1921
Volume 101, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Between 1990 and 2015, Kenya had a 0.9% annual reduction in maternal mortality, one of the lowest reductions globally. This slow decline was linked to the relatively low utilization of delivery services. We designed a mobile phone–enhanced 24-hour transport navigation system coupled with personalized and interactive gestation-based text messages (MAccess) to address maternal child health service utilization. The primary purpose of this analysis is to explore the ways in which pregnant and postnatal women made decisions regarding care-seeking for pregnancy and childbirth services, the processes of getting care from home to the hospital as well their perceptions on how the MAccess intervention affected their pregnancy and childbirth care-seeking and utilization experience. We conducted semistructured, individual interviews with 18 postpartum women. Participants were purposively sampled. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. For participants in this study, all three delays interacted in a complex manner to affect women’s utilization of pregnancy and childbirth services. Even though women were aware of the benefits of skilled birth attendance, other health system factors such as opening hours, or health workers’ attitudes still deterred women from delivering in health facilities. The MAccess innovation was highly acceptable to women throughout pregnancy and childbirth and helped them navigate the complex and layered individual, infrastructural, and health system factors that put them at risk of adverse maternal and newborn outcomes. These findings emphasize that an integrated approach, which addresses all delays simultaneously, is important for reducing perinatal morbidity and mortality.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Lawn JE, 2014. Every Newborn: progress, priorities, and potential beyond survival. Lancet 384: 189205. [Google Scholar]
  2. Alkema L, 2016. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 387: 462474. [Google Scholar]
  3. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L, , 2014. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2: e323e333. [Google Scholar]
  4. Kassebaum NJ, 2014. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384: 9801004. [Google Scholar]
  5. Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B, , 2018. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health 15: 98. [Google Scholar]
  6. Lawn JE, Cousens S, Zupan J, , 2005. 4 million neonatal deaths: when? where? why? Lancet 365: 891900. [Google Scholar]
  7. Exavery A, Kante AM, Njozi M, Tani K, Doctor HV, Hingora A, Phillips JF, , 2014. Access to institutional delivery care and reasons for home delivery in three districts of Tanzania. Int J Equity Health 13: 48. [Google Scholar]
  8. Lozano R, 2011. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 378: 11391165. [Google Scholar]
  9. Gabrysch S, Cousens S, Cox J, Campbell OM, , 2011. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 8: e1000394. [Google Scholar]
  10. Lohela TJ, Campbell OM, Gabrysch S, , 2012. Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia. PLoS One 7: e52110. [Google Scholar]
  11. Malqvist M, Sohel N, Do TT, Eriksson L, Persson LA, , 2010. Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam. BMC Public Health 10: 762. [Google Scholar]
  12. Rutherford ME, Mulholland K, Hill PC, , 2010. How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review. Trop Med Int Health 15: 508519. [Google Scholar]
  13. Doctor HV, Nkhana-Salimu S, Abdulsalam-Anibilowo M, , 2018. Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda. BMC Public Health 18: 765. [Google Scholar]
  14. Thaddeus S, Maine D, , 1994. Too far to walk: maternal mortality in context. Soc Sci Med 38: 10911110. [Google Scholar]
  15. WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division, 2014. Trends in Maternal Mortality: 1990–2013. Estimates by WHO, UNICEF, UNFPA, The World bank and the United Nations Population Division, World Health Organization. Geneva, Switzerland: World Health Organisation. Available at: https://apps.who.int/iris/bitstream/handle/10665/112682/9789241507226_eng.pdf?sequence=2. Accessed April 14, 2019. [Google Scholar]
  16. National Council for Population and Development, 2015. Reducing Maternal Deaths in Kenya. Nairobi, Kenya: National Council for Population and Development. Available at: http://www.ncpd.go.ke/wp-content/uploads/2016/11/Policy-Brief-46-Maternal-Deaths-in-Kenya-1.pdf. Accessed April 14, 2019. [Google Scholar]
  17. Chavane LA, Bailey P, Loquiha O, Dgedge M, Aerts M, Temmerman M, , 2018. Maternal death and delays in accessing emergency obstetric care in Mozambique. BMC Pregnancy Childbirth 18: 71. [Google Scholar]
  18. Kenya National Bureau of Statistics KMoH, Kenyan National AIDS Control Council, Kenya Medical Research Institute, Kenyan National Council for Population and Development, The DHS Program, ICF International, 2015. Kenya Demographic and Health Survey 2014: ICF International, Nairobi, Kenya. Available at: https://dhsprogram.com/pubs/pdf/FR308/FR308.pdf. Accessed April 12, 2019.
