Title

Difference in the level of utilization and determinants of preconception care among pregnant women in Aga Khan University Hospital and Maragua level four hospital.

Date of Award

5-30-2018

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Mukaindo Mwaniki

Second Supervisor/Advisor

Prof. Marleen Temmerman

Third Supervisor/Advisor

Dr. Dorothy Kamya

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Background: Preconception care (PCC) is an important form of primary health care that aims to identify risks, offer patient education and evidence based interventions prior to conception in order to improve maternal and fetal short and long term health outcomes. Despite the benefits of PCC, the global levels of utilization are still low, more so in developing countries and in the rural settings. This study aimed to determine the difference in the level and determinants of PCC in both urban and rural settings in Kenya.

Objectives: The primary objective of this study was to compare PCC among pregnant women in Aga Khan University Hospital, Nairobi (AKUH, N) (urban) and Maragua Level Four Hospital (MLFH) (rural). The secondary objective was to determine the factors affecting PCC among pregnant women in the two hospitals.

Design and Methodology: Unselected pregnant women seeking antenatal care (ANC) were recruited consecutively at the Mother and Child Health (MCH) clinics in AKUH, N and MLFH. The study design was a mixed method study that employed a cross-sectional approach to determine the level of PCC, using a 5-10 minutes self-administered questionnaire, and a qualitative approach to assess factors affecting PCC using a semi-structured interview guide. Quantitative data was analyzed using SPSS version 22. Qualitative interviews were transcribed verbatim, a thematic framework was thereafter manually constructed through coding, creating categories, sub-themes and themes. Indexing, charting, mapping and data interpretation were thereafter carried out.

Results: A total of 194 pregnant women were recruited, 97 in each setting (rural and urban). Of these, 21 women were selected through purposive sampling to participate in in-depth interviews for the qualitative aspect of the study. Saturation of themes occurred after 13 interviews (7 at AKUH and 6 at MLFH) after which 4 more interviews were conducted at each site to confirm saturation.

Of the total participants, 25.8% received PCC. There was a significant difference (p < 0.01) in PCC between the rural and urban participants with an OR of 0.3 (0.19-0.72, 95 % CI). Univariate analysis of possible related factors showed that age, marital status, education, parity and occupation had potential effect on PCC.

Transcription, coding and thematic analysis of the in-depth interviews yielded 97 categories which were merged into 39 sub-themes and subsequently into 12 main themes. Eleven of the main themes were identified as factors affecting PCC while one theme contained suggested strategies of increasing PCC awareness and utilization. The dominant themes were level of awareness about PCC, attitudes towards PCC and pregnancy in general and responsibility for PCC.

Most of the factors affecting utilization were similar in urban and rural settings with a few exceptions. Exclusive to the rural area was level of education with poor previous interactions with health professionals overriding there as well.

Conclusion and Recommendations: The low level of PCC in Kenya revealed in this study is consistent with the low global levels. This study revealed that majority of the participants felt that many people (including health providers) were unaware about the concept of PCC. This exposes gaps in the Kenya maternal health service delivery which can be bridged by educating the population about PCC and also ensuring that health providers are well informed about the concept of PCC. Some strategies towards achieving this goal as suggested by the study participants can be adopted such as using print and broadcast media. Furthermore, robust strategies on how best to deliver it could be developed such as setting up PCC clinics or integrating them into family planning and postnatal clinics as fronted by some study participants.

More research is needed to look at the PCC practices and perspectives of health providers, and other non-patient factors affecting utilization.

This document is available in the relevant AKU library

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