Introduction gestational diabetes mellitus is an emerging global public health threat due to adverse health outcomes. This study aimed to determine the risk factors for caesarean delivery and macrosomia among women with gestational diabetes in Nyeri County, Kenya. Methods this study used a cross-section design. Randomly, 152 women with gestational diabetes and attending antenatal clinics and maternity were enrolled in this study. Data was collected using a questionnaire upon consent. Data were subjected to binary logistic regression and binomial multiple logistic regression. Results the mean age of the women with gestational diabetes was 30.86 (SD 5.81) years. Among women with gestational diabetes, a proportion of 59.9% (n=91) delivered through caesarean delivery. The positive history of diabetes in a family, previous positive history of gestational diabetes and positive previous adverse obstetric history increased chances of caesarean section delivery by more than 3.824 (95% CI = 1.001-14.608, p=0.05), 10.331 (95% CI = 2.464-43.308, p=0.001) and 7.051 (95% CI = 1.577-31.801, 0.01) folds, respectively. Fetal macrosomia incidence was 42.1% (n=64) among women with gestational diabetes. The primary level of education, previous positive history of gestational diabetes and previous positive adverse obstetric history increased the likelihood of fetal macrosomia by more than 6.289 (95% CI = 1.241-31.870, p=0.03), 5.390 (95% CI = 1.498-19.386, p=0.01) and (95% CI = 5.804 1.349-18.423, p=0.02) folds, respectively. Conclusion antenatal health care programs and delivery facilities should be strengthened in women with gestational diabetes to improve the risk associated with caesarean delivery and fetal macrosomia.

Background: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019.Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval.Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138-0.990, p-value 0.048).Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.

Background: Maternal complications are the second leading cause of death among women after HIV/AIDS. World Health Organization (WHO) estimates that about 94% of all maternal deaths worldwide occur in developing countries. Evidence shows that birth preparedness; the process of strategizing for normal spontaneous vaginal delivery and anticipating the action plan in an obstetric emergency, reduces maternal mortality.Methods: The study assessed the predictors of birth preparedness among women in Laikipia county, Kenya. It was a mixed method, cross-sectional analytical study conducted among 259 women who had delivered within one year prior to the study. Facilities were selected through simple random sampling, whereas participants were selected through systematic sampling. It was a facility-based study using structured questionnaire and key informant interview guide, and data analysed using Statistical package for the social sciences (SPSS).Results: The level of birth preparedness was 23.2%. Inferential statistical tests showed that education, occupation and income, were statistically significant associated with the level of birth preparedness p<0.05, CI=95%). Logistic regression showed that tertiary education (AOR=8.469), formal employment (AOR=4.898) and, income above Kshs 39,000 (AOR=4.834) had a positive association with birth preparedness.Conclusions: The level of birth preparedness was low in Laikipia County. Woman’s education, occupation and household monthly income were the predictors of birth preparedness.

Purpose: The objective of the study was to establish the level of utilization of obstetric care services; to establish factors promoting utilization of obstetric care services, and to identify factors hindering utilization of essential obstetric care services among Bajun women in the Faza Division.Methodology: The study was cross-sectional. Purposive and systematic sampling was used in getting participants. The research instruments to be used were self-administered semi-structured questionnaires and Focused Group Discussions (FGDs). Chi-square values were used to test the significance of the association between the dependent and independent variables. Qualitative data from FGDs were transcribed and analyzed by the thematic content analysis technique.Results: More than half of the respondents (95.6% (175)) indicated that obstetric services are important essential services while 4.4% (8) of them indicated that obstetric services are not important essential services. More than half of the respondents, (74.4% (131)) indicated that they have ever been provided with these services while 25.6% (45) of them indicated that they have never been provided with these services. The findings also indicate that there was an insignificant association (x2 = 2.135a, p = 0.711) between age of the respondents, the level of education (x2 = 0.258, p = 0.612) and (X2 = 1.144a, P = 0.887) between religion of the respondents and the utilization of essential obstetric care services. There is thus, a high probability of utilization of essential obstetric care services (1.049, 2.045, 1.219 and 1.051 times respectively) for those women who have received the information about obstetric services from mass media, the health care, parents and their teachers respectively compared to those who received information from their peers. For the women who were pregnant, the findings indicate a low probability of the utilization of essential obstetric care services for the women who sought pregnancy help from their doctors and nurses/wives (0.357 and 0.102 times respectively). There is also a high probability of utilization of essential obstetric care services for those women who have ever been pregnant, those who have ever had complications during pregnancy, labour & delivery, those who seek help during their pregnancy complications and those who seek help from the hospital during their pregnancy complications.Unique contributions to theory, policy and practice: Therefore, the study recommends the intensification of knowledge to the women in Faza Division, Lamu County about the importance of utilization of essential obstetric services. This will help to reduce the cases of complications affecting mothers during pregnancy, labour and delivery and thus reduce the infant as well as the maternal mortality rate in the County.

Background: Improving women’s health through modern family planning to spontaneous post abortion care is a key to prevent unwanted pregnancy immediately after miscarriage, world health organization indicates that spacing for six months period following miscarriage prevent earlier pregnancy. South Sudan ranks the lowest country with the prevalence rate of 5.5% nationwide. This study helped to uncover the factors contribute to the low uptake of modern family planning options among spontaneous post abortion patients in Kuajok hospital, provide evidence to ministry of health, policy makers and health care providers to improve modern family planning services.Methods: study adopted a descriptive cross-sectional designed and data was collected from spontaneous post abortion patients to determine the prevalence in the study area.Results: Urban and rural have difference choice of modern family planning a total of 38.4% (481) of post abortion women had sort care at the hospital in the past one year revealed that they preferred modern family planning over the other methods. With a total of 17.9% (224) women utilized pills to manage their family sizes, while injectable accounted for 8.6% (108) used of modern family planning among spontaneous post abortion women in that year. The study also noted that male condom was equally popular as a preferred among population at 11.9% (149). Female condoms and cervical diaphragm were unpopular and none patients used them.Conclusions: Ministry of health, policy makers to increase awareness on modern family planning to spontaneous post abortions patients.