MST-Department of Nursing Sciences

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    Modern Contraception Utilization among Adolescent Girls in Ntcheu District, Malawi
    (Kenyatta University, 2020-05) Damson, Ellen Chifundo
    The World Health Organization (WHO, 2018) defines adolescents as individuals in the 10-19 years age group. Every year estimated 21million girls aged 15-19 years, and 2.5 million girls under 15 years become pregnant and approximately 3.9 million girls aged 15-19 years undergo unsafe abortion every year. Despite the high sexual activity by the Malawian adolescents which is rated at 51 percent, there is low utilization of modern contraception. Failure to utilize the modern contraception has resulted in adolescent girls getting unplanned pregnancies which have detrimental effects both to their health as well as their social life. Therefore, the aim of this study is to assess the modern contraception utilization among adolescent girls at Tsangano Turnoff community in Ntcheu District, Malawi. The objectives of the study were to determine the prevalence of modern contraception, to assess the level of knowledge among adolescent girls’, to determine socio-demographic, socio-cultural and health systems factors influencing the utilization of modern contraception among adolescent girls at Tsangano Turnoff community in Ntcheu District, Malawi. This study focused on all unmarried adolescent girls living in the study area at the period of study. The study used a cross sectional study employing both simple random sampling technique for quantitative data and purposive random sampling technique for qualitative. The research instruments were self-administered questionnaires and Focused Group Discussions (FGD). Quantitative data was analyzed using Statistical Package for Social Sciences (IBM SPSS®) version 22.0. Analysis proceeded in two steps. First, univariate descriptive statistics were used to describe sample characteristics and estimate contraceptive prevalence among the adolescents. Contingency table methods were used to test associations between independent (categorical) variable and utilization of contraception and the qualitative data from the FGDs was transcribed and analyzed by thematic content analysis techniques. Overall 180 adolescent girls aged 10-19 took part in the study (mean age 15.2 ±1.5 years). The findings showed that 41% of the respondents had sexual debut at the age of 15 years but modern contraception utilization is still low (36%) with the majority using condoms. On knowledge, it revealed that with higher knowledge are ≥1.5 times more likely to use contraceptives than their counterparts (OR=1.595: 95% CI 1.3394-1.825: P (χ2) ≤0.001).The study revealed that the odds of utilizing contraception among the adolescent girls is more ≥1.5 times higher in those of 15-19 years than those of the lesser age (10-14years) (OR = 1.561: 95% CI 1.386-1.758: P(χ2)≤ 0.001) similarly, those adolescent girls with higher education are ≥ 3.8 times higher than those with lower education levels (OR= 3.869:95% CI 2.381-4.972: P(χ2)< 0.05). On sociocultural, religion is significant in utilization of modern contraception as those from Zion and Catholics are less likely to utilize contraception than their counterparts from other denominations (OR=4.421:95% CI1.874-7.692: p(χ2)<0.05). However, health-care workers attitude, commodity availability and opening hours of the facility have no significant statistically as the odds of adolescent girls utilizing contraceptives because of these factors are less than 1 (OR =0.908, 95% CI 1.596-1.384: P (χ2)>0.05; OR = 0.944: 95% CI 0.167-5.325: P(χ2)>0.05 and OR= 0.344: 95% CI 0.104-1.173: P (χ2)>0.05) respectively. These results showed a big gap between knowledge and utilization among adolescent girls as it showed that 74% knew about modern contraceptive but only 36% utilized it. There is a need to develop age specific reproductive health messages to guide schools’ education curriculum as well as parents and guardians to specifically communicate to this group of people. Secondly, develop adolescent friendly health services as another vital aspect to improve adolescent health access to sexual and reproductive health services which will subsequently improve modern contraception utilization.
