Respectful Maternity Care Interventions in Promoting Quality at Level 5 Health Facilities in Bungoma County, Kenya

Abstract

High maternal and newborn mortality is a pressing problem in developing settings. Poor treatment during childbirth contributes directly and indirectly to this problem at 82%. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya 20% of women report to have experienced some form of disrespect and abuse. Bungoma County is among the 15 counties with the worst maternal and newborn health statistics. Maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births. Skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited interventional and formal research on respectful maternity care. The study aimed at evaluating maternity care interventions for promoting quality of maternal and newborn care at level 5 health facilities in Bungoma County. Quasi-experimental pre-and-post-comparison study design was used. It involved 71 midwives, 351 mothers and 18 key informants. Sensitization was done using respectful maternity care learning resource package.  Analysis was done using statistical package for social sciences (SPSS v. 25.0). Descriptive statistics were presented in graphs, tables, frequencies and percentages. On Inferential statistics, Chi square (X2) was used with 95% confidence interval (CI) to determine associations. P values ≤ 0.05 were considered significant. On statistical testing, Pearson Chi-Square was used to measure relationship between women's experience of care and their socio-demographic characteristics, Wilcoxon Signed Ranks test to measure association between the women's experience of care and midwives' performance and McNemar test to measure the statistical difference before and after the intervention. Qualitative data was analyzed thematically. The baseline prevalence of D&A was 42.2% and 25% post intervention, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationship were factors leading to D&A. Sociodemographic characteristics and experience of D&A- age (X2-26.07, P-0.00), marital status (X2-20.851, P-0.002. Association between self-reported and observation report- privacy and confidentiality (Z- -7.728, P-0.00), communication (Z- -2.132, P-0.033), dignity and respect (Z- -7.599, P-0.00). Correlation Pre-Post intervention- dignity and respect (P-0.002), privacy and confidentiality (P-0.00), communication (P-0.00), autonomy (P- 0.063). Conclusion, incorporate RMC in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritizing policy actions for improving quality of maternal and newborn health outcomes and indicator