared to the national average of 61%, this magnitude present a key challenge to improvement in maternal survival. Pregnant women in Kakamega County have varied reasons for delivering at home where deliveries are conducted by unskilled birth attendants. The study was motivated by the poor maternal indicators and low utilization of skilled birth attendance in Kakamega County despite interventions to address the problem. This study attempted to identify reasons to persistent utilization of unskilled birth attendance by women in Kakamega County. It was a descriptive cross-sectional study utilizing quantitative and qualitative approaches targeting postnatal mothers with children aged less than six months who delivered without skilled attendance. Quantitative data was collected through household interviews of eligible women using structured questionnaire and qualitative data collected using Focused Group Discussions (FGDs). All the analysis was done using Statistical Package for Social Sciences (SPSS v. 20.0). Chi square (X2) was used to assess if there was significant relationship or association between independent variables and utilization of Unskilled Birth Attendance (UBA). Pearson product-moment correlation coefficient was used to measure the strength of the linear relationship between the dependent and independent variables under study. The results showed antenatal attendance rate of 92.7%. Low knowledge, socio-cultural factors and health system factors favoured utilization of UBA. Knowledge factors found to enhance utilization of UBAs in the study area were: knowledge on danger signs during labour and delivery (r= 0.430 X2=36.104, P= 0.0001), knowledge on danger signs during post natal period (r=0.466, X2=37.403, P=0.0001) and knowledge on individual birth plan (r=0.374, X2=23.67, P=0.0001). Socio-cultural factors on uptake of unskilled birth attendance were influenced by receipt of support from partner or significant others (r= 0.964, X2=23.210, P=0.00), marital status (r= 0.720, X2=36.104, P=0.00), education level (r=0.562, X2=28.360, P=0.003) and decision maker on choice of place of delivery (r=0.504, X2=29.42, P=0.0001). Health system factors influencing utilization of unskilled birth attendance were perception towards health facility staff (r=0.287, X2=20.46, P=0.000), availability of service (r=0.341, X2=18.13, P=0.006) and availability of 24 hour service (r=-0.249, X2=8.764, P=0.005). There is need to equip women with knowledge on pregnancy, labour and delivery and postnatal periods and ensuring that health care providers are kind and culturally sensitive to the needs of clients hence scaling up utilization of skilled birth attendance. Birth preparedness should be advocated for every pregnant woman. The information generated from this study will be utilized by policy makers leading to appropriate interventions or strategies which can reduce the number of home deliveries and maternal deaths
The Role of Maternal, Psychosocial and Social-Cultural Factors in HIV-Exposed Infants’ Service Uptake; Nakuru County Refferal Hospital, Kenya
(Kenyatta University, 2016-10) Wambui, Eliza Wachuka
Treatment compliance among women with pregnancy induced hypertension attending selected health facilities in Rachuonyo North Sub-County, Homabay County, Kenya.
(Kenyatta University, 2016-11) Jabuya, Eucabeth Agola
Treatment compliance among pregnant women with pregnancy induced hypertension (PIH) continues to be a major global health challenge. Maternal and infant mortality and morbidity remain high and PIH is one of the leading causes. However very little has been achieved to bring this condition under control and many mothers and newborns continue to die or suffer many complications. The main objective of this study was to assess treatment compliance among women with PIH in Health Facilities within Rachuonyo North Sub-County Homa-Bay County. The specific objectives were to establish the socio-demographic factors that influence treatment compliance among women with PIH, to determine the knowledge level of women with PIH and to establish the health system factors influencing treatment compliance among women with PIH in Rachuonyo North Sub-county. A cross sectional descriptive study was undertaken targeting pregnant women already diagnosed with PIH in selected Health Facilities within Rachuonyo North Sub-County. Data collection tools used was researcher-administered questionnaires, FGD guides and KIIs. The questionnaires were filled by 175 women who were proportionately allocated the 3 Level 4 health facilities in the Sub-county. Within each health facility, pregnant women with PIH were conveniently sampled. Two doctors, two clinical health officers and two Nurses were used as key informants to provide additional information. The association between the variables was assessed using Chi Square and logistic regression. The level of treatment compliance among women with PIH stood at 18.3%. Among the women with PIH, 68.1% had high knowledge on treatment compliance. Sociodemographic factors that were significantly associated with treatment compliance were age (p-value = .007) and highest level of education attained respondents (p-value = .038). On the health system factors; explanation of PIH during diagnosis (p-value = .001), advice on the importance of taking PIH medications (p-value = .025), explanation on schedule and timing of taking medications (p-value = .024) and frequency of follow up (p-value = .001) were significantly associated with treatment compliance. However education level was the only significant factor that could predict treatment compliance with respondents who had completed primary schools were 4.968 (Adjusted Odds Ratio = 4.968, p-value = .05) times more likely to comply with PIH treatment as compared to respondents who had not completed primary. The study findings are useful for planning and designing appropriate intervention by the Ministry of Health, Non-governmental organization and stakeholders in order to create awareness about treatment compliance among pregnant mothers with PIH so as to avert the trend and prevalence of Pregnancy Induced Hypertension.
