Evidence-based Teenage Health Education: an Approach to Reduce Neonatal Morbidity and Mortality Among Teenage Mothers, Busia County Referral Hospital, Kenya

Abstract

Background: Neonatal mortality accounts for about 40% of under-5 morbidity and mortality globally with 99% occurring in resource strained countries. Busia County reported 107 per 1000 live births in the general population. Of these, 58% were neonates born to mothers aged <20 years. The purpose of this study was to try the ‘Evidence-Based Health Education’ approach for reducing neonatal deaths among teenage mothers aged ≤ 19 years. The study objective was to determine if ‘Evidence -Based Education’ would reduce this neonatal morbidity and mortality. Ethical approvals were obtained from Kenyatta National Hospital/University of Nairobi Research and Ethics Committee, National Commission for Science, Technology and Innovation, Busia Directorate of Public Health and Sanitation, Medical Superintendent; Busia County Referral Hospital and informed consents from the respondents. Methodology: This was an Interventional Randomized Control Trial study carried out at Busia County Referral Hospital in three steps. The target population comprised expectant teenage mothers aged ≤19years, attending antenatal clinic at the hospital. The sample size was 528 respondents calculated using a formula by Pagano. Simple randomization was applied to assign them to two groups; cases n=264 and controls n=264. The study was contacted in three steps. Step1: the baseline data was a desk-top review. The data was extracted from records in the newborn unit and files of the teenage mothers from the postnatal ward using a check-list. The descriptive data was collected using semi-structured researcher-administered questionnaire. Step2 was the implementation of the ‘Evidence-based health education approach’ where only respondents in the intervention group were involved. Themes were identified from the sessions and explored to ensure understanding of the information taught. Step3 addressed neonatal follow-up and intervention evaluation. I collected all data. The statistical methods included descriptive statistics, logistic and multivariate regression analysis to test the level of significance which was set at p<0.05. The Chisquare tested the relationship between the risk factors and the state of the neonate. Data was anlysed using MS excel, Epi Data version 3.1 and STATA. The qualitative data was analysed in themes. Results: The findings in steps1 and 2 were presented in figures and tables while findings in step 3 were presented in themes. Most respondents, (94%) were aged 16-19 years, school dropouts- 82.5% and unemployment, 95.6%. The respondents were predominantly Christians, 61% resided in rural areas. Chi-square: there was significant relationship between the state of life and witchcraft (P≤ 0.001), neonatal infections (P≤ 0.000), prematurity (P≤ 0.000) and negligence (P≤ 0.000) as causes of neonatal deaths. There was a significant (2-Tailed) value (0.031), hence a statistically significant difference between intervention and control groups on the state of neonates. Conclusion: Evidence-based health education was effective in reducing neonatal deaths. Recommendations: There is need to intensify health education for the expectant teenage mothers during antenatal, childbirth, postnatal, neonatal care, breastfeeding and family planning. Key words: teenage mothers, neonatal morbidity and mortality