Search

Purpose: The broad objective of the study was to assess the utilization of preconception care services among couples (18-49 years) in Kanduyi Sub-County, Bungoma County, Kenya. Methodology: The study used a descriptive cross-sectional study design. Both qualitative and quantitative methodologies were employed. A pre-test study was carried out in one randomly selected ward in Webuye East sub-county. Four wards in Kanduyi Sub-County were purposively selected for the study, using the Lottery random sampling method. The study participants were sampled proportionately from each ward. Data collection instruments, used by the researcher were a semi-structured, interviewer-administered questionnaire and focused group discussions. The Statistical Package for Social Sciences, version 22 was used for the descriptive analysis of the quantitative data. The quantitative results were presented using bar graphs, tables, and pie charts. Results: The findings from this study have; first helped to depict a low-level of knowledge on preconception care services among couples, whereby only 41% (159) of the couples had adequate knowledge on preconception care while the rest 59% (230) had inadequate knowledge. Secondly, the utilization of preconception care services among the couples in Kanduyi sub-county in Bungoma County is very low, especially on some services. For instance, the majority 65% (251) of the couples were not screened for any medical condition and a significant proportion 61% (238) were not in any family planning program prior to conception. The socio-demographic factors that were noted to influence the utilization of preconception care services among couples include; level of education (p=0.029), age (p=0.042), occupation (p=0.030), place of residence (p=0.002) and gravidity (p=0.001). In contrast, the sociocultural factors were partners' support (65%), traditional beliefs (81%), and church attendance (85%). Unique contribution to theory, practice and policy: The Study recommends that the ministry of health and Bungoma County government should scale up education and empowerment initiatives and programs targeting the men, with the overall aim of enhancing the utilization of preconception care services by the couples. The ministry of health should integrate the various preconception health care services in all the existing reproductive health care facilities to facilitate ease of access to health care services. The ministry of health, faith-based organizations, as well as the non-governmental organizations, should develop initiatives to empower and train the couples, especially the men, on the value of preconception care services despite the prevailing traditional and cultural beliefs

Purpose: The objective of the study was to establish the level of utilization of obstetric care services; to establish factors promoting utilization of obstetric care services, and to identify factors hindering utilization of essential obstetric care services among Bajun women in the Faza Division.Methodology: The study was cross-sectional. Purposive and systematic sampling was used in getting participants. The research instruments to be used were self-administered semi-structured questionnaires and Focused Group Discussions (FGDs). Chi-square values were used to test the significance of the association between the dependent and independent variables. Qualitative data from FGDs were transcribed and analyzed by the thematic content analysis technique.Results: More than half of the respondents (95.6% (175)) indicated that obstetric services are important essential services while 4.4% (8) of them indicated that obstetric services are not important essential services. More than half of the respondents, (74.4% (131)) indicated that they have ever been provided with these services while 25.6% (45) of them indicated that they have never been provided with these services. The findings also indicate that there was an insignificant association (x2 = 2.135a, p = 0.711) between age of the respondents, the level of education (x2 = 0.258, p = 0.612) and (X2 = 1.144a, P = 0.887) between religion of the respondents and the utilization of essential obstetric care services. There is thus, a high probability of utilization of essential obstetric care services (1.049, 2.045, 1.219 and 1.051 times respectively) for those women who have received the information about obstetric services from mass media, the health care, parents and their teachers respectively compared to those who received information from their peers. For the women who were pregnant, the findings indicate a low probability of the utilization of essential obstetric care services for the women who sought pregnancy help from their doctors and nurses/wives (0.357 and 0.102 times respectively). There is also a high probability of utilization of essential obstetric care services for those women who have ever been pregnant, those who have ever had complications during pregnancy, labour & delivery, those who seek help during their pregnancy complications and those who seek help from the hospital during their pregnancy complications.Unique contributions to theory, policy and practice: Therefore, the study recommends the intensification of knowledge to the women in Faza Division, Lamu County about the importance of utilization of essential obstetric services. This will help to reduce the cases of complications affecting mothers during pregnancy, labour and delivery and thus reduce the infant as well as the maternal mortality rate in the County.

Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.