Implementation of Preterm Birth Interventions among Health Care Providers During Provision of Intrapartum and Perinatal Care in Embu County, Kenya

Abstract

Preterm birth interventions (PTBI) are basic and specialized care packages designed to improve Preterm birth outcome (PTBO) hence increase the survival rates of babies born preterm. Without PTBI, the survivors of PTB are at risk of facing lifelong disability and poor quality of life affecting the individual and family leading to productivity loss and socio-economic constraints. Globally PTB leads in causing neonatal and child mortality rate (CM R )). Accounts for one million deaths yearly a risk factor to over 50% of all global neonatal death ( NND Despite the PTBI put in place in SSA and in Kenya neonates and children continue to die annually due to complications arising from PTB . Specifically in Embu County the rate of PTB increased by (24.6%) exposing survivors to life threatening health problems, social economic constrains and death. Efforts to reduce these deaths remain futile since , decline of childhood deaths related to prematurity remains low at 2.1% as compared to overall chi ldho od deaths reduction of 4.1% annually Moreover, Embu County has scanty information on PTBI. T he main objective of this study was to asses implementation of preterm birth interventions among health care providers (HCP) in Embu County, Kenya. Specific objectives were; to determine level of implementation of PTBI, to establish social- demographic characteristics, to establish training related to PTBI and to determine health facility factors (HFF) that influence implementation of PTBI among health care providers during provision of intrapartum and perinatal care in Embu County. The study used cross-sectional design. Random sampling technique was used to determine the sample size of 94 HCP, while Purposive sampling technique was used to sample study hospitals and 5 Key informants. The study was conducted in three hospitals in Embu County. Questionnaires and Key informant interview (KII) guides were used to collect quantitative and qualitative data respectively. Data analysis, was done using SPSS version 21, descriptive statistics; Chi squires, Fisher’s test and binary logistic model to test the association between independent and dependent variables, to generate odds ratio (OR), confidence limits and variation between variables represented by Nagelkerke R Squared. Qualitative data was categorized in themes. Data findings were presented using tables and charts. The study results revealed that highest number (83%) of the respondents were female while the least (17%) were male. Highest number (48%) were aged above 35 years while the least (13%) were aged between 26-30 years. The results revealed statistically significant association between HCP level of education, experience, training related to PTBI and health facility with a p-value of ( 0.033, 0.024, 0.037 and 0.009) respectively. Highest implementation of PTBI was found among the HCP trained on EmOC (57%), of whom (69.2%) were associated with high implementation as compared to those who had low (32.8 %) implementation. The study concluded that implementation of PTBI is influenced by socio-demographic characteristics; education (OR=0.947, p= 0.157, FET=0. 871), experience (OR= 0.275, p= 0.0.024, FET=5.482), training related to PTBI (OR= 3.15; 95% CI, p= 0.023, FET=1.629) and adequacy of health facility factors (OR= 2.538, p= 0.007, FET= 2.371,). However, the study concluded that implementation of PTBI among health care providers during provision of intrapartum and perinatal care in Embu County was low at (52.7%) as compared to those who had high implementation at (47.3%).