School of Nursing and Midwifery

EFFECTIVENESS OF TARGETED ANTENATAL FAMILY PLANNING INFORMATION PROVISION ON EARLY POSTPARTUM FAMILY PLANNING UPTAKE IN KISUMU COUNTY, KENYA

2024-11-01T00:00:00Z

EFFECTIVENESS OF TARGETED ANTENATAL FAMILY PLANNING INFORMATION PROVISION ON EARLY POSTPARTUM FAMILY PLANNING UPTAKE IN KISUMU COUNTY, KENYA Shisanya, Morris Senghor The need. for. early. Postpartum. Family. Planning. (PPFP). is. often. overlooked, resulting. in. missed. opportunities. to. achieve. inter-birth. interval. of. at. least. three. years. to. improve. maternal, perinatal. and. neonatal. outcomes. As. such, the. unmet. need. for. early. PPFP. remains. high. especially. in. West. and. Central. Africa. where. it. is. estimated. to. be. 75%. In. Kenya, the. unmet. need. for. PPFP. is. 73%. The. maternal. and. child. health. continuum. presents. an. opportunity. for. PPFP. interventions. to. be. integrated, particularly. through. targeted. information. giving. Currently, there's. no. structured. protocol. for. information. delivery, and. evidence. on. fertility. intentions. and. optimal. early. PPFP. strategies. is. insufficient. or. non-replicable. This. study. therefore. examined. the. effectiveness. of. antenatal. FP. information. provision. on. early. PPFP. uptake. using. a. pragmatic. randomized. control. trial. in. Kisumu. guided. by. Theory. of. Planned. Behaviour. (TPB). to. guarantee. replicability. The. study. compared. early. PPFP. uptake. between. control. and. intervention. groups, assessed. the. effect. of. the. intervention. on. individual. attitude. towards. early. PPFP. uptake, evaluated. the. effect. of. the. intervention. on. of. perceived. social. normative. beliefs. towards. early. PPFP. uptake, measured. the. effect. of. the. intervention. on. perceived. individual. control. of. early. PPFP. choice, analyzed. the. effect. of. the. intervention. on. intentions. for. early. PPFP. and. established. the. determinants. of. early. PPFP. uptake. among. the. 246. study..participants..in..Kisumu..County..after..at..least..6..months..of..intervention..and..3..m onths..of..postpartum..followup..Case..Report..Forms,.client..exit..interview,.and..questionna ire..were..used..to..collect..data..which.was.analyzed.using.SPSS.version.26..ANOVA.with. post.hoc.tests,.Chisquare.statistic,.ordinal.logistic.regression.analysis,.and.binary.logistic.reg ression.analysis.were.the.main.statistical.tests.with.α<0.05..There.was.a.high.PPFP.uptake. (85.8%),.positive.attitude.(96.4%),.positive.normative.beliefs.(75.2%),.perceived.control. (92.3%).and.intention. (96.3%).for.early.PPFP.with.a.significantly.higher.early.PPFP.uptake.within.the.intervention .arm.(90.9%).than.the.control.arm.(75.6%). (OR:3.2;.95%.CI:1.5.to.6.7;.P<0.0001)..Nurses’.arm.showed.higher.rates.of.early.PPFP.com mencement.(95.1%).as.compared.to.control.75.6%.OR=6.3.and.community.arms. (86.6%).OR=3.0..Likewise,.the.intervention.had.a.significant.effect.on;.perceived.social.nor mative.beliefs.(P=0.015),.perceived.control.of.PPFP.choice. (P<0.0001).and.intention.for.early.PPFP. (P<0.0001)..The.nurses’.arm.had.a.superior.influence.on.these.constructs.compared.to.the.co ntrol.and.community.arms..The.determinant.of.early.PPFP.uptake.were;.being.health.educat ed.in.pregnancy.(P=0.03,.OR:4.6),.good.intimate.partner.relationship. (P<0.0001,.OR:2.3),.setting.a.postnatal.appointment.for.PPFP. (P=0.021,.OR:2.6),.perceived.normative.belief.about.early.PPFP. (P<0.0001,.OR:3.6),.perceived.behavioural.control.of.PPFP.choice. (P<0.0001,.OR:6.6),.intention.to.use.early.PPFP. (P<0.0001,.OR:3.3),.high.FP.counselling.turnaround.time. (P=0.032,.OR:0.94).and.being.counselled.in.group. (P=0.002,.OR:0.28)..The.study.demonstrated.effectiveness.of.nurse.led.antenatal.FP.informa tion.provision.on.early.PPFP.uptake.by.enhancing;.positive.social.normative.beliefs.on.early .PPFP,.perceived.individual.control.of.early.PPFP.choice,.and.intention.for.early.PPFP..The. study.recommends.promotion.of.nurse.led.targeted.antenatal.FP.counselling.for.early.PPFP. uptake,.streamlining.counselling.processes.to.enhance.quality.and.client.satisfaction.by;.tail oring.interventions.to.address.comorbidity.related.attitudes.and.individual.preferences,.with. future.research.focusing.on.inclusive.participant.recruitment..The.study.presents.a.practical. model.for.targeted.antenatal.FP.information provision to foster early PPFP uptake.

