Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya.

IntroductionHaiti has the highest maternal mortality rate in the Western Hemisphere. Facility-based childbirth is promoted as the standard of care for reducing maternal and neonatal mortality. We conducted a convergent,...

BackgroundResearch suggests that birth companionship, and in particular, continuous support during labor and delivery, can improve women’s childbirth experience and birth outcomes. Yet, little is known about the extent to which birth companionship is practiced, as well as women and providers’ perceptions of it in low-resource settings. This study aimed to assess the prevalence and determinants of birth companionship, and women and providers’ perceptions of it in health facilities in a rural County in Western Kenya.MethodsWe used quantitative and qualitative data from 3 sources: surveys with 877 women, 8 focus group discussions with 58 women, and in-depth interviews with 49 maternity providers in the County. Eligible women were 15 to 49 years old and delivered in the 9 weeks preceding the study.ResultsAbout 88% of women were accompanied by someone from their social network to the health facility during their childbirth, with 29% accompanied by a male partner. Sixty-seven percent were allowed continuous support during labor, but only 29% were allowed continuous support during delivery. Eighteen percent did not desire companionship during labor and 63% did not desire it during delivery. Literate, wealthy, and employed women, as well as women who delivered in health centers and did not experience birth complications, were more likely to be allowed continuous support during labor. Most women desired a companion during labor to attend to their needs. Reasons for not desiring companions included embarrassment and fear of gossip and abuse. Most providers recommended birth companionship, but stated that it is often not possible due to privacy concerns and other reasons mainly related to distrust of companions. Providers perceive companions’ roles more in terms of assisting them with non-clinical tasks than providing emotional support to women.ConclusionAlthough many women desire birth companionship, their desires differ across the labor and delivery continuum, with most desiring companionship during labor but not at the time of delivery. Most, however, don’t get continuous support during labor and delivery. Interventions with women, companions, and providers, as well as structural and health system interventions, are needed to promote continuous support during labor and delivery.

Background Reliable, complete and accurate documentation of key health indicators form a critical part of quality of care to improve outcomes of pregnancy especially when dealing with preterm labor. Unfortunately, this is often not achieved in the rural areas in low- and middle-income nations due to a myriad of challenges, including lack of tools, low staffing, task shifting and inadequate training. Poor reporting from the source facilities lead to inaccuracies of data reported to the central registry at the Ministries of Health (MOH) which compounds the problem. As part of a large cluster randomized trial that used facility data as a primary source, we explored whether data quality assessments (DQAs) combined with facility-level mentorship, feedback and upgrades of patient chart storage space improved the quality of routine data in maternity units in a rural county in Kenya. Methods Within the East Africa Preterm Birth initiative, we conducted three DQA’s sequentially in 17 selected health facilities, in Migori County, Kenya. The process involved reviewing of key indicator data collected from the maternity register over a period of time while noting gaps in documentation. We also compared the concordance of data reported from the maternity register into the facility-level integrated service delivery form (MOH 711). Each DQA was followed up with targeted trainings and feedback on areas that needed strengthening. Over the period, we also renovated several facilities’ documents storage spaces for safety and better traceability of patient’s charts. Results Results show that over time the patients’ charts traceability and the quality of key indicator data captured in the maternity register improved significantly. The concordance of data reported from the primary source document to the central registry through the data capture tool MOH 711also showed significant improvement over time. Conclusions Targeted regular DQA with facility-level mentorship and upgrades in records storage can improve data capture, patient-records retrieval and quality of data reported to the MOH; ultimately helping in improving the care for preterm cases.

Introduction:Traditionally, men are not supposed to take part in maternal health issues in many cultures. Nevertheless, pregnancy care and childbirth are the most crucial matters of reproductive health influenced by men. Hence, the aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.Objectives:The aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.Methods:A community-based cross-sectional study accompanied with a qualitative method was carried out from 1 July to 30 August 2019. A multistage cluster sampling technique was employed to recruit study participants. Descriptive statistics, frequencies, proportions, and mean were calculated, and the results of the analysis were presented in text, tables, and graphs. A multivariate logistic regression model was fitted to investigate the independent effect of each explanatory variable on the likelihood of men’s involvement in facility-based childbirth. Qualitative data were analyzed thematically using OpenCode 4.0 software.Results:Out of 800 men, only 36.5% (95% confidence interval: 33.3%–39.6%) were found to have involved in facility-based childbirth. Several factors were associated with men’s involvement in facility-based childbirth of this, being in the age group of 40–49 (adjusted odds ratio 5.04, 95% confidence interval: 2.49–10.20), attaining secondary education and above (adjusted odds ratio 2.14, 95% confidence interval: 1.53–5.60), and having sufficient knowledge of danger signs during pregnancy (adjusted odds ratio 5.65, 95% confidence interval: 3.25–7.46) associated with men’s involvement in facility-based childbirth.Conclusion:Relevant entities had better design-specific educational programs targeting younger age groups, those with lower schooling, and had previous bad obstetrics outcomes. Involving elders and religious leaders in the reproductive health program could also help in overcoming the existing cultural barriers. Moreover, creating a men-friendly facility environment and extensively engaging medias are suggested to improve men’s involvement in the study area.

