Quality Of Postpartum Care Among Teenage Mothers At Kenyatta National Hospital

Abstract

Introduction: Teenage mothers constitute a high risk group for poor outcomes in pregnancy. Better pregnancy outcomes can be achieved through improving care provided to teenage mothers attending care in health facilities that provide skilled health provider assisted delivery. To date a limited number of studies have focused on assessing quality of care provided to teenage mothers in the postpartum period. Objective: To determine the quality of postpartum care amongst teenage mothers in Kenyatta National Hospital. Study design: A cross-sectional study involving assessment of the care provided to teenage mothers in the postpartum period. Setting: The postnatal clinics, postnatal wards and youth clinic at Kenyatta National Hospital, Nairobi. Methods: A sample of 150 adolescent mothers was obtained from among 240 teenagers delivering in KNH during the 3-month study period using consecutive sampling technique. A structured questionnaire for assessment of quality of postpartum care was administered to participants during an interview conducted after recruitment of eligible mothers who provided informed consent. Quality of care was assessed using Donabedian framework for structure, process and outcome of care defined through standards in current national and international obstetric care guidelines. Data analysis was conducted using the SPSS version 17. The sample characteristics were summarized using descriptive statistics including mean (SD) for continuous iii variables and frequency distribution for categorical variables. The results were presented in narratives, tables, bars charts and pie charts. Findings: The mean age of teenage mothers in KNH was 18.8 years (SD ± 0.87), range 13 to 19 years. Most mothers were married 81 (54.4%), and had either primary 48 (32.4%) or secondary 51 (34.5%) education. The mean age at menarche was 14.4 (SD ±1.3) and a mean age at coitarche was 15.5 (SD ± 1.6). From the patient perspective most (85%) participants rated quality of postnatal care as good. Quality assessment from a clinical perspective reported relatively lower levels of overall quality of care reported across all the three areas of assessment namely, maternal observation (27.5%), maternal physical examination (25.5%) and newborn physical examination (19.5%). Following recent delivery 112 (76.2%) mothers reported that they intended to take up contraceptives. Conclusion: The quality of postnatal care amongst teenage mothers was rated highly from a client perspective but clinical examination suggested that there were gaps and hence the need to improve process of care within the postnatal period.