Utilization of individual birth plan during pregnancy among women aged 18-49 years in Kisau Division Makueni County, Kenya
(Kenyatta University, 2016-11) Ndeto, John Kyunguti
Maternal and prenatal mortalities and morbidities have remained a challenge in many developing countries like Kenya, despite the fact that the causes are preventable if not avoidable. Utilization of birth plan in preparation for childbirth is one of the strategies utilized by women in middle and low-income countries to reduce maternal and prenatal mortalities. However, the relationship between utilization of individual birth plan and maternal and prenatal mortalities in developing countries has been inadequately established. Complications related pregnancy and childbirth cannot be reliably and accurately predicted, therefore, this calls for implementation of strategies to solve these problems and especially in the rural areas of developing countries where the situation is most dire. The study aimed at examining the utilization of individual birth plan during pregnancy among women in Kisau division, Makueni County, Kenya. Specifically, the study aimed to determine the proportion of post-natal women who utilized individual birth plan in their last delivery, to establish the demographic characteristics, socio-cultural and healthcare providers’ factors that influence individual birth plan utilization during pregnancy among women in Kisau division. This was a descriptive cross-sectional study that utilized both qualitative and quantitative approaches involving 326 women aged 18-49 who were had delivered 9 months preceding the survey. Systematic random sampling technique was used to recruit the study participants. Data was collected using a pretested and structured interviewer administered questionnaire for women aged 18 -49 years and focus group discussion for healthcare providers.Statistical Package for Social Sciences (SPSS) program version 20 was used for data management and statistical analysis. The study established that 157 of the 326 women interviewed had utilized an individual birth plan. Hence, overall proportion of users of IBP in the study population was 48.2% (95% CI (42.7%-53.6%). Women of the age bracket 28 to 37 years were two times more likely to utilize IBP compared to those of the older age (OR=2.108, p=0.005) while having attended school was a significant factor in the utilization of individual birth plan (OR=12.828, p<0.001). A married woman had a 2.2-fold increment in the likelihood of utilizing the IBP as opposed to her counterparts who were not married (OR=2.20, p=0.001).Despite the high level of ANC attendance IBP utilization is low in the study area. There exists a gap between knowledge and practice of utilization of individual birth plan among women of reproductive age. Moreover, heavy workload to the health care providers is an impediment to the provision of adequate information on IBP to women of reproductive age. Therefore, there is need to increase the patient-healthcare provider ratio in the health facilities. The Ministry of Health should encourage the utilization of individual birth plan among women of reproductive age by use of satisfied clients. In addition antenatal care program stakeholders should focus on young women of reproductive age (<27 years) so as to increase IBP utilization. Lastly healthcare providers should adopt IBP as a tool in ANC care provision and discuss its utilization with women of reproductive age to allay any fears and address the related perceptions as this will go a long way in enabling the realization of United Nations Sustainable Development Goal 3.
Homosexuality and its related health risks in Kilifi Town Council, Kilifi County, Kenya
(Kenyatta University, 2017) Maina, Evah M.
