Determinants Of Utilization Of Active Management Of Third Stage Of Labour Among Skilled Birth Attendants In In Kiambu County, Kenya

ABSTRACT

Maternal mortality is a major concern worldwide and more so in Kenya which ranks eleventh country with highest maternal mortality ratio (530 per 100,000) worldwide. Post partum haemorrhage is one of the main causes of maternal death contributing 34% of maternal death in Kenya. Active management of third stage of labour (AMTSL) is an inexpensive and effective technique of preventing post partum haemorrhage. In spite of this technique being adopted in Kenya and internationally, its actual utilization and factors influencing it’s utilization were yet to be established. In Kiambu County 78% of women were delivering in health facilities, however, post partum haemorrhage was still causing two maternal deaths monthly besides causing serious morbidities e.g. shock and anaemia. This study aimed at assessing determinants of AMTSL utilization in Kiambu county. Specifically the study aimed at establishing the status of utilization of AMTSL and determining the health facility and birth attendant factors influencing utilization of AMTSL in Kiambu county. The study used cross-sectional design. The study population was 431 birth attendants working in maternity units in Kiambu County. Multistage sampling technique was used to sample 203 birth attendants. Data was collected using questionnaires and observation checklists and was analysed using STATA version 11. Descriptive statistics were used to generate proportions and frequencies while chi square, Fisher’s exact test were used to draw inferences. Logistic regression was used to identify the determinants of utilization of AMTSL. The results show that (68.5%) of the birth attendants do not utilize AMTSL. Oxytocin (76.9%) administration and controlled cord traction (96.5%) were the most utilized components. The variables that influenced AMTSL (those that had statistically significant association) included type of health facility, level of health facility, authorization to order supplies, availability of a fridge, availability of standards documents, training, type of training and knowledge on AMTSL. Utilization of AMTSL was higher in government health facilities (37.4) and in level 4 and 5 facilities (49.5%). Utilization of AMTSL was higher in facilities with AMTSL supplies at the point of use (92.1%), facilities with a fridge (44.5%), facilities with more staffs authorised to order supplies (34.9%) as well as facilities with AMTSL standards documents (68.0%). Looking at birth attendant factors, utilization was higher among the trained birth attendant (44.2%) than those who were not trained (13.2%). Also, utilization of AMTSL was higher among those who had pre-service training (60.7%) than those with in-service training (39.1%). Utilization of AMTSL was higher among birth attendants who knew AMTSL; however majority (71.9%) of the birth attendants did not know the components of AMTSL. In conclusion, majority of birth attendants in Kiambu County do not utilize AMTSL. Both facility and birth attendant factors influence utilization of AMTSL in Kiambu county. 1 CHAPTER