IMPLEMENTATION OF TARGETED POSTNATAL CARE AND ITS ASSOCIATED FACTORS AMONG MIDWIVES IN SELECTED HEALTH FACILITIES IN KAKAMEGA COUNTY, KENYA

Abstract

Postnatal care (PNC) is essential in improving maternal health and reducing maternal mortality, especially in low-resource settings yet studies show its largely neglected. Targeted Postnatal Care (TPNC) is an approach to postnatal care for mothers and newborns involving a set of assessments and interventions given in four scheduled visits from birth to 6 months after delivery. The goal of TPNC is to improve outcomes for these mothers and babies by implementing 100 percent of the recommended TPNC interventions. The study aimed to assess the implementation of targeted postnatal care and its associated factors among midwives at selected public health facilities in Kakamega County, Kenya. The specific objectives were to assess implementation level of TPNC, examine midwife factors, determine maternal factors, and assess facility factors influencing implementation of TPNC. This was a cross-sectional study conducted in maternity and the Maternal and Child Health (MCH) units of selected public health facilities in Kakamega County, Kenya. A cross-sectional analytic method approach was adopted in this study using interviewer administered questionnaire. The study employed multistage sampling, facilities were clustered according to KEPH levels and level four facilities selected due to high workload. KCGH was purposively selected being the only level five facility in the county. Through proportionate sampling N=1695 (Kakamega county average monthly deliveries) the calculated mothers sample size was 325 across the selected facilities. Midwives were selected through census sampling n=160. Statistical package for social sciences (SPSS) version 25 was used for data entry. Data collected was descriptively analyzed, where the mean, median, and standard deviation were computed and compared across the visits. Analysis of variance (ANOVA) was used to measure the significance of the variations in implementation across the various visits. Across the various scheduled visits, implementation level was sub-optimal and even decreased further as the mother progressed through the period. Maternal targeted postnatal care interventions declining from (66.62%) at 48hour visit to (50%) at4-6 months visit. Similarly, newborn targeted postnatal care interventions declined from (59.55%) at 48hour visit to (57.5%) at the 4-6 months. Midwife related factors like age, sex, Emergency Obstetric Newborn care (EMONC) trained, years of experience, and level of training were not significantly associated with TPNC implementation as they all were greater than the thresh hold of p ≤0.05. Maternal related factors like period after delivery(p˂0.0001), Mother came back for review as per scheduled visit (p˂0.0001), cultural beliefs (p ˂0.012) and feedback on baby’s health(p˂0.012) were significantly associated with implementation of TPNC. Facility factors like equipment’s (p˂0.026), Laboratory tests (p˂0.014), number of midwives implementing TPNC (p˂ 0.001), support supervision (p˂0.003) were significantly associated with implementation of TPNC. The study concluded that maternal and facility factors significantly influenced implementation of TPNC. The study recommended that community midwifery be emphasized through level one of care to ensure that mothers do not miss out on these important interventions especially the second visit. Advocacy on hospital delivery through level one of care, at facilities and media is key as this significantly impacts the initiation and continuity of TPNC. Further research on midwife factors influencing implementation of TPNC.