HIV/AIDS was originally referred to as “gay disease” because high numbers of initial patients were homosexuals. Understanding causes of homosexuality and related health risks is important in formulating MSM targeted behavioral interventions towards positive health outcomes. Men who have sex with men are in this category of key populations according to World Health Organization. This study’s main objective was to determine predisposing factors to homosexuality and its related health risks in Kilifi town council. Specific objectives were: to determine factors predisposing men to homosexuality, determine health risks among homosexuals and to establish health promotion and management services for MSM in Kilifi town council. This study used a descriptive cross-sectional design and snowballing sampling was used to reachMSM. The study population included MSM in Kilifi town council, both self-identified and non-self-identified. Data collection methods included self-administered questionnaires with MSM, 2 focused group discussions each with 12 participants and key informant interviews. The key informants were drawn from health care institutions providing MSM friendly services both in the private and the public health sector, and law enforcement agencies that ensure the safety of MSM in the community, CASCO, MSM representative and an NGO officer.Quantitative data analysis was conducted using IBMSPSS® 21.0. Chi- square values and cross tabulation were used to test the significance of the association between the dependent and independent variables. Qualitative data from FGDs and key informant interviews were transcribed and analyzed by thematic content analysis technique. Overall, 72 MSMaged between 18.0 to 58.0 years (mean age: 24. ±0.676 years) took part in the study.This study showed that homosexuality is as a result of socialization rather than biological causes. Majority of respondents(66.7%) cited choice as the reason they are homosexuals. Majority (88.9) cited homosexuality as a lifestyle, meaning it’s a decision they made. Peer pressure was the leading cause of homosexuality (58.3%), with friends (69.4%) being the primary people who introduced most homosexuals to the behavior. Watching pornography (69.4%) when growing up was a predisposing factor to homosexuality. Non condom use at 69.4%, multiple sexual partners (83.3%), drug abuse (91.7%), and discrimination (63.9%) are some of the health risks the homosexuals had. Health services were somewhat gay friendly (55.6%). Majority (80%) access health services from government facilities.In Chi-Square statistic, type of family setup is related to respondents watching pornography while growing up (p < 0.05).This study recommends policy formulation to enhance gay friendly comprehensive health service provision, MSM sexual reproductive health education and community and parental involvement to reduce number of boys who convert to homosexuality at some point in life.
Assessment of utilization of postpartum care services among women in Webuye West, Bungoma County, Kenya
(2017-10) Otunga, Claire Luseno
Postpartum care is an important link in the continuum of care for maternal health. The postpartum period is critical because most maternal deaths occur during this time, yet this is the most neglected period for quality care provision. Postpartum Care (PPC) services are essential in the first six weeks extending to six months. When not offered they lead to complications, poor outcomes like morbidity and mortality. The aim of this study was to assess utilization and factors influencing utilization of PPC services among women in Webuye West, Bungoma County, Kenya. The study adopted a descriptive cross sectional design. The study population was all women of reproductive age with living children aged 6-9 months. Six Health Care Workers (HCWs) were key informants. The study composed of a sample of 384 women. The sampling techniques were purposive and simple random sampling. Data collection tools were a semi structured questionnaire, focus group discussions and interview guide. Data was analyzed using Statistical Package of Social Sciences (SPSS) version 20.Statistical analysis was done using Pearson‟s Chi-Square test.On proportion of women utilizing postpartum care services only 33.6% utilized in the required timings and the attendance of mandatory visits was less than 40% which was below the recommended. All the four PPC visits were statistically significant to utilization. On socio cultural factors majority 85.8% of the women reported staying indoors during this period. Majority 55.7% of them had cultural beliefs and practices performed, both being statistically significant to PPC utilization. Religious beliefs and practices too were dependent on use of PPC (X2 p<0.011).On knowledge factors majority 70.6% of the women first knew the services during ANC from HCWs, awareness of first and fourth visits were statistically significant to PPC service use .On health facility factors majority 74.8% of the women reported availability of the basic services and majority 75.9% of HCWs were friendly and helpful. These influenced service utilization. Majority 51.0% paid for services and waited for 31-60 minutes.HCWs availability, friendliness, waiting time and service charges were statistically significant (p < 0.005) thereby influencing PPC utilization .In