| dc.description.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. | en_US |