  19. Ministry of Health Kenya, 2013. Speech by HE Hon. Uhuru Kenyatta, CGH, President and Commander-In-Chief of the Defence Forces of the Republic of Kenya during the Madaraka Day Celebrations (Nyayo National Stadium, June 1, 2013). Nairobi, Kenya: Nation Media Group. Available at: www.nation.co.ke/blob/view/-/1869340/data/521193/-/ttjgrk/-/speech.pdf. Accessed April 14, 2019. [Google Scholar]
  20. McKinnon B, Harper S, Kaufman JS, Bergevin Y, , 2015. Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries. Health Policy Plan 30: 432441. [Google Scholar]
  21. McCain GC, , 1988. Content analysis: a method for studying clinical nursing problems. Appl Nurs Res 1: 146147. [Google Scholar]
  22. Clarke VBV, , 2006. Using thematic analysis in psychology. Qual Res Psychol 3: 77101. [Google Scholar]
  23. Ryan GW, Bernard HR, Lincoln YS, , 2000. Data management and analysis methods. , ed. Handbook of Qualitative Research. Thousand Oaks, CA: Sage, 769802. [Google Scholar]
  24. Tesch R, , 1990. Qualitative Research: Analysis Types and Software Tools. New York, NY: Falmer Press. [Google Scholar]
  25. Win T, Vapattanawong P, Vong-ek P, , 2013. Three delays related to maternal mortality in Myanmar: a case study from maternal death review. J Health Res 29: 179187. [Google Scholar]
  26. Kabakyenga JK, Ostergren PO, Turyakira E, Pettersson KO, , 2012. Influence of birth preparedness, decision-making on location of birth and assistance by skilled birth attendants among women in south-western Uganda. PLoS One 7: e35747. [Google Scholar]
  27. Essendi H, Mills S, Fotso JC, , 2011. Barriers to formal emergency obstetric care services' utilization. J Urban Health 88 (Suppl 2): S356S369. [Google Scholar]
  28. Markos D, Bogale D, , 2014. Birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia. BMC Pregnancy Childbirth 14: 282. [Google Scholar]
  29. Solnes Miltenburg A, Roggeveen Y, Shields L, van Elteren M, van Roosmalen J, Stekelenburg J, Portela A, , 2015. Impact of birth preparedness and complication readiness interventions on birth with a skilled attendant: a systematic review. PLoS One 10: e0143382. [Google Scholar]
  30. Kabakyenga JK, Ostergren PO, Turyakira E, Pettersson KO, , 2011. Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reprod Health 8: 33. [Google Scholar]
  31. Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui AH, , 2010. Birth preparedness and complication readiness among slum women in Indore city, India. J Health Popul Nutr 28: 383391. [Google Scholar]
  32. Nesbitt RC, 2016. The influence of distance and quality of care on place of delivery in rural Ghana. Sci Rep 6: 30291. [Google Scholar]
  33. Pearson L, Shoo R, , 2005. Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet 88: 208215. [Google Scholar]
  34. Hofman JJ, Dzimadzi C, Lungu K, Ratsma EY, Hussein J, , 2008. Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost? Int J Gynaecol Obstet 102: 191197. [Google Scholar]
  35. Pagalday-Olivares P, Sjöqvist BA, Adjordor-van de Beek J, Abudey S, Silberberg AR, Buendia R, , 2017. Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana. BMC Med Inform Decis Mak 17: 156. [Google Scholar]
  36. Onono MWS, Wekesa P, Adhu CK, Waguma LW, Serem T, Owenga MA, Ong’wen P, , 2019. Effects of an expanded Uber-like transport system on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homabay, Kenya. BMJ Glob Health 4: e001254. [Google Scholar]
  37. Bhopal SS, Halpin SJ, Gerein N, , 2013. Emergency obstetric referral in rural Sierra Leone: what can motorbike ambulances contribute? A mixed-methods study. Matern Child Health J 17: 10381043. [Google Scholar]