Background: Disrespect or abuse is a mistreatment of women during pregnancy, childbirth or postpartum period. It is one of the contributing factors of low uptake of institutional delivery. In Ghana, there is little information about disrespect or abuse during childbirth in public health facilities. The objective is to identify factors associated with disrespect and abuse during facility-based childbirth in Tamale metropolis. Methods: The study employed a descriptive cross-sectional study design with a mixed methods approach. The study was conducted in the Northern Regional Hospital and the Tamale West Hospital, both in the Tamale Metropolis. The study population comprised women who had given birth in the selected health facilities within northern Ghana. Participants were chosen using a systematic random sampling technique. The total study participants for this study were 424 as the final sample size. Data collection was facilitated using a computerized instrument deployed on tablets. The data were downloaded from the Google Form into Microsoft Excel, cleaned, coded, imported, and analysed by employing the Statistical Package for the Social Sciences (SPSS) version 24. Results: The result showed that the majority of the respondents (53%) agreed that lack of healthcare provider training in respectful maternity care can lead to disrespect and abuse. Respondents strongly agree (52.0%) that cultures that normalize disrespect and abuse during childbirth contribute to disrespect and abuse. Respondents (56.4%) were aware of any efforts or initiatives in their area to raise awareness and address disrespect and abuse during childbirth. Moreover, respondents (49.0%) agree that lack of nurses and midwives’ adherence to the patient’s charter of Ghana Health Service can lead to disrespect and abuse. Conclusion: The occurrence of disrespect and abuse during facility-based childbirth is determined by an intricate interaction of elements associated with the health system, provider attitudes, training, sociocultural norms, and health regulations. To tackle these concerns, a thorough strategy is needed that encompasses enhancing health systems, training providers, and tackling societal attitudes and practices that contribute to disrespect and abuse.

Purpose: The online shopping sector in Kenya is still not well developed and online commercial activities contribute to just over 1% of Kenya’s GDP. Kenya’s rate of online shopping is 23% and currently lags behind the global rate of online shopping which is 59%. The different level of development in online shopping between Kenya and other developed economies shows that the sector still has a long way to go in Kenya. Online shops face competition from the conventional ‘brick-and-mortar’ stores and supermarkets. In order to deal with the competition most online shops market their products using internet marketing, which is defined as advertising of a company’s products or services over the internet with the view of increasing profits or market share. Market share is the percentage of an industry acquired by a company during a certain period of time. This study aimed to establish the influence of internet marketing strategies on the market share of online shops in Kenya. The specific objectives of the study were: to determine the influence of website design strategies on the market share of online shops in Nairobi County in Kenya; to establish the influence of content marketing strategies on the market share of online shops in Nairobi County in Kenya; to assess the influence of affiliate marketing strategies on the market share of online shops in Nairobi County in Kenya and to establish the influence of social media marketing strategies on the market share of online shops in Nairobi County in Kenya. 
 Methodology: This study adopted descriptive research design. The study covered 68 respondents drawn from a population of 34 online shops operating within Nairobi County, with an average of 2 respondents selected per organization. The study relied on data collected using a questionnaire comprising of both open-ended and close-ended questions, structured to meet the objectives of the study. The data was analyzed using inferential statistics by means of Statistical Packages for Social Sciences version 20. 
 Results: The results indicated a P-value of 0.0002, which is less than 0.05 against all the variables in the study. This indicated that website design marketing strategies, content marketing strategies, affiliate marketing strategies and social media marketing strategies had a significant influence on the market share of online shops in Nairobi County. The study revealed a positive correlation between website design and market share with a correlation coefficient of 0.015, a positive correlation between content marketing and market share with a correlation coefficient of 0.163, a positive correlation between affiliate marketing and market share with a correlation coefficient of 0.057, and a positive correlation between social media marketing and market share with a correlation coefficient of 0.923. The study concluded that social media marketing strategies contributed the most to the overall market share of online shops in Nairobi, followed by content marketing strategies, affiliate marketing strategies and finally website design marketing strategies. 
 Unique Contribution to Theory and Practice: The study recommended that online shops needed to come up with an internet marketing mix that incorporated all the different strategies given that the respondents gave varied views on which internet marketing strategies were more influential. The County governments were encouraged to look into ways of making internet connectivity more affordable since most online shops indicated unreliable and expensive internet as a challenge when trying to conduct internet marketing. The ‘brick-and-mortar’ shops that were not making a profit were also urged to consider the online business model. Retail customers were advised to be willing to accept change and embrace online shopping.
 Keywords: Website design strategies Content marketing strategies, Affiliate marketing strategies, Social media marketing strategies and Market share.

