Effect of a Training Intervention on Utilization of Maternal Health Quality of Care Standards Among Nurse-midwives in Embu and Meru Teaching and Referral Hospitals, Kenya.

Abstract

Introduction: Kenya targets to reduce maternal mortality ratio (MMR) to 113 per 100,000 Live births by the year 2030. However, World Health Organization (WHO) data indicates that the Kenya MMR increased from 480 in 2015 to 530 in 2020. One of the factors derailing the efforts to reduce this ratio is suboptimal quality of care provided in health facilities. This is despite WHO in 2016 developing quality of care (QoC) standards to help health care facilities improve the quality of maternal health care. It is still not clear whether the problem lies in the poor implementation, the poor knowledge and attitude of nurse-midwives, inadequate training of the nurse midwives on the standards, presence of system barriers to the implementation or if the QoC standards have no effect on MMR since there are very few studies, if any, which have been conducted on the implementation of the standards. Objectives: This study’s main purpose was to determine the level of knowledge, attitude and utilization of QoC standards by nurse midwives in Embu and Meru teaching and referral hospitals, barriers to the utilization of the standards as well as the effect of a training intervention on selected maternal health QoC standards on knowledge attitude and utilization of the said standards. Materials and methods: This study used a Quasi-experimental convergent mixed method design with pre-post intervention evaluation. A stratified random sampling strategy was employed to pick the study participants. Data were collected through a self-administered semi-structured questionnaire, structured observation and a focused group discussion. Quantitative data were analyzed using SPSS version 26.0, summarized and described using descriptive statistics. Pearson correlation, Chi-square, and paired samples t test were used to test relationships at a 95% CI. Qualitative data were thematic analyzed using Nvivo version 12.0. Data were then presented in narrative form and through tables and figures. Results: The mean age of the participants was 36.6 years (SD+ 10.7) with almost half of the participants (44.7%, n=38), aged 20-39 years. Most participants (84.7%, n=72) were female. Two thirds of the participants (64.7%, n=55) were diploma holders. Most participants (44.7%, n=38) had practiced for 1-9 years. Before the intervention only 30.6% (n=26) had a knowledge score of >7. After the intervention there was a significant rise in knowledge scores (t=3.774, df= 42 p=<0.001). Most of the participants (88.2%, n=75) supported the use of the QoC standards before the intervention. There was no significant change in support after the intervention (t=1.775, df= 42, p=0.083). Two thirds of the nurse midwives (67.0, n=57) indicated using the QoC standards in their practice. This significantly increased after the intervention (t=12.287, df= 42, p=<0.001). After the intervention, heavy workload and inadequate resources remained as significant barriers to the utilization of the standards. Conclusion: A training intervention is an effective strategy for improving the nurse-midwives’ utilization of maternal health QoC standards. However, there are system barriers that cannot be addressed by a training intervention that may hinder the successful implementation of quality of care standards. Recommendations: It is recommended that in-service education and training be offered to all nurse-midwives at all health facility levels to equip them with the knowledge and skills required for the implementation of WHO (2016) maternal health QoC standards. Maternal health QoC standards should be added as content to the obstetric nursing/midwifery training curricula. The supply management system should also be streamlined, and more resources should be availed to ensure availability of adequate resources. Further research is recommended to establish the effect of utilization of Maternal QoC standards on maternal mortality and Satisfaction of mothers and their companions on maternal health Quality of service following the implementation of QoC standards.