Assessment of health workers perinatal knowledge and practices related to service delivery in Makueni County, Kenya

Abstract

A health system has six interdependent and interrelated pillars: health workforce; service delivery; information; financing; medical products, vaccines and technologies; leadership and governance. This study addressed health workforce pillar in order to strengthen maternal and new born services delivery in Makueni County. Globally, new born (neonatal) mortality remains unacceptably high. Neonatal mortality accounts for 60% of infant mortality rate in Kenya. In Makueni County, 1 in 22 children does not live to his or her first birth day. This unacceptable high mortality is despite existence of cost-effective evidence-based interventions which could reduce up to 70% of current deaths. Review of client complaints in Makueni has revealed gross medical mismanagement raising concerns whether health workers attending to them are knowledgeable. This study assessed perinatal knowledge and practices among health workers in Makueni County. It specifically established prenatal care knowledge and practices, pre-eclampsia knowledge, postnatal care knowledge, home visits and hand hygiene knowledge among health workers in Makueni County. The study was cross sectional in design where 163 health workers selected randomly were interviewed using a structured questionnaire and a checklist used to observe antenatal care consultation practices. Data analysis was done using SPSS v25 and chi-square statistic test used to examine associations within variables. On prenatal care, 89 (54.6%) of health workers were rated as having good knowledge. However, practice did not conform to guidelines since 10 (30.3%) and 23 (69.7%) of mothers didn’t have full history taken and general physical examination done respectively. On pre-eclampsia 78 (49.4 %) had poor knowledge while on use of recommended drugs for pre-eclampsia, 70 (42.9%) had moderate knowledge and 39 (23.9%) poor knowledge. On postnatal care, 132 (80%) had good knowledge on young infant feeding while 35 (21.5%) had poor knowledge on new born care. On management of neonatal infections, 58 (37.4%) had good knowledge while on home visits 80 (48.5%) knew the importance of home visits but 88 (80.4%) did not know the optimal time for the visits. On hand hygiene 127 (77%) of health workers knew the four critical times for washing hands with soap under running water. The study concluded that workers had good knowledge on prenatal care, young infant feeding and hand hygiene. There were critical gaps in knowledge on pre-eclampsia, use of recommended drugs for pre-eclampsia, new born care, management of neonatal infections and home visits. Prenatal care practice did not conform to guidelines. The study recommended refresher courses and continuous medical education in focused antenatal care, management of pre-eclampsia, newborn care, management of neonatal infections and home visits. It also recommended strengthening of supportive supervision to ensure guidelines are available and adhered to in practice.