BackgroundReducing malnutrition remains a major global challenge especially in low- and middle-income countries. Lack of knowledge on the motive of nutritional behaviour could ultimately cripple nutrition intervention outcomes. The purpose of this study was to investigate how health beliefs influence nutritional behaviour intention of the pregnant Kalenjin women of rural Uasin Gishu County in Kenya. The study findings provide useful information for culturally congruent nutrition counselling and intervention.MethodsIn this qualitative study semi-structured interviews were conducted with 42 pregnant and post-natal (with children less than one year) Kalenjin women in selected rural public health facilities of Uasin Gishu County Kenya. Furthermore, key informant interviews took place with 6 traditional birth attendants who were also pregnancy herbalists, two community health workers and one nursing officer in charge of Maternal and Child Health (MCH) for triangulation and provision of in-depth information. Content analysis of interview transcripts followed a grounded theory (Protection Motivation Theory) approach, using software MAXQDA version 12.1.3.Resultsed labour (big babies and lack of maternal strength), haemorrhage (low blood), or having other diseases and complications (evil or bad food) were the major perceived health threats that influence nutritional behaviour intention of the pregnant Kalenjin women in rural Uasin Gishu County in Kenya.ConclusionThe pregnancy nutritional behaviour and practices of the Kalenjin women in rural Uasin Gishu County act as an adaptive response to the perceived health threats, which seem to be within the agency of pregnant women. As a result, just giving antenatal nutritional counselling without addressing these key health assumptions that underlie a successful pregnancy outcome is unlikely to lead to changes in nutritional behaviour.

Cassava (Manihot esculenta Crantz) is a staple food crop grown by smallholder farmers in the marginal regions of western, coastal and eastern Kenya. The objective of this study was to evaluate popular cassava varieties for yield and cyanide content in the arid and semi-arid regions of Kenya. The study was carried out at five sites located in three sub-counties of Nakuru county in Kenya. Treatments included a collection of 27 sweet cassava varieties obtained from Western Kenya. Results revealed significant variations among varieties in all sites, for all parameters measured. The highest yields were obtained at Subukia, with the variety MM99/0067 yielding up to 200 t ha-1. Cyanide content varied significant among the varieties and sites; and was high in most of the cultivars, with highest levels recorded in variety Rao Onyoni (17.3 mg100 g-1) grown at the Lare site. The highest dry matter content was recorded in variety Selele rabuor (60.5%), at the Solai III site. Participating farmers ranked the materials based on yield, taste and order of general preference as follows: Subukia site (MM96/0067, NyaTanga, Adhiambo Lera, KME-1 and MH95/0183); Lare site (Nyar AICAD, Nyar Maseno, NyaTanga, and MM96/2480); and Solai site (KME-1, Nyar AICAD, Adhiambo Lera, Karembo, and Obaro dak).

Low- and middle-income countries (LMICs) account for 99% of the global neonatal mortality. Limited access to advanced technology, such as bedside patient monitors contributes to disproportionately poor outcomes for critically ill newborns in LMICs. We designed a study to assess the feasibility, performance, and acceptability of a low-cost wireless wearable technology for continuous monitoring of sick newborns in resource-limited settings. This was a mixed-methods implementation study conducted between March and April 2021 at two health facilities in Western Kenya. Inclusion criteria for newborns monitored included: age 0 to 28 days, birthweight ≥2.0 kg, low-to-moderate severity of illness at admission and the guardian's willingness to provide informed consent. Medical staff who participated in monitoring the newborns were surveyed about their experience with the technology. We used descriptive statistics to summarize our quantitative findings and qualitative data was coded and analyzed as an iterative process to summarize quotes on user acceptability. The results of the study demonstrated that adoption of neoGuard was feasible and acceptable in this setting. Medical staff described the technology as safe, user-friendly and efficient, after successfully monitoring 134 newborns. Despite the positive user experience, we did observe some notable technology performance issues such as a high percentage of missing vital signs data. The results of this study were critical in informing the iterative process of refining and validating an innovative vital signs monitor for patients in resource-limited settings. Further research and development are underway to optimize neoGuard's performance and to examine its clinical impact and cost effectiveness.