conclusion the proportion of women utilizing PPC service was low. Utilization of PPC services being statistically significant and dependent on various factors including , staying indoors, religious beliefs and practices , knowledge during ANC , availability of HCW,waiting time, HCWs helpfulness and friendliness and service charge ( p < 0.005). The study therefore rejected the null hypothesis. The study recommends that there is need to increase more awareness on PPC service utilization by HCWs and community volunteers. Community involvement and collaboration of teams to mitigate socio cultural beliefs and practices. The County MOH and facility managers to implement policies on PPC and continuous capacity building that emphasize PPC service utilization and maternal, neonatal, child health (MNCH) integration
Health Seeking Behavior Associated With Prostatism among Men Aged Over Forty Years in Nyamira County, Kenya
(Kenyatta University, 2018) Matoke, Omwenga Vincent
Prostatism refers to obstruction of the bladder neck due to an enlargement of the prostate as men age leading to urinary difficulties. Prostatism symptoms are majorly irritative and obstructive. The obstructive ones include hesitancy, the need to initiate micturition and a weakened urinary stream while the irritative ones which are usually more troublesome to patients includes urgency, frequency as well as nocturia. The study sought to assess the health seeking behavior with regards to Prostatism among adult men in this area. The study mainly focused on the individual factors, health system factors, IPSS scores and attitude of men towards Prostatism. This study was cross sectional study which was conducted at Nyamira County. The study utilized qualitative and quantitative research methods in order to obtain the required information from respondents. Quantitative data collection was done by use of open and closed ended questionnaires while qualitative data was collected through focused group discussions with adult Men. Confidentiality of information collected was observed and consent was sought from the respondents before collecting any form of information from them. A total of 387 respondents from 18 villages representing 3 villages from six sub locations of Nyamira south and Masaba wards that were randomly selected, were interviewed representing 91.7% response rate. The tools that the researcher used included questionnaire and focused group discussion guides. Descriptive data was analyzed with the aid of the Statistical Package for Social Sciences (SPSS) version 20.0 with the help of Microsoft Excel programme to generate frequency tables, graphs and pie-charts. Inferential statistics was calculated using Chi- Square tests (p=0.005) done at 95% confidence level to determine the linkage between the Variables. Most people in Nyamira County live in rural settings where the awareness levels and knowledge on Prostatism is low, health facilities and providers are few. The study found that the overall uptake level of Prostatism services was 12.1%. Chi-square analysis revealed significant relationship between age (0.001), educational level (0.001), seriousness of condition(0.02), whether screening helps prevent Prostatism (0.001), knowledge about Prostatism screening(0.021), cost of screening (0.001), having medical insurance(0.001), reception and quality of care (0.01), distance to health facility (0.001), fear of Prostatism (0.001), risk of developing Prostatism(0.043), believe it was embarrassing to be screened(0.001), scared of screening results(0.001), whether one discussed health concerns with professionals(0.001), believe that one can live a longer life with condition (0.001) and uptake of Prostatism services. International prostate symptoms scale (IPSS) tool was used to determine individual scores for the respondents with 49.4% reporting mild (0-7), 35.4% moderate (8-19) and 15.2% severe symptoms (20-35). The findings of this study will help policy makers, facility administrators and care providers to shape comprehensive healthcare policies and programs targeting Prostatism services. This will help address stigma and myths associated with Prostatism, increase awareness about the services and thereby increase uptake of Prostatism services among men over forty years and above
Risk Factors Associated With Born Before Arrival and Birth Outcome among Postnatal Women in Tharaka Nithi County, Kenya
(Kenyatta University, 2018) Mbogo, John Muriithi
Born before arrival (BBA) is a childbirth that occurs outside health facility. BBA constitute a high-risk newborn population and have increased perinatal mortality and morbidity. BBA neonatal adverse birth outcome prolong hospital stay. Tharaka Nithi was among Counties with the highest number of BBA (2 %) compared with national (0.9%). The objective of the study was to assess risk factors associated with BBA and birth outcome among postnatal women in Tharaka Nithi County. The study used 1:2 age matched case-control study design to analyze the comparison between the case and the control. The study was conducted in Tharaka Nithi County and the study population were post-natal women in Tharaka Nithi. Purposive and simple random sampling techniques were used to select cases and Controls, and questionnaire was used to collect the data. Data was analyzed using SPSS version 23.0. Descriptive statistics (frequencies and percentages) were used to describe sample characteristics and inferential statistics (chi square, Fishers exact test and Odds Ratio) were used to infer the sample characteristics to the population level. Ethical clearance was sought from Kenyatta University Ethical and Review Committee, permit was sought from NACOSTI and consent sought from respondents. The Socio-demographic risk factors associated with BBA were; marital status (p=0.005), education level (p=0.004), monthly income (p=0.001) and parity (p=0.003), however there was no association between occupation and BBA The physical risk factors associated with BBA were; distance to the health facility (p=0.005), availability of means of transport (p=0.004), status of the road (p=0.003) and time of delivery (p=0.001). The Obstetric risk factors associated with BBA were; duration of labor (p=0.011), mode of previous delivery(p=0.016), and recognition of onset of labor (p=0.001). The non-ANC compliance and birth preparedness factors associated with BBA were; ANC attendance (p=0.004), timing of ANC attendance (p=0.001), number of ANC visits (p=0.014),identification for health facility for delivery (p=0.001), identification for means of transport (p=0.020), knowledge of signs and symptoms of labor (p=0.003), knowledge of EDD (p=0.001), financially prepared for hospital delivery (p=0.010), and basic supplies for birth (p=0.001). There was significant difference between BBA and hospital birth outcome. The adverse birth outcome were asphyxia, neonatal sepsis, prematurity, and hypothermia. The study recommends Tharaka Nithi County Government responsible departments to use the study new knowledge to reduce/eliminate risk factors associated with BBA and consequently reduce BBA and advanced birth outcome
HIV infection Predisposition among women of reproductive age attending Postnatal clinic in a District Hospital. Homabay County - Kenya
(Kenyatta University, 2018-01) Odhiambo, Roselyne Akinyi
This study is about HIV infection Predisposition among women attending Postnatal clinic in a District Hospital in Homabay County. Postpartum period is a period after birth which is the most neglected aspect of maternal health, yet a time of high risk for maternal mortality. While many women access antenatal care, much fewer women globally have access to postnatal care. It is clearly evident that some women who test HIV negative in pregnancy end up testing HIV positive post-delivery. Although most pregnant women in sub-Saharan Africa are HIV negative, they remain at risk for HIV infection in the breastfeeding period (Kinuthia et. al.2004). The broad objective of this study is to contribute to a better understanding of the risk factors for HIV infection in the breastfeeding period among mothers in Homabay county. A descriptive cross-sectional study was conducted among postpartum mothers. The study was conducted in Homa Bay District Hospital – Homa Bay county. The target population was women, who were breastfeeding within 2years, tested HIV negative in their previous postnatal HIV test and attended clinic within 2months. Simple random sampling was used to select the study participants. The target population was 234. Pre-testing of the study tool on breastfeeding women was done at Rachuonyo district hospital. Researcher administered questionnaires were used to collect data. Data collected was entered into an excel spreadsheet for computation. SPSS version 22 was used to analyze the data. In the study, there was a 100% response rate, (n=234), the HIV seroconversion rate was 22%. From the analysis, the status of employment (p <0.0001) correlated with HIV transmission. Violence of a partner correlated with mothers post HIV test (p <0.0001). Refusal to use condom also correlated with mothers post HIV test (p <0.001). Lastly, being forced to have sex correlated with mothers post HIV test (p <0.001). The type of rituals commonly practiced were wife inheritance (84%). The ability to refuse sex if partner did not want to use condom was a strong factor that showed correlation (p<0.001). The number of sexual partners affected the HIV status according to the most recent test and most who had 3 to 4 partners were positive (n=46). The fewer the partners, the less the chances of being positive and the correlation was significant at alpha level of 0.05 (p=0.001). From the study, mothers perceived differently the risks that predispose them to HIV infection during their breastfeeding period agreeing that, condom use prevents spread of HIV infection. Other factors such as domestic violence, unprotected sex and multiple sex partners were seen to be part of the major contributors to HIV infection. Need for further research to be carried out to determine the uptake of HIV related care services for both pre and post natal mothers as there is minimal evidence to show that women actually utilize these services, which then becomes a risk to both mother s and their children who eventually become exposed to the virus. The study was conducted following approval by the Kenyatta University research and ethics committee and National Council for Science and Technology. Permission was sought from the specific facility heads (Medical Superintendent) where the research was conducted, and finally the study participants were consented before participating in the study.
