A Comparative Study of Maternal and Neonatal Outcomes During the 2016/17 Doctors Strike in Public Hospitals and a Similar Period the Previous Year at Nazareth Hospital; a Private Faith-based Facility

Abstract

Background: The 2016/2017 Kenyan Doctors’ strike lasted 100 days involving all Public Health facilities. Pregnant women sought alternative care including from private or faith-based facilities. Studies done on effects of doctors’ strike on service delivery show conflicting data with some showing a change in maternal and neonatal outcomes and others none. Justification: Maternal and neonatal outcomes are likely to be impacted in private and faith based health facilities during doctors’ strike in public health facilities due to a likely increase in the number of patients attended. Objectives: To compare the maternal and neonatal outcomes during the 2016/17 public sector doctors strike and a similar period during the previous year at Nazareth Hospital; a faith based hospital. Methodology: This was a pre and post observational study using a ‘before and after’ design. Data were collected from the Nazareth hospital, maternity ward from 5th December 2016 to 14th March 2017, when the doctors were on strike and with a comparison group from 5th December 2015 to 14th March 2016. Using Fox’s formula, sample size was estimated at 474 women in each group. However, for this study the whole population was studied; 500 women before the strike and 1300 during it. Data were collected using a structured questionnaire de-identified and entered in an Excel spreadsheet. Analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Relevant tests of significance were applied and P-values of less than 0.05 considered statistically significant. Data were presented using tables and figures as appropriate. Results: There was three times more admissions in the maternity department during the strike than before the strike. Significant changes were seen in the following maternal and neonatal outcomes: increase of mean duration of time in minutes from diagnosis to decision implementation during the strike period compared to before the strike (OR 183.2; 95% CI 164.4- 202 vs 117.5 95% 94.8-140.2; p val <0.001), an increase in the number of livebirths (OR 1.4; 95% CI 1.1-1.8; p val 0.037), macerated stillbirths (OR 6.5; 95% CI 1.05-49; p val 0.037) and neonatal deaths (OR 18.4; 95% CI 2.5-133.7; p val <0.01); decreased neonates with birth asphyxia (OR 0.05; 95% CI 0.01-0.43; p val <0.01) and admissions to the Newborn Unit (OR 0.5; 95% CI 0.4-0.7; p val <0.01). Other maternal outcomes showed no significant change namely: mode of delivery (OR 0.9; 95% CI 0.7-1.1; p val =0.324); eclampsia (OR 2.3; 95% CI 0.3-19; p val=0.435); postpartum haemorrhage (OR 0.8; 95% CI 0.3-2.2; p val = 0.606) and referrals to other facilities (OR 0.5; 95% CI 0.03-6.0; p val = 0.407) respectively. There was no significant change in the number of fresh still births (OR 0.9; 95% C.I 0.4-2.2; p val <0.037). Conclusion: The 2016/17 Kenyan Doctors’ strike was associated with a change in most neonatal outcomes especially increased neonatal deaths and an increase in time taken from diagnosis to decision implementation as the change in maternal outcome. Recommendations: There should be increased focus on public-private partnership with public health facilities to plan for increased patient load in private and faith based facilities during doctors’ strikes in public health facilities to ameliorate adverse neonatal outcomes.