  38. Oguntunde O, Yusuf FM, Nyenwa J, Dauda DS, Salihu A, Sinai I, , 2018. Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria. Int J Womens Health 10: 773782. [Google Scholar]
  39. Tuncalp Ö, 2015. Quality of care for pregnant women and newborns-the WHO vision. BJOG 122: 10451049. [Google Scholar]
  40. Miller S, 2016. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 388: 21762192. [Google Scholar]
  41. Bedford J, Gandhi M, Admassu M, Girma A, , 2013. ‘A normal delivery takes place at home’: a qualitative study of the location of childbirth in rural Ethiopia. Matern Child Health J 17: 230239. [Google Scholar]
  42. Shah R, Rehfuess EA, Paudel D, Maskey MK, Delius M, , 2018. Barriers and facilitators to institutional delivery in rural areas of Chitwan district, Nepal: a qualitative study. Reprod Health 15: 110. [Google Scholar]
  43. Gao Y, Barclay L, Kildea S, Hao M, Belton S, , 2010. Barriers to increasing hospital birth rates in rural Shanxi Province, China. Reprod Health Matters 18: 3545. [Google Scholar]
  44. Oyugi B, 2018. A facility-based study of women’ satisfaction and perceived quality of reproductive and maternal health services in the Kenya output-based approach voucher program. BMC Pregnancy Childbirth 18: 310. [Google Scholar]
  45. Creanga AA, Gullo S, Kuhlmann AKS, Msiska TW, Galavotti C, , 2017. Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi? BMC Pregnancy Childbirth 17: 150. [Google Scholar]
  46. Otis KE, Brett JA, , 2008. Barriers to hospital births: why do many Bolivian women give birth at home? Rev Panam Salud Publica 24: 4653. [Google Scholar]
  47. Mwangome FK, Holding PA, Songola KM, Bomu GK, , 2012. Barriers to hospital delivery in a rural setting in Coast Province, Kenya: community attitude and behaviours. Rural Remote Health 12: 1852. [Google Scholar]
  48. Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M, , 2013. Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth 13: 5. [Google Scholar]
  49. Maya ET, Adu-Bonsaffoh K, Dako-Gyeke P, Badzi C, Vogel JP, Bohren MA, Adanu R, , 2018. Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study. Reprod Health Matters 26: 7087. [Google Scholar]
  50. McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RN, Winch PJ, , 2014. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 14: 268. [Google Scholar]
  51. Ishola F, Owolabi O, Filippi V, , 2017. Disrespect and abuse of women during childbirth in Nigeria: a systematic review. PLoS One 12: e0174084. [Google Scholar]
  52. Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM, , 2014. ‘They treat you like you are not a human being’: maltreatment during labour and delivery in rural northern Ghana. Midwifery 30: 262268. [Google Scholar]
  53. Kowalewski M, Jahn A, Kimatta SS, , 2000. Why do at-risk mothers fail to reach referral level? Barriers beyond distance and cost. Afr J Reprod Health 4: 100109. [Google Scholar]
  54. Pagalday-Olivares P, Sjoqvist BA, Adjordor-van de Beek J, Abudey S, Silberberg AR, Buendia R, , 2017. Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana. BMC Med Inform Decis Mak 17: 156. [Google Scholar]
  55. USAID, 2017. Joint Statement: Improving Quality of Maternal and Newborn Care in Low- and Middle-Income Countries. Addis Ababa, Ethiopia: USAID. Available at: https://www.who.int/pmnch/media/events/2017/lilongwe_statement_qoc.pdf?ua=1. Accessed January 20, 2019.
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  • Received : 12 Feb 2019
  • Accepted : 03 Jun 2019
  • Published online : 23 Sep 2019

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