Utilization of Perinatal Verbal Autopsy and its Determinants among Community Health Volunteers in Homa Bay County, Kenya
Ongala, Elizabeth Achieng
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Ending preventable perinatal mortality is one of the global public health priorities. Despite integrating World Health Organization’s essential maternal and newborn care package into Homa Bay County’s community health strategy in 2016, the perinatal death rate remained high at 29/1000 compared to the national ratio of 22/1000 births. To achieve Special Development Goal 3, efficient, timely stillbirths and newborn deaths surveillance and response are vital. This study’s broad objective was to assess the utilization of Perinatal Verbal Autopsy (PVA) among Community Health Volunteers (CHVs) in Homa Bay County, Kenya. The study had four specific objectives; to establish PVA utilization level, determine the influence of socio-demographic and socio-cultural factors on PVA utilization, and establish the influence of data processing issues on PVA utilization. Socio-ecological theory and descriptive cross-sectional study design were adopted for the research conducted in Kasipul Sub County of Homa Bay. All CHVs in the study area formed the study population and were systematically sampled. Mothers identified by the participating CHVs to have had stillbirths or newborn deaths in the community within six months preceding the study were interviewed. Sub County Health Managers, Program Coordinators, and Community Health leaders were purposively sampled as key informants and FGD participants. Yamane’s simplified formula was used to draw a sample size of 184 CHVs. Data collection tools included structured questionnaires, in-depth interviews, KII, and FGD guides. Software Package for Statistical analysis (SPSS v22) and thematic analysis was done for quantitative and qualitative data respectively. Chi-square and fishers’ exact analyses were used to determine associations between independent and dependent variables at 95% confidence interval and <0.05 statistical significance level. The study established a 15.4% PVA utilization among CHVs. There was an association between PVA utilization level and its application. A significant association (p=0.000) existed between previous verbal autopsy conduct and the CHVs’ readiness for PVA. Marital status (p=0.004), gender (p=0.014) and voluntarism period (p=0.012) had statistically significant associations with PVA utilization among CHVs. Bereaved family attitude and PVA utilization had a significant association (p=0.000). CHV training (p=0.020), (p=0.000); database establishment (p=0.000), (p=0.035); and feedback (p=0.032), (p=0.042) were statistically significant to PVA utilization. Meanwhile, HH coverage (p=0.615) and supervision (p=0.657) had no association with PVA utilization. PVA utilization among CHVs was low at 15.4%, far below the WHO recommendation above 80%. Interviewers’ marital status, gender, and volunteerism period are facilitative socio-demographic factors for PVA utilization. Bereaved family attitude and perception of CHV work are important socio-cultural factors for PVA utilization. Training, database, and feedback are important enablers of PVA utilization. VA has considerable potential to informing policy and closing information gaps while guiding monitoring and evaluation of the health systems. The study results will inform National and County Health Surveillance & Response programs, bringing out useful data for prioritization, planning, and resource allocation to enhance populations’ health and livelihoods. Policymakers will use the study findings to design evidence-based health promotion interventions to increase PVA practice towards reducing preventable perinatal deaths in households.