Quality of Postnatal Care Among Mothers Within 24-48 Hours of Delivery in Postnatal Wards at Machakos County Referral Hospital, Kenya

Abstract

Background: In Africa, substandard postnatal care is associated with the deaths of 34% of women during the first 24 hours. Additionally, at least 38% of infants die due to infections, low birth weight or prematurity; aspects that are associated with poor early postnatal care. Appropriate and timely delivery of quality postnatal care is crucial in reducing maternal and neonatal morbidity and mortality. Particular attention needs to be paid on the quality of postnatal care being provided in the health facilities. Information on quality of care needed post-delivery is important in guiding postnatal care delivery. Objective: This study assessed the quality of postnatal care among mothers within 24 - 48 hours of delivery in postnatal wards at Machakos County Referral Hospital (MCRH), Kenya. Methodology: This was a cross-sectional descriptive study applying mixed-method approaches. An interviewer-administered questionnaire and focused group discussion (FGD) interview guide were used for data collection. The study was carried out among 264 postnatal mothers and eight participants for the FGD in the postnatal wards of MCRH. Pre-testing of the study tools was done. Statistical Package for Social Sciences (SPSS) was used for quantitative analysis. Descriptive statistics involved in seeking measures of central tendency like means, modes, and medians between the variables. Inferential statistics involved seeking associations between variables where the fisher’s exact test was used and a p-value of ≤0.05 was considered statistically significant. Qualitative data was transcribed, checked for completeness before thematic analysis using NVivo 12 software. Ethical approval was sought from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee, National Commission of Science Technology and Innovation and the hospital management. Results: The mean overall quality of postnatal nursing care rating was reported to be 73.9% (n =196) with a standard deviation of 22.9. The mean rating of quality postnatal care for those who delivered via caesarian section was 52.3% with a standard deviation of 15.4 while the mean rating for the respondents who delivered via spontaneous vertex delivery was 83.3% with a standard deviation of 19.9. Fisher's exact test showed no statistically significant differences between the reported quality of postnatal care and residence (p-value = 0.55), as well as marital status (p-value=0.12). There was a statistically significant difference in the quality of care rating reported and age-groups (p-value=0.01), parity (p-value = 0.00), Level of education (p-value = 0.02) mode of delivery (p-value =0.00), occupation (p-value = 0.00) and number of living children (p-value=0.00). Qualitative analysis identified four themes: client-provider interaction, emotional support, care provided and the improvements in care. Conclusion: Although quality of postnatal care was found to be highly rated by the respondents, there were glaring gaps in the experiences and quality of nursing care specific to postnatal clients. Recommendations: There is need to improve the nursing specific postnatal care offered to mothers within 24-48 hours post-delivery and regularly monitor and evaluate the postnatal care services offered.