Determinants of access to skilled birth attendants by women in Galkacyo District, Somalia
(Kenyatta University, 2018-02) Mohamed, Suleiman Yusuf
ABSTRACT Globally over half million women of reproductive age (15-49 years) die every year as result of pregnancy and childbirth complications, and 300 million women endure from debilitating injuries. The lack of availability and access to basic and obstetric emergency care is a major cause of the high levels of maternal mortality and morbidity in Somalia. Barriers to accessing skilled birth attendant services are many as reflected, in Somalia only one out of 6 women receive the appropriate care. WHO report states during 2011, 55.5%, of pregnant mother preferred to deliver at homes instead of health facilities and the availability and accessibility of traditional birth attendants influenced their choices. The main objective of this study was to investigate the determinants of access to skilled birth attendants by women in Galkacyo district, Somalia. The specific objectives were to determine the proportion of women accessing to skilled birth attendants, to investigate demographic characteristics, socio-cultural practices, and socio-economic factors that influence access to skilled birth attendants by women in Galkacyo district, Somalia. This study was descriptive cross-sectional. The study was conducted in Galkacyo district, Puntland, Somalia. The target population of this study was women of reproductive age (15-49 years).In this study administered questionnaires was used to collect data from the respondents while key informants interview was done to find overall picture on access to SBAs. Purposive sampling was used to select key informants. Convenience sampling was used in this study to select 384 respondents who met inclusion criteria. Informed consent was obtained from the study participants. SPSS version 20 was used for data analysis. After entry, cross tabulation was done followed by chi square statistics to get the independent variables that were significantly associated with access to skilled SBAs. Logistic regression was used to generate odds ratios on the variables that were significant at chi square level. Information generated was then presented in forms of text, tables and graphs. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. This study found that low proportion of women (27%) had access to skilled birth attendants in Galkacyo district, Somalia (27%) of respondents delivered with assistance of skilled birth attendants. The following factors were significantly associated with access to skilled birth attendants in the study area: Respondents level of education (OR=10.11; 95% CI: 4.8 – 21.28; p<0.001). Marital status (OR=0.23; 95% CI: 1.11 – 0.46; p<0.001). Husband's level of education (OR=4.99; 95% CI: 2.285 – 10.90; p<0.001). Decision maker about delivery (OR=0.15; 95% CI: 0.03 – 0.66; p=0.012).Respondent's occupation(OR=3.17;95% CI=1.52-6,62; P= 0.002). Husband's occupation (OR=2.69; 95%CI: 1.02-7.09; P=0.046). Household's monthly income(OR=0.20; 95%CI: 0.11-0.37,P<0.001). This study recommends that there is need to upgrade educating young girls, so that they enable to make informed choice for their health outcomes. To overcome socio-cultural practices influencing access to SBAs, MOH should increase community health education. Women should be economically improved as to enable them access to higher quality of services including delivery care, more jobs should be created for women.
Health Seeking Behaviour for Key Sexually Transmitted Infections among the Female Sex Workers in Eldoret Municipality, Uasin-Gishu County, Kenya
(Kenyatta University, 2018-05) Ngure, Miriam Wanjiru
Sexually transmitted infections (STIs) are being increasingly recognized as serious global health problem with impact on individual women and men, their families and communities. They can have severe consequences, including infertility, ectopic pregnancy, chronic pelvic pain, miscarriage, and increased risk of HIV transmission. STIs are the main preventable cause of infertility, particularly in women. The general objective of the study was to establish the determinants of health seeking behaviour among the female sex workers for key STIs in Eldoret Municipality in Uasin Gishu county, Kenya. The specific objectives were to examine the female sex workers’ knowledge of key STIs, to determine the healthcare seeking behaviour on key STIs among the female sex workers and to evaluate the determinants influencing health seeking behaviour for key STIs among the female sex workers. The sample size was 139 female sex workers who were selected through snowballing sampling technique. Data was collected using questionnaires, key informant interview schedule guide and Focused Group Discussions guide(FDGs). Data was analyzed using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was used to describe the variables. Hypothesis testing was done using chi-square and significance established at p≤ 0.05. Binary logistic regression analysis was used to determine independent predictors of health seeking behaviour for key sexually transmitted infections. The study findings indicated that majority (66.2%) of FSWs had high knowledge level on STIs, majority (80.7%) of the FSWs had ever experienced STI symptoms though only (52.1%) of them sought for treatment. The main determinants for health seeking behaviour for STIs were; perceived health care providers attitude and behaviour (χ2=66.617, df=1, P=<0.001), distance to the health facility (χ2=28.116, df=1, P=<0.001), treatment cost (χ2=41.707, df=1, P=<0.001), average waiting time (χ2=14.938, df=1, P=<0.001), level of education (χ2=6.802, df=2, P=0.033), monthly income (χ2=9.183, df=3, P=0.027), number of years in sex work (χ2=8.861,df=3,p=0.031) and sex debut(χ2=7.857,df=2,p=0.020)according to chisquare test of significance. The main predictors of health seeking behaviour for key STI were; perceived health care providers attitude and behaviour (OR=63.278: (18.973-211.036) P=<0.001), distance to the health facility (OR=10.993: (4.186- 28.869), P=<0.001), treatment cost (OR=18.462: (6.931-49.174), P=<0.001), average waiting time (OR=5.111: (2.165-12.067, P=<0.001), FSWs who had received a HIV test (OR=3.196; (1.389-7.352); p=0.001), educational level (OR=2.636; (1.060- 6.560); p=0.037) and monthly income (OR=2.880; (1.052-7.882); p=0.030). The study concluded that there were several determinants to accessing healthcare services for STIs and they were related to both individual and structural factors. Thus, there is need for NASCOP to continuously sensitize healthcare workers on healthcare service provision to FSWS indiscriminately and in a friendly manner in order to reduce on the barriers of accessing STI services among the FSWs.
