System barriers to the provision of quality maternal health care in two regional teaching and referral hospitals in Kenya: a qualitative study

Domisiano Koome Impwii , Lucy Kivuti-Bitok
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Abstract

Objective

Sub-Saharan Africa accounts for 66% of global maternal deaths. In Kenya, 362 maternal deaths occur in every 100 000 live births. Most of these deaths occur as a result of suboptimal quality care of mothers during labor, delivery, or within 24 h of delivery. This study explored barriers that nurse-midwives encounter in trying to provide high-quality obstetric care during these periods.

Methods

A qualitative research design utilizing focus group discussion as part of a mixed method study was used to find out the participants’ experiences. Data were collected between February and March 2022 in the maternity units of two regional teaching and referral hospitals in Kenya. Eligible participants were nurse-midwives in charge of the maternity unit. The discussion was conducted in English, tape-recorded, and transcribed verbatim. Data were analyzed thematically, following Braun and Clarke 6-step framework. Nvivo version 7.0 computer software was used to facilitate this process.

Results

Two focused group discussions each involving seven participants were conducted. The participants agreed that maternal mortality due to postpartum hemorrhage and pregnancy-induced hypertension is a major health concern. Further, maternal care in the two hospitals was substandard. Themes that emerged as barriers were: inadequate supplies; inadequate obstetric knowledge and skills; shortage of nurse-midwives, and inadequate support supervision. The underlying factors include inadequate funding by the county government and high staff turnover.

Conclusion

This study showed that nurse-midwives are working under very difficult circumstances which are hindering the provision of quality maternal care. This is mainly due to system failures and inadequate nurse-midwife numbers. Targeted strategies need to be urgently implemented to mitigate these challenges to improve the quality of maternal health care.

肯尼亚两家地区教学医院和转诊医院提供优质孕产妇保健服务的系统障碍:定性研究
目标撒哈拉以南非洲占全球孕产妇死亡人数的 66%。在肯尼亚,每 10 万名活产婴儿中就有 362 名产妇死亡。这些死亡大多是由于在分娩、接生或产后 24 小时内对产妇的护理质量不达标造成的。本研究探讨了助产士在这些期间提供高质量产科护理时遇到的障碍。研究方法采用焦点小组讨论的定性研究设计作为混合方法研究的一部分,以了解参与者的经验。数据收集时间为 2022 年 2 月至 3 月,地点在肯尼亚两家地区教学医院和转诊医院的产科。符合条件的参与者是负责产科的助产士。讨论以英语进行,录音并逐字记录。数据按照布劳恩和克拉克的 6 步框架进行专题分析。结果进行了两次焦点小组讨论,每次有七名参与者。与会者一致认为,产后出血和妊娠高血压导致的孕产妇死亡是一个主要的健康问题。此外,两家医院的孕产妇护理不达标。作为障碍出现的主题是:供应不足;产科知识和技能不足;助产士短缺以及支持监督不足。结论这项研究表明,助产士的工作环境非常艰苦,这阻碍了优质孕产妇护理服务的提供。这主要是由于系统故障和助产士人数不足造成的。迫切需要实施有针对性的战略来缓解这些挑战,以提高孕产妇保健的质量。
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来源期刊
Global health journal (Amsterdam, Netherlands)
Global health journal (Amsterdam, Netherlands) Public Health and Health Policy
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5.00
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