An assessment of postnatal care education given to mothers pre-discharge in health facilities in Nairobi county
Kamau, Immaculate Wambui
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The early postnatal period is a dangerous time for both mother and baby where morbidity and mortality is highest. Many of these complications and avoidable deaths have been reported in Kenya. Health education on Post Natal Care (PNC) has been suggested as a way of avoiding such deaths. Little is known on the nature of PNC education in Kenya. This study was designed to assess the postnatal education provided by maternity health workers (HW's) to postpartum (PP) mothers prior to discharge in various health facilities in Nairobi. This was a descriptive cross-sectional study applying both quantitative and qualitative approaches. The health facilities from which respondents were sampled were 18. Exit interviews among mothers (n=422) were conducted and 25 maternity health workers (HW's) were interviewed using structured questionnaires administered by the enumerators. Key informant interviews were conducted with maternity in-charges and head of Division of Reproductive Health (DRH). Data was analyzed using SPSS. Cross tabulations and chi-square correlations were used to evaluate the relationships of the various variables. Level of significance was set at 5%. The Test of Functional Health Literacy in Adults (TOFHLA) was used to determine adequacy of knowledge cut offs at 0-74 inadequate and 75-100 adequate. Tables, graphs and pie charts were used to present the data. Thematic descriptions were also adopted for qualitative data. The results indicated that none of the facilities had the national guidelines. In particular, over 40% of facilities visited did not have PNC educations guidelines of any form and the components in those that had them were inconsistent. Seventy nine percent of HW's had training/orientation of guidelines. A statistically significant association was observed between frequency of reference to existing PNC guidelines and orientation on PNC guidelines (p <0.029). Only 34% of the HW's adhered thereby giving adequate information. Factors affecting the delivery of PNC education included facility norms, availability of time, duration of hospital stay, workload, PNC infrastructure, language barrier, staffing, health worker attitude, guidelines, mother’s literacy among others. Adequacy of knowledge among mothers was 49%. A statistically significantly difference was noted across facility levels and ownerships (P<0.05), with level three, and NGO/FBO performing better. Factors found to affect knowledge among the mothers included; language barrier, lack of individualized PNC, poor communication at PNC facilities, inadequately trained or hostile attendants, duration of hospital stay, among others. The national guidelines have not been disseminated thus health facilities use variant PNC reference materials hence giving diverse information. Most of the health workers educate the mothers off hand and few adhere to the required standards. Less than half of the mothers have adequate knowledge on discharge. Dissemination and implementation of the standardized national PNC guidelines to all facilities should be prioritized. There should be consistent training and enforcement of best practices among HW's. The infrastructure for PNC health education should be improved to enhance learning and this should start at Ante Natal Clinic (ANC) and continue to the community after discharge through the community health workers (CHW's).