EFFECTIVENESS OF MIDWIFE LED DEBRIEFING ON POSTPARTUM DEPRESSION IN WESTERN, KENYA

2024-09-01T00:00:00Z

EFFECTIVENESS OF MIDWIFE LED DEBRIEFING ON POSTPARTUM DEPRESSION IN WESTERN, KENYA Oronje, Sally Jepkosgei Childbirth is a stressful event in women’s lives and could influence emotions which may lead to mental ill health like depression in the postnatal period if not resolved. Depression is a common mental disorder with serious consequences especially during the postpartum period. Many African countries have not explored interventions to reduce or prevent postpartum depression, though the prevalence of postpartum depression has been the focus and there is evidence that it exists among postpartum women. Postpartum midwife-led debriefing has not been explored in low-Middle Income Countries including Kenya. Therefore, this study aimed to investigate the effectiveness of midwife led debriefing on Postpartum Depression in Western region, Kenya. Specifically, to examine the effectiveness of approaches used in midwife-led debriefing, to assess factors influencing Midwife led debriefing, to determine the outcome of midwife led debriefing on postpartum depression and to develop Midwife led debriefing protocol on Prevention of postpartum depression. The study was a quasi-experimental design with pre and post-test assessments. Systematic random sampling was used to identify and allocate participants to both intervention and control groups of the study. The target population were the women of child bearing age. The study participants were women who gave birth during the study period, of which a sample of 212 participated in the study. The 165 participants were allocated to the intervention group while 47 participants being in the control group. Data was collected using standard questionnaire. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Chi-square was used to test association between dependent and independent variables, odds ratio was used to determine the strength between variables that were more likely to influence the debriefing outcome. Logistic regression model was used to assess the influence of time-based outcome variables, social cultural and demographic characteristics of women on midwife-led debriefing. Following midwife-led debriefing, depression levels were found to have decreased according to the study's significant findings on group approach, parity, and social support (p=0.02; p=0.004; p=0.001). Additionally, it showed that debriefing lead by a midwife significantly reduced the risk of postpartum depression (t-statistic=14.672, p value=0.003< 0.05). The Odds ratio (OR= 5.41) indicated association between the intervention of midwife led debriefing and the outcome being reduced signs and symptoms of depression as compared with the standard care. In conclusion, at the 5% significance level, the null hypothesis was rejected (p=0.003), suggesting that postpartum depression might potentially be prevented using midwife-led debriefing. The coefficient of B=0.871 shows a proportional shift in postpartum depression prevention of 0.871 units for every unit increase in midwife-led debriefing. Women's postpartum depression scores could be significantly lowered by midwife-led debriefing following delivery. A proposed protocol from this was recommended for early identification of symptoms of postpartum depression and to improve the quality of life for both the mother and the child.

EFFECTIVENESS OF EDUCATIONAL PROGRAM ON UTILIZATION OF ALTERNATIVE BIRTHING POSITIONS DURING SECOND STAGE OF LABOUR AMONG PARTURIENT WOMEN IN FORMER WESTERN KENYA

2025-02-01T00:00:00Z

EFFECTIVENESS OF EDUCATIONAL PROGRAM ON UTILIZATION OF ALTERNATIVE BIRTHING POSITIONS DURING SECOND STAGE OF LABOUR AMONG PARTURIENT WOMEN IN FORMER WESTERN KENYA Bore, Wilfrida Chemutai Alternative birth positions are one of the interventions in reducing maternal and neonatal mortality and morbidity (WHO, 2020).The use of supine positions during second stage has been associated with maternal neonatal complications. supine or lithotomy positions is the most used position in both develop and developing countries, despite of evidenced based literature which discourages its utilization, this has been associated to lack of knowledge among parturient women. The study, therefore aimed at investigating effectiveness of educational program on utilization of alternative birth positions during second stage of labor among parturient mothers in western Kenya. The study was a non-equivalent pre and post test quasi experimental research design. Antenatal register was used as sampling frame and systematic sampling was used to identify and allocate participants to both groups of study.Sample size was computed using fleis formular with a total 500 as the sample size. The intervention group received two sessions of 2 hours each of the training between the 32th to 37th weeks of gestation. Data was collected using standard questionnaire, checklist,and focus group discussions. Data was analyzed using Statistical SPSS version 28. Chi-Square, paired t-test, logistic regression were the main statistical tests with p<0.05.Lithotomy position was the most used birth position during the last delivery, with 94.6% control,93.3% intervention. Both groups had limited Knowledge about alternative birth positions at baseline, with only 1.68%(intervention) and 1.23% (control group).The intervention group had increase in knowledge of alternative birth positions, from 0% at baseline to 68.5% at end line ( χ2= 41.6, p < 0.001),control group remained static, with no knowledge reported at baseline and only 9.4% at end line(after education).The intervention group uptake alternative positions from 6.7% to 68.5% at end line, control group (5.3% to 10.7% in end line), χ2= 16.8, p= < 0.001.Being married ( p = 0.028) or being unemployed (housewives or farmers) ( p = 0.044) decreased uptake of alternative birth position. Necessary resources, facilitated utilization of alternative birth position (AOR = 28.64; p < 0.0001). Previous birthing experiences negatively influenced decision regarding birth positions (AOR = 0.40; p = 0.037). Spontaneous labor was also more in the intervention group (51.0%),control group (49.0%), χ2=4.6, p=0.032).Intact perineums (62.1%) and a lower rate of episiotomies (4.7%) compared to the control group, with (χ2=96.4, χ2=306.7, respectively, p= 0.0001. Intervention group had higher rate of blood loss less than 500ml (53.6%), control group (46.4%), χ2 =27.1, p=< 0.0001 and a lower rate of augmentation during the second stage of labor (28.6%) ,control group (71.4%), χ2 =6.6 , p= 0.010 was also observed. Likewise intervention group had shorter mean duration of the second stage of labor (18.9 minutes) compared to the control group (62.1 minutes), with a t-test = -18.8, p=< 0.0001 and had a higher rate of 1st Minute APGAR scores ≥7 (57.4%),control group (42.6%), with a p= < 0.0001.In conclusion the study showed that educating Parturient women during prenatal visits increases the knowledge on alternative birth positions and improves uptake of alternative birth positions during second stage of labour. Marital status, occupation, previous birthing experiences, access to equipment are critical factors influencing the uptake of alternative birth positions educating parturient women on alternative birth positions during second stage will enable them to make inform choice and enhance the overall positive birth outcomes. the study recommend incorporating educational program into routine prenatal care to ensure that all parturient women have access to information on alternative birthing positions.