Knowledge and Competency of Midwives in Implementation of Active Management of Third Stage of Labour in Meru County, Kenya
(Kenyatta University, 2018-06) Mugambi, Benson Kiogora
Active Management of the Third Stage of Labor (AMTSL) is an evidence-based, low-cost intervention focusing prevention of postpartum hemorrhage (PPH) which accounts for over 25% globally and Kenya at 33.9% translating to 510 deaths /100,000 live births. The study aimed at assessing knowledge and competencies of midwives in active management of third stage of labor in health facilities of Meru County. The study adopted a descriptive cross sectional design and utilized stratified random sampling to categorize the health facilities and participants were randomly selected. The target population was 375 midwives from the selected facilities out of which a sample population of 125 midwives were selected. Primary data was collected using questionnaires, interview guide and observational checklist. Data collected was edited, coded and analysed using the Statistical Package for Social Sciences (SPSS) version (20.0) after which the findings were presented using data tables, bar graphs and pie charts. Percentages, and chi-square, correlation, regression, factor analysis were used in data analysis.The researcher got permit from National Commission for Science and Technology (NACOSTI) and clearance from Kenyatta University Research Ethics Committee (KUERC). The researcher also sought authority from the hospital management board and informed consent was sought from the respondents before issuing of the questionnaires. From the study, 87 Registered Nurse-midwives, 19 Enrolled Nurse-midwives and 19 degree holder’s respondents filled-in and returned the questionnaires making a response rate of 100%. The study showed that midwife demographic characteristics are a major determinant of the outcomes of active management of third stage of labor. Majority 33(26.4%) of the respondents fell into the ages of 26-30 years. The minority 13(10.4%) of the respondents were between 18-25 years old. Majority 87(69.6%) of the respondents were registered nurse-midwives. In addition, 19(15.2%) of respondents were enrolled nurse-midwives while the 19(15.2%) of the respondents were degree holders midwives. All 125(100.0%) of the respondents knew the AMTSL standards document. The level of knowledge of midwives on active management of third stage of labor in selected health facilities of Meru County was inadequate as 17(13.6%) didn’t have the idea on factors that promote AMSTL administration. A section of the respondents were in agreement that the AMTSL standards application should take between 5 and 10 minutes, massaging of the uterus within the first 2 hours at an interval of 15 minutes. There was association between whether respondents were aware of AMTSL and where they got expertise on AMTSL, since the source of AMTSL and knowledge was statistically significant at 95% confidence interval (χ² =22.24, DF=1, P=0.001). Most (46.4%)of the midwives used the AMTSL wall charts as their reference during the AMTSL standards application and most (86.4%) of the midwives stated that they do keep the AMTSL standards to counter postpartum hemorrhage. Understaffing was regarded by majority (40.8%) of the midwives as a challenge in keeping the AMTSL standards during their practice. Finally, the study concluded that competence of the midwives in active management of third stage of labor was an issue since some (49.6%) midwives took more than one minute in oxytocin administration which is against International federation of gynecology and obstetrics (ICM/FIGO) definition. It was also seen that IM Oxytocin was used by majority (96.8%) of nurses and 67.2% administered 10 I.U as recommended on AMTSL standards. The null hypothesis was accepted in that midwives with high level of knowledge and competence performed well in AMTSL than those who did not have.

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