Free Maternal Health Care Policy in Kenya; Level of Utilization and Barriers

ObjectivesTo examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DesignA population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SettingCountrywide, Kenya and Uganda.ParticipantsMost recent live births of 24 502 mothers within 1–59 months prior to the 2014–2016 Demographic and Health Surveys.OutcomesCare-seeking continuum and neonatal mortality.ResultsOverall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.ConclusionStrategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother’s continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.

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“…Additionally, there are hidden hospital charges due to underfunding or delayed distribution of funds. 39 41 43 …”

Section: Discussionmentioning

confidence: 99%

“…38–42 Additionally, indirect expenses such as costs of transportation to the health facility are still challenges common among poor households. 39 Further, in Kenya, prior to June 2013, maternal services were partly free and partly subsidised. 43…”

Section: Methodsmentioning

confidence: 99%

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

2021

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“…In 2017, the maternal mortality ratio was estimated to be 342 per 100,000 live births [ 12 ], and data from the most recent Demographic and Health Survey in 2014 found that only about 60% of women attended four or more antenatal care (ANC) visits and delivered with a skilled birth attendant [ 13 ]. Recent government reforms have aimed to improve access and utilization of maternity services [ 14 ]. In 2017, the government launched a new scheme called Linda Mama as part of its strategy to progress towards universal health coverage.…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of the impact of health worker strikes on maternal and child health care utilization in western Kenya

Scanlon

Maldonado

Ikemeri

et al. 2021

BMC Health Serv Res

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Background There have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies of their impact on maternal and child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal and child health services in western Kenya. Methods We utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers (“strike group”) and women who were pregnant in 2018 when there were no major strikes (“control group”). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). Results Of 1341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p = 0.002). Conclusion We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.

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“…In 2017, the maternal mortality ratio was estimated to be 342 per 100,00 live births [12], and data from the most recent Demographic and Health Survey in 2014 found that only about 60% of women attended four or more antenatal care (ANC) visits and delivered with a skilled birth attendant [13]. Recent government reforms have aimed to improve access and utilization of maternity services [14]. In 2017, the government launched a new scheme called Linda Mama as part of its strategy to progress towards universal health cover.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of the Impact of Health Worker Strikes on Maternal and Child Health Care Utilization in Western Kenya

Scanlon

Maldonado

Ikemeri

et al. 2021

Preprint

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BackgroundThere have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies on their impact on maternal child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal child health services in western Kenya. MethodsWe utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers (“strike group”) and women who were pregnant in 2018 when there were no major strikes (“control group”). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). ResultsOf 1,341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate in close-ended interviews. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p=0.002).Conclusion We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.

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Free Maternal Health Care Policy in Kenya; Level of Utilization and Barriers

Cited by 18 publications

References 16 publications

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

A retrospective study of the impact of health worker strikes on maternal and child health care utilization in western Kenya

A Retrospective Study of the Impact of Health Worker Strikes on Maternal and Child Health Care Utilization in Western Kenya

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