Low postnatal care rates in two rural counties in Anhui Province, China: Perceptions of key stakeholders

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

Purpose: This study investigates the impact of the pandemic on access to prenatal and postnatal HIV services for pregnant women living with HIV (WLHIV) in Nairobi (urban), Machakos (semi-urban), and Kajiado (rural/semi-arid) counties in Kenya. Methodology: A retrospective comparative study design was employed to analyze historical healthcare data from 2019 to 2022. Data were collected from government health records and included the number of pregnant WLHIV receiving antiretroviral therapy (ART) before and during the pandemic, the percentage of pregnant WLHIV attending antenatal care (ANC) visits, MTCT rates, and the number of infants born to HIV-positive mothers receiving ART prophylaxis. Descriptive and inferential statistical analyses were conducted using SPSS software to compare HIV service accessibility and MTCT rates across the three counties before and during the pandemic. Findings: The study found that urban counties, such as Nairobi, experienced minimal disruptions, with 85% of pregnant WLHIV continuing to access ART, and MTCT rates remaining stable at 6.5%. In contrast, semi-urban and rural counties, such as Machakos and Kajiado, faced severe service accessibility barriers due to facility closures, reductions in healthcare providers, economic hardships, and pandemic-related mobility restrictions. In Machakos, ART access declined to 65% (from 75%), while MTCT rates increased from 8% to 12%. The situation was even more severe in Kajiado, where only 50% of pregnant WLHIV accessed ART (down from 70%), and MTCT rates surged from 10% to 18%. Unique Contribution to Theory, Practice, and Policy: This study highlights the public health impact of healthcare service disruptions on women living with HIV (WLHIV), emphasizing the need for resilient healthcare systems to sustain essential services during crises. It reveals urban-rural disparities in HIV service access, showing that rural healthcare systems are more vulnerable to external shocks. The study underscores the importance of community-based healthcare models, such as mobile clinics and decentralized ART distribution, to maintain HIV care in emergencies. From a policy perspective, it advocates for telemedicine expansion, mobile clinic deployment, emergency ART stockpiling, and flexible ANC service models to strengthen Kenya’s healthcare system and protect maternal and child health.

Comparing the validity of the payment card and structured haggling willingness to pay methods: The case of a diabetes prevention program in rural Kenya

BackgroundHealth systems are complex, consisting of multiple interacting structures and actors whose effective coordination is paramount to enhancing health system goals. Health sector coordination is a potential source of inefficiency in the health sector. We examined how the coordination of the health sector affects health system efficiency in Kenya.MethodsWe conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 37) with national and county-level respondents, and document reviews. We analyzed the data using a thematic approach.ResultsThe study found that while formal coordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the coordination of the health sector. These challenges were observed in both vertical (coordination within the ministry of health, within the county departments of health, and between the national ministry of health and the county department of health) and horizontal coordination mechanisms (coordination between the ministry of health or the county department of health and non-state partners, and coordination among county governments). These coordination challenges are likely to impact the efficiency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate coordination also impairs the implementation of health programmes and hence compromises health system performance.ConclusionThe efficiency of the Kenyan health system could be enhanced by strengthening the coordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector-specific coordination mechanisms, strengthening the implementation of the Kenya health sector coordination framework at the county level, and enhancing donor coordination through common funding arrangements and integrating vertical disease programs with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff, respectively. Finally, counties should consider initiating health sector coordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.

BackgroundDisrespect and abuse violates women’s basic human rights and autonomy and can traumatize women who are already in a vulnerable position during childbirth and deter them from utilizing skilled care for future childbirth. This study explored women’s perspectives on the acceptability of disrespect and abuse during facility-based childbirth in Ethiopia.MethodsA qualitative descriptive design using five focus group discussions and fifteen in-depth, semi-structured, interviews was conducted with women between October 2019 to January 2020 in north Showa zone of Oromia region, central Ethiopia. Using purposive sampling, women who had given birth at public health facilities of North Showa zone during the twelve months preceding data collection were recruited, regardless of birth outcome. Inductive thematic analysis using Open Code software was used to explore the perspectives of participants.ResultsWhile women reject disrespectful and abusive acts during childbirth generally, they may consider some disrespectful acts as acceptable and or necessary under certain circumstances. Four emerging themes were identified. (1) Disrespect and abuse is not acceptable, (2) Disrespectful and abusive actions are acceptable only if intended to save lives, (3) Disrespectful and abusive actions are an accepted part of everyday practice to prevent complications and adverse outcomes, (4) Disrespectful and abusive actions are necessary to discipline disobedient women.ConclusionWomen’s perceptions of disrespectful and abusive acts of care providers is deeply rooted within the context of violence in Ethiopia and the societal hierarchies that have systematically disempowered women. Given the pervasiveness of disrespect and abusive actions during childbirth, policymakers, clinical managers and care providers must take these essential contextual and societal norms into account and devise comprehensive clinical interventions that addresses the root causes.