Doctoral Degrees (School of Nursing)

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Browsing Doctoral Degrees (School of Nursing) by Subject "Childbirth -- Kenya"

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    A framework to improve postnatal care in Kenya
    (University of the Free State, 2015-01) Chelagat, Dinah; Roets, L.; Joubert, A.
    English: More than half a million women encounter complications during childbirth annually with a significant number of fatalities (UNFPA 2009: Online). It is estimated that 1,000 girls and women die in pregnancy or child birth each day (The White Ribbon Alliance 2010: Online; Ashford, Wong and Sternbach 2008:457-473). Ashford et al. (2008) further state that almost 40% of women experience complications after delivery with about 15% of these women developing potentially life-threatening complications. Maternal mortality can occur either during the antenatal, intrapartum or postnatal period. However, strategies to reduce maternal mortality have focused on the antenatal and the intrapartum periods (Ministry of Health, Kenya 2006: 52). Maternal mortality can be reduced with improved postnatal care by skilled health care professionals , the majority of whom are the midwives in many low and middle income countries (Senfuka 2012: Online; UNFPA 2011c: Online). Maternal mortality is greatest during the postnatal period which remains the most neglected stage of maternal care especially in the LMICs Kenya included (Safe motherhood 2011: Online). The aim of this study was to develop a Framework to improve postnatal care in Kenya. The study was accomplished in three phases whereby the first objective was to determine factors contributing to the current state of postnatal care services in Kenya which was undertaken in Phase 1.This objective was achieved through data collection where by 258 midwives completed a self-administered questionnaire plus a checklist used in 37 hospitals to assess the availability of physical resources required in the provision of postnatal care. Data analysis revealed that shortage of midwives exists in all the hospitals utilised for the study with a nurse midwife ratio of more than 10. It was further observed that midwives received incomplete orientation on being posted to the maternity units/postnatal wards hence their inability to provide quality postnatal care services. Policies and guidelines were reported to be inaccessible by a majority of the midwives and that cultural and religious beliefs of clients were deemed to have some influence on the provision of the postnatal care. The Nominal Group Technique was used among 13 Reproductive health coordinators in phase 2 to identify the strategies they deemed if employed would improve postnatal care in Kenyan hospitals.The six strategies identified in order of priority are capacity building, data management, quality assurance, human resource management, supportive supervision and coordination of postnatal care activities. The objective of this phase of study was achieved as the NGT process was followed scientifically and results obtained (the strategies) contributed to the development of the Framework as one of the important components of The Theory of Change Logic Model. The third objective and final phase of the study was to develop a Framework to aid in improving postnatal care in Kenya. Development of the framework was accomplished by triangulating the results obtained from Phases 1 and 2. The Framework development was guided by the Theory of Change Logic Model which describes the casual linkages that are assumed to occur from the start of the project to the goal attainment (Frechtling 2007: 5; Taylor-Powell and Henert 2008: 4). The components of the Theory of Change logic by Kellogg (2004: 28) are the problem or issue, community needs, desired results, influential factors, strategies and assumptions (Kellogg 2004: 28). The draft Framework was presented to the Reproductive Health coordinators for validation in a meeting held on 12th March 2014. The stakeholders who are the Reproductive Health coordinators added their expert input to the components of the Theory of Change Logic Model during the validation process leading to a complete Framework aimed at improving postnatal care in Kenya.