EFFECTIVENESS OF BëST SOCIAL SUPPORT MODEL ON MENTAL HEALTH OUTCOMES AMONG STUDENTS EXPERIENCING INTIMATE PARTNER VIOLENCE IN UNIVERSITIES IN WESTERN KENYA

2025-10-01T00:00:00Z

EFFECTIVENESS OF BëST SOCIAL SUPPORT MODEL ON MENTAL HEALTH OUTCOMES AMONG STUDENTS EXPERIENCING INTIMATE PARTNER VIOLENCE IN UNIVERSITIES IN WESTERN KENYA Tuitoek, Doris Jeptalam Intimate partner violence (IPV) encompasses sexual, psychological and physical abuse committed by a partner either during marriage, cohabitation, or any other type of partnership. Global estimates of IPV are at 30% among women, a range of 21-32% among college students. The detrimental effects of IPV on health classify it as a major priority for prevention and intervention. Various researchers have evidently linked IPV to poor mental health outcomes; however, studies among the college students have yielded contradictory findings. Therefore, this study sought to evaluate the effectiveness of the BëST social support model on mental health outcomes among students experiencing intimate partner violence in universities in Western Kenya. It assessed the characteristics of study participants at baseline, examined the effects of IPV on mental health, determined the mental health outcomes of using the model, explored factors influencing its use, and evaluated its effect on perceived levels of social support. This research adopted a quasi experimental study design utilising mixed method. Data was collected using questionnaires, FGDs and interviews. Snowball sampling was used to identify study participants whose sample size was determined using the Solvin’s formula. All four universities in the region were recruited; two were for the control group, which did group counselling, and two were for the intervention group, which underwent the BëST social support model. The sessions for both groups were done twice weekly for a duration of one month. A pilot study using 10% of the participants was done at Maseno University; the study also utilised validated screening tools. NVivo and the Statistical Analysis System software were used to analyse the findings. 426 participants completed the study, and the findings reveal that the majority (62%) were aged 20–29 years, and 67% were male. Student leaders shared their views on IPV awareness, its impact on students, and the support systems available within the universities. This study found a significant effect of IPV on mental health at baseline. Physical and psychological violence had an effect on depression (p-value 0.012 and 0.022, respectively), while sexual violence did not have a significant effect on IPV. However, over a varied period of time it had an effect on PTSD (p-value 0.049). Both therapies were effective in improving depression and anxiety (p < 0.0001); despite the intervention group showing a significant decrease in the mean scores for PTSD, depression and anxiety, the findings on PTSD were not significant. The themes that emerged from the focus group discussion (FGD) regarding factors influencing the use included navigating trust and decision-making, dynamics of the perpetrator, emotional complexity, and the uptake of institutional support services. On the effect of BëST support on perceived levels of social support, there were improved mean scores with significant p-values (<0.0001). This study concludes that IPV substantially affects the mental health outcomes of university students, highlighting the noticeable effects of physical and psychological violence on depression and anxiety. This study found that the BëST support model improved depression and anxiety and resulted in a steady decrease in PTSD mean scores. The Focus Group Discussions (FGDs) highlighted the necessity of structuring the BST support to foster trust, tackle emotional complexity and decision-making, and effectively address the perpetrator's dynamics. This study recommends strengthening the informal support system, screening IPV participants on mental health outcomes and initiating tailored support for the victims, such as the adoption of this model. In addition, there is a need to identify other intervention programs that may help support PTSD victims.