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Determinants of Perinatal Outcomes Among Women Seeking DETERMINANTS OF PERINATAL OUTCOMES AMONG WOMEN SEEKING ANTENATAL CARE IN SELECTED KISII COUNTY LEVEL FOUR HEALTH FACILITIES IN THE CONTEXT OF FREE MATERNITY CARE. MICAH ONYIEGO MATIANG’I DOCTOR OF PHILOSOPHY (Public Health) JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY 2018 Determinants of Perinatal Outcomes Among Women Seeking Antenatal Care in Selected Kisii County Level Four Health Facilities in the Context of Free Maternity Care. Micah Onyiego Matiang’i A thesis submitted in fulfillment for the Degree of Doctor of Philosophy in Public Health in the Jomo Kenyatta University of Agriculture and Technology 2018 DECLARATION This thesis is my original work and has not been presented for a degree in any other university Signature………………………………… Date……………………………… Micah Onyiego Matiang’i This thesis has been submitted for examination with our approval as University Supervisors: Signature……………………………… Date……………………………… Prof. Simon Karanja, P.h.D JKUAT, Kenya0 Signature…………………………… Date……………………………… Dr. Peter Wanzala, P.h.D KEMRI, Kenya Signature…………………………… Date……………………………… Dr. Kenneth Ngure, P.h.D JKUAT, Kenya ii DEDICATION This thesis is dedicated to my beloved parents, wife and children for their social, moral and spiritual support through prayers. iii ACKNOWLEDGEMENT I sincerely thank God for leading me this far. I do appreciate the team of the three supervisors who have been resourceful all along; Prof. Simon Karanja and Dr.Kenneth Ngure from School of Public Health, Jomo Kenyatta University and Dr. Peter Wanzala from the Centre of Public Health and Research (CPHR) located in Kenya Medical Research Institute (KEMRI). I do also appreciate the members of staff from the Institute of Tropical Medicine and Infectious Diseases (ITROMID) for their support too. My gratitudes too go to the Kisii County Teaching and Referreal Hospital (KTRH) for allowing me carry out the study in its affiliated health facilities. I also wish to thank the leadership of the health services in Kisii county moreso the County Excecutive Committee ( CEC) member for health, Ms. Sarah Omache and the Couny director of health, Dr. Geoffrey Otomu for giving me the authorization to undertake by research project in kisii county health facilities. I also appreciate the immense goodwill I received from the facility managers of Tabaka, Kenyenya, Christamarrianne and Oresi health facilities. I sincerely thank them all for creating an enabling and supportive environment for the entire period during which I collected data. The research assistants and enumerators led by Ms. Eunice Ombongi, I thank them all for withstanding various challenges during data collection. I also extend my appreciation to the staff of Hass® scientific and medical supplies limited,Nairobi for always trying their best to import for me the kits I needed for zinc and ferritin analysis all the way from Paris France. Finally to my nuclear family; Waceke, Nicole, Mitchelle and Joshua, I appreciate you all for being great pillars of hope and sources of encouragement all along. iv TABLE OF CONTENTS DECLARATION ............................................................................................................. ii DEDICATION ................................................................................................................ iii ACKNOWLEDGEMENT ............................................................................................. iv TABLE OF CONTENTS ............................................................................................... v LIST OF TABLES .......................................................................................................... x LIST OF FIGURES ...................................................................................................... xii LIST OF APPENDICES ............................................................................................. xiii ABBREVIATIONS AND ACRONYMS .................................................................... xiv ABSTRACT ................................................................................................................ xviii CHAPTER ONE ............................................................................................................. 1 INTRODUCTION ........................................................................................................... 1 1.1 General introduction ................................................................................................... 1 1.2 Statement of the problem ............................................................................................ 2 1.3 Justification of the study ............................................................................................. 3 1.4 Research questions ...................................................................................................... 4 1.5 Null Hypothesis .......................................................................................................... 4 v 1.6 Objectives ................................................................................................................... 4 1.6.1 General objective .............................................................................................. 4 1.6.2 Specific objectives ............................................................................................ 5 CHAPTER TWO ............................................................................................................ 6 LITERATURE REVIEW .............................................................................................. 6 2.1 Perinatal outcomes in pregnancy ................................................................................ 6 2.2 Health facility service delivery and perinatal care outcomes ..................................... 7 2.3 Client level factors and perinatal outcomes .............................................................. 11 2.4 Women and midwives’ perception of perinatal care in public and non-public facilities ................................................................................................................. 15 CHAPTER THREE ...................................................................................................... 18 MATERIALS AND METHODS ................................................................................. 18 3.1 Study site ................................................................................................................... 18 3.2 Study Design ............................................................................................................. 18 3.3 Study population ....................................................................................................... 21 3.4 Inclusion criteria of study subjects ........................................................................... 21 3.5 Exclusion Criteria of study subjects ......................................................................... 21 3.6 Sampling and Sample size determination for the study ............................................ 22 vi 3.7 Sampling procedures and recruitment of participants.............................................. 24 3.8 Data collection .......................................................................................................... 26 3.9 Quality assurance of study results ............................................................................. 30 3.10 Data management and Analysis .............................................................................. 30 3.11 Ethical Considerations and approval...................................................................... 35 3.12 Study Limitations ................................................................................................... 36 CHAPTER FOUR ......................................................................................................... 37 RESULTS ...................................................................................................................... 37 4.1 Distribution of respondents and perinatal outcomes ................................................. 37 4.2Client-level factors that affect perinatal outcomes among women attending public and non-public health facilities in Kisii County .................................................... 39 4.2.1 Client demographic factors during pregnancy ................................................ 40 4.2.2 Client pregnancy knowledge trends during ANC period ................................ 48 4.2.3 Client self-care health practices during pregnancy ......................................... 50 4.2.4 Client commobidity indicators during pregnancy........................................... 55 4.3 Facility-level factors that affect perinatal outcomes among women attending public and non-public health facilities in Kisii County ......................................... 57 4.3.1 Comparison on Quality of facility-provided services in 1st, 2nd and 3rd visits ................................................................................................................ 61 vii 4.3.2 Safe motherhood services ............................................................................... 65 4.4 The relationship between facility and client factors on perinatal outcomes among women attending public and non-public health facilities in Kisii County ............ 70 4.5 Mothers and midwives perceptions of Maternal and Neonatal Care (MCN) services in public and non-public facilities
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