Alloys S.S OrageJohn Paul OyorePeter GichangiCrispin, Ndedda Ouma2023-02-032023-02-032022http://ir-library.ku.ac.ke/handle/123456789/24635A Thesis Submitted for the Award of the Degree of Doctor of Philosophy in Public Health (Epidemiology and Disease Control) in the School Of Health Sciences, Kenyatta UniversityThe global focus on demand creation and increasing access to facility maternity services has not led to improved maternal and newborn outcomes. There is inadequate attention to preservation, impartiality, respect and ―quality of care‖ along the continuum of maternal health care. Provision of woman-centred quality obstetric care that includes supportive companionship during labour and childbirth in Kakamega County is hampered by the low provider-client ratio. Birth companionship is now a key component of intrapartum care because of the abundant evidence of its benefits in improving maternal and newborn outcomes. The current recommendation is to convert traditional birth attendants into birth companions. There is paucity of evidence on effectiveness of the new birth companion role to inform integration of this cadre into the formal health system. This study sought to answer the question ―Are Traditional birth attendants effective as birth companions?‖. This study sought to establish acceptability, feasibility for scaling-up and effectiveness of the new birth companionship role in Kakamega County, Kenya. A non-equivalent quasi-experimental design with mixed methods was adopted. The control group had usual care during delivery while the intervention group had birth companions. Quantitative and qualitative data were collected before and after introduction of birth companionship in intervention and comparison sites. Quantitative data were downloaded from the server and analyzed using Stata Version 11 and the ―Statistical Package for social Sciences software version 20‖. Both univariate and multivariate analyses were conducted. Impact was analyzed using the difference in Differences computation. Respondents in the experimental group were 1.2 ―times more likely to be satisfied‖ with the birthing process than those in the control group at 95% confidence levels OR 1.230 (1.168-1.295) p-value <0.001. Clients were 0.4 times less likely to experience high state anxiety after the birth companionship intervention than before at 95% CI OR 0.473(0.442-0.505) p<0.001 and 1.2 times more likely to have increased self-esteem after the birth companion intervention than before at 95% CI OR 1.217 (1.191-1.243) p<0.001. This study established that ―traditional birth attendants‖ are effective birth companions and the new the birth companion role was acceptable as perceived by health workers, health managers, policy makers and members of the community. The acceptance was linked to numerous perceived benefits of birth companionship to the parturient women, families and health system. Fifteen of the 18 key informants (83%) were of the opinion that it was both feasible and sustainable to scale-up the new role and integrate former traditional birth attendants into the formal health system. Birth companionship is ―both a health system and a client-centred‖ high impact intervention that should be institutionalized by governments.enFeasibilityScaling-UpAcceptabilityEffectivenessTraditional Birth AttendantsBirth CompanionsKakamega County, KenyaThesis