Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals.

Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitoring of patients for signs of postpartum hemorrhage, the leading cause of maternal mortality, despite providers' having the necessary training and equipment. Using survey vignettes conducted with 144 maternity providers, we documented evidence consistent with subjective risk and perceived uncertainty driving providers' decisions to actively monitor patients.

Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge.

A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study.

This study assessed the effectiveness of a school-based stigma-reduction intervention focusing on stigmatising attitudes towards girls associated with abortion and contraceptive use. In February 2017, two gender-mixed secondary schools ( = 1368) in peri-urban areas of Kisumu County, Kenya, were assigned to receive either an 8-hour stigma-reduction intervention over four sessions (intervention school: IS) or standard comprehensive sexuality education (control school: CS). A classroom survey entailing two five-point Likert scales - the 18-item Adolescents Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale, which measures abortion stigma, and the seven-item Contraceptive Use Stigma (CUS) scale - was conducted to collect data at baseline, 1-month and 12-months after the intervention.

Feasibility and impact of a postpartum hemorrhage emergency care package using a bundle approach in Migori County, Kenya.

Objective: To investigate the impact of the PPH Emergency Care package (PPH EmC)-a holistic intervention that uses a bundle approach that has been implemented in Kenya, India, Nepal, Bangladesh, and Central America-in a low-resource setting.

Methods: The feasibility and impact of PPH EmC implementation in Migori County, Kenya was studied using a qualitative research design. In March and April 2022 key informants were identified using purposive sampling.

Health care providers' knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study.

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide despite its often-preventable nature. Understanding health care providers' knowledge of clinical protocols is imperative for improving quality of care and reducing mortality. This is especially pertinent in referral and teaching hospitals that train nursing and medical students and interns in addition to managing emergency and referral cases.

Immediate postpartum care in low- and middle-income countries: A gap in healthcare quality research and practice.

The immediate postpartum period carries significant risks for complications such as postpartum hemorrhage and sepsis. Postpartum monitoring, including taking vital signs and monitoring blood loss, is important for the early identification and management of complications, but many women in low- and middle-income countries receive minimal attention in the period following childbirth to facility discharge. The World Health Organization recently released new guidelines on postnatal care, which include recommendations for immediate postpartum monitoring.

FIGO and the International Confederation of Midwives endorse WHO guidelines on prevention and treatment of postpartum hemorrhage.

FIGO and the International Confederation of Midwives produced two joint statements endorsing WHO guidelines on prevention and treatment of postpartum hemorrhage.

Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.

Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system.

Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya.

Objectives: To investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP.

Study Design: This was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7-10 days and by 472 women at 3 months.

Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation.

Objective: To systematically develop evidence-based bundles for care of postpartum hemorrhage (PPH).

Methods: An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated "GRADE Evidence-to-Decision" framework. Twenty-three global maternal-health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences.

Abortion and contraceptive use stigma: a cross-sectional study of attitudes and beliefs in secondary school students in western Kenya.

Social stigma related to women's reproductive decision-making negatively impacts the health of women. However, little is known about stigmatising attitudes and beliefs surrounding abortion and contraceptive use among adolescents. The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya.

Stigma related to contraceptive use and abortion in Kenya: scale development and validation.

Background: Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion.

Methods: A study nested in a cluster-randomised trial.

Decision-making preceding induced abortion: a qualitative study of women's experiences in Kisumu, Kenya.

Background: Unwanted pregnancies and unsafe abortions are prevalent in regions where women and adolescent girls have unmet contraceptive needs. Globally, about 25 million unsafe abortions take place every year. In countries with restrictive abortion laws, safe abortion care is not always accessible.

Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.

Aim: The aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.

Methods: This study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016.

Safety of a condom uterine balloon tamponade (ESM-UBT) device for uncontrolled primary postpartum hemorrhage among facilities in Kenya and Sierra Leone.

Background: Postpartum hemorrhage is the leading cause of maternal mortality in low- and middle-income countries. While evidence on uterine balloon tamponade efficacy for severe hemorrhage is encouraging, little is known about safety of this intervention. The objective of this study was to evaluate the safety of an ultra-low-cost uterine balloon tamponade package (named ESM-UBT) for facility-based management of uncontrolled postpartum hemorrhage (PPH) in Kenya and Sierra Leone.

Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya.

Introduction: Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya.

Methods: A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya.

Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya.

Objective: To assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.

Design: A multicentre randomised controlled equivalence trial. The study was not masked.

Nurse-midwives' ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya.

Background: Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women.

Shock progression and survival after use of a condom uterine balloon tamponade package in women with uncontrolled postpartum hemorrhage.

Objective: To examine the outcomes of women in advanced shock from uncontrolled postpartum hemorrhage (PPH) who underwent placement of an Every Second Matters for Mothers and Babies Uterine Balloon Tamponade (ESM-UBT) device.

Methods: In a prospective case series, data were collected for women who received an ESM-UBT device at healthcare facilities in Kenya, Senegal, Sierra Leone, and Tanzania between September 1, 2012, and September 30, 2016. Shock class was assigned on the basis of recorded blood pressures and mental status at the time of UBT placement.

Cost-effectiveness of condom uterine balloon tamponade to control severe postpartum hemorrhage in Kenya.

Objective: To evaluate the cost-effectiveness of condom uterine balloon tamponade (UBT) for control of severe postpartum hemorrhage (PPH) due to uterine atony versus standard PPH care in Kenya.

Methods: A cross-sectional analysis was conducted using cost data collected from 30 facilities in Western Kenya from April 15 to July 16, 2015. Effectiveness data were derived from the published literature.

Qualitative study of the role of men in maternal health in resource-limited communities in western Kenya.

Objective: To better understand the beliefs of men and women in western Kenya regarding the appropriate role of men in maternal health and to identify barriers to greater involvement.

Methods: Between June 1 and July 31, 2014, a cross-sectional qualitative study enrolled lay men, lay women, and community health workers from Kisumu and Nyamira counties in western Kenya. Semi-structured focus group discussions were conducted and qualitative approaches were utilized to analyze the transcripts and identify common themes.