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    Utilization of Free Maternity Services among women Aged 18-49 Years in Machakos County, Kenya
    (Kenyatta University, 2021) Ngesa, Alice Mukunzu; Joyce Kirui
    Globally, the rate of maternal mortality is unacceptably on the rise. Maternal mortality rates in Kenya remain high at 362 per 100,000 live births. Only 62% of women deliver under the care of a skilled provider indicating a deficiency in the quality of care. The government of Kenya introduced the policy of Free Maternity Services to all women attending public health facilities in June 2013 to increase skilled birth attendance and reduce inequality by making services available to all pregnant women. Despite the introduction and adoption of the free maternity policy in all government facilities, there is still low utilization of the free maternity services by pregnant women. The study sought to establish the determinants of utilization of free maternity services among postnatal women in Machakos County. A cross sectional study was carried out in Machakos County. A sample size of 421 postnatal women was proportionally selected from each ward through systematic random sampling and interviewed. The study mainly focused on the individual client characteristics, the client related factors and organizational factors related to utilization of free maternity services, which encompassed use of both quantitative and qualitative data collection methods. Both quantitative and qualitative data was collected. Necessary approvals were sought from relevant authorities and informed consent obtained from research participants prior to data collection. Descriptive data was analyzed using Statistical Package for Social Sciences version 25.0. Frequency distribution tables, graphs and pie charts were used for data presentation. Qualitative data was presented as direct quotes or narrations from respondents and triangulated with quantitative results. Inferential statistics were calculated using Fischer’s exact tests and chi-square test (p<0.05) done at 95% confidence interval to establish the association between study variables. The study found out that the overall utilization level of free maternity services by respondents was 75.6%. Chi-square test showed significant statistical association between marital status (p=0.006), parity (p=0.038), distance from facility and utilization of free maternity services (p=0.000), satisfaction with maternity services offered during labour (p=0.000), treatment of mothers by healthcare workers during labour (p=0.000) provision of adequate food (p=0.005), maternity services offered were of high quality (p=0.000), maternity ward was not congested (p=0.009). Fischer’s exact test showed significant statistical association between cleanliness of the maternity ward (p=0.000), respect to clients by health workers (p=0.001) availability of bed/linen (p=0.002), satisfaction with labour ward services during delivery (p=0.000) with utilization of free maternity services. The study concludes that the utilization of FMS was optimal, organizational factors were majorly significantly associated with utilization of FMS.The study recommends that the department of health to support health facilities to offer FMS by providing the necessary supplies. These findings would assist key healthcare stakeholders to design strategic policies and initiatives to ensure sustenance of Free Maternity Services in the country. This would further ensure that the Free Maternity policy leads to improved quality of maternal service provision in all public hospitals thus increased utilization among women of reproductive age.
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    Utilization of Mobile Maternal Health Services among Women of Reproductive Age in Makueni County, Kenya
    (Kenyatta University, 2024-02) Mumo, Joyce Kanini
    Mobile maternal health is a way of resolving challenges that are of public health concern while shifting the pattern of accessing care and provision to rural areas hence improving maternal and child outcomes. The health of women depicts the economic growth and a country’s well-being. Despite this, it is worrying that approximately 295,000 mothers died in 2017 with impoverished countries accounting for 94%. About 66% of those deaths occurs in Sub-Saharan Africa. Maternal mortality rate in Kenya is 362 per 100,000 live births. The Kenyan Government has put in place several interventions to address this including mobile maternal health services. This research sought to evaluate mobile maternal health service use among women within reproductive age in Makueni County, Kenya. An analytical cross-sectional study was carried out in Makueni County. Kibwezi East and Kaiti Sub-Counties were purposively selected. Ukia ward from Kaiti sub-county and Nzambani ward from Kibwezi East sub-county were randomly selected using folded pieces of paper. Both qualitative and quantitative data were collected. Questionnaires were the tools used for quantitative data while guides for key informant were used to collect data qualitatively. The study systematically sampled 367 women of reproductive age as primary respondents from households at a sampling interval of 5. Twelve Key Informant Interviewees were purposively selected to provide additional qualitative data which were community health extension workers and healthcare providers. The research instruments were pretested at Kilome Sub County before actual data collection. Analytical correctional statistical analysis was done using the Statistical Package for Social Sciences software version 20.0. Pie-charts, frequency tables and graphs were used to present data. Triangulation of data collected qualitatively with quantitative data was done and presented as direct quotes. Tests of Chi-Square were done at 95% CI and an error of precision of 0.05 to calculate inferential statistics showing variable associations. Ethical considerations were taken into account and informed consent acquired from participants. The study concludes that 40.6% of respondents utilized mobile maternal health services in Makueni County. The most common service sought was antenatal care. Distance from health facilities was the main reason for using mobile maternal health services. Majority of individual factors such as average family income (p=0.001), parity (p=0.019), type of pregnancy related complication experienced (p=0.027) and awareness (p=0.006) influenced use of mobile maternal health services. About 59.9% of respondents had a positive attitude towards mobile maternal health services and attitude (p=0.010) significantly affected mobile maternal health service use. Further, the study concludes that most health system factors including facility distance (p=0.001), source of information (p=0.012), waiting time (p=0.004), affordability (p=0.013) and experience with healthcare providers (p=0.023) played a key role in influencing utilization mobile maternal health services. These results would inform policy makers to craft interventions seeking to advance mobile maternal health services utilization. This would further avoid preventable complications thus improving maternal and health outcomes of children in the country.