Effectiveness of post-discharge educational intervention in improving recommended postnatal practices among primiparas mothers in informal settlements in Nairobi County, Kenya
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Date
2025-09
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Kenyatta University
Abstract
Reducing Maternal Mortality Ratio (MMR) and Neonatal Mortality Rate (NMR) are critical Sustainable Development Goals. Informal settlements in Nairobi exhibit an inordinate MMR of 706 per 100,000 live births. While KDHS 2022 estimates NMR in Nairobi as 20 per 1000 live births, most occur among the poorer. Prioritizing disadvantaged populations contributing to higher mortalities is recommended. Postnatal care (PNC) is a high-impact intervention but it is neglected, compromising Postnatal Education (PNE)- a key evidence-based strategy to improve postnatal practices (PNPs). Early discharge for normal deliveries curtails pre-discharge PNE compromising knowledge and Maternal Self-Efficacy (MSE) leading to poor practices. This is accentuated among low-income primiparas who therefore require follow-up. This study examined the influence of a multi-modal follow-up PNE intervention which comprised of a home visit by CHP within the first week, educational videos and wall hanging, self-affirmation pamphlets, telephone access to a CHP and SMS reminders on MSE, adoption of recommended PNPs among primiparas in Nairobi slums. The effect of MSE on PNPs and its mediating role was established. It was a quasi-experimental study in Viwandani and Kwa Reuben (Experimental site) and Korogocho and Huruma (control site) where convenience sampling was applied to recruit 118 primiparas per group with normal singleton delivery discharged early from facilities serving the slums. Interviewer-administered questionnaires were used for quantitative data, FGD guide for qualitative data and Perceived Maternal Parental Self-Efficacy (PMPS-E) questionnaire for MSE. Data were analyzed using IBM SPSS version 20.0 and descriptive statistics, t-tests, Chi-square, Mann-Whitney test, and multiple linear and logistic regressions were derived. Thematic analysis was used for qualitative data. The MSE was a mediating variable while the adoption of recommended PNPs was a composite dependent variable comprised of health-seeking for maternal danger signs, newborn danger signs, self-care, baby care practices, and utilization of PNC contacts. The intervention was a positive predictor of MSE (β=0.59, p=0.00), composite PNPs (β=0.26, p=0.00), self-care practices (β=0.39,p=0.00), and mothers’ two weeks PNC contact (OR=4.64, p=0.00, 95% CI=1.9-11.2) components. It had no significant influence (p<0.05) on health seeking for mothers and newborns after experiencing danger signs, baby care practices, two weeks PNC contact for the newborn, and six weeks PNC contact for the dyad. The PMSE score influenced composite PNPs (β=0.15, p=0.02) and self-care practices (β=0.38, p=0.00), two weeks PNC visit for both the baby (OR 1.06, p= 0.00, 95% CI=1.02-1.11) and mother (OR=1.03, p=0.01, 95% CI 1.0-1.06). MSE was inversely related to seeking emergency health care after an MDS (β=-0.19, p=0.04), but had no influence (p0.05) on health seeking after NDS, baby care practice, and attendance of six weeks PNC visit for the dyad. MSE was not a mediator between the intervention and PNPs. Primiparas appreciated the diverse follow-up support, especially CHP home visits. Post-discharge PNE intervention can improve MSE and PNPs among low-income primiparas and thus Ministry of Health can incorporate it into routine PNC. Applying multipronged PNE delivery methods is effective. Further research is needed on primiparas who have complicated births thus stay longer in hospital and on the cost-effectiveness of scale-up
Description
Department of Environmental and occupational health a research thesis submitted for the degree of doctor of philosophy reproductive health in the
School of Health Sciences of Kenyatta University, September 2024
Supervisors:
Prof. Margaret Keraka
Dr. Eliphas Gitonga