Occurrence And Management Of Puerperal Sepsis Amongst Women Of Reproductive Age (15-49) Attending Two Hospitals In Nandi County, Kenya

ABSTRACT

Puerperal sepsis is a major cause of maternal morbidity and mortality and is usually within the first 42 days after child birth/pregnancy termination. It is a common pregnancy-related condition, which could eventually lead to obstetric shock or even death. Studies have shown that puerperal sepsis is the second cause of maternal morbidity and mortality in the resource poor countries. One‘s susceptibility to developing an infection is related to such factors as cesarean section, extended labor, obesity, anemia and poor prenatal nutrition, socio economic status, geographical factors amongst others. The aim of this study was to evaluate the occurrence of Puerperal Sepsis among women in Nandi County and establish the relationships that exist between the associated factors with puerperal sepsis. Moreover, the study examined the strategies that were put in place to control the infection and identify the challenges being faced in executing them. This study employed a descriptive, cross sectional study design with a sample size of 215 of Puerperal Sepsis patients of the age group 15-49 years from two selected Hospitals in Nandi County. The hospitals included Nandi Hills and Kapsabet District Hospitals. Purposive sampling was used in selection of the study respondents. Data was collected using a structured interview guides for patients on exit. Additional data on patient‘s health seeking behavior and management challenges were obtained from a key informant using an open ended guide. Data collected was analyzed using SPSS version 20. Data was presented in form of percentages, frequencies through tables, graphs and charts. Qualitative data was grouped into categories, themes developed and presented in text form. The demographic data showed that women aged 20-29 years (57.2%), were the most affected while above 40 years (2.8%) were the least affected. It was found that majority (50.2%) of the respondents had attained primary school education and 62.8% were married. Most (56.2%) of the respondents were of lower parity level, 66.5% had spontaneous deliveries and 46% had experience multiple vaginal examinations 28.4% of the respondents had procured unsafe abortions. There was a high significant relation between ANC attendance and labour duration, (OR=5, 95%CI, 1.8-14.28), indicating ANC visits had a positive impact on duration of labour that a woman will experience. Proper nutrition also showed significant relationship with duration of labour,( OR=0.35, 95% CI, 0.15-0.08). Women who had balanced nutrition were more likely to experience short labour durations. Further, results indicated that there was lack of knowledge on the etiology of infection in the area, 81.9% of the respondents did not have knowledge on Puerperal Sepsis. Facilities lacked adequate prerequisites to perform PS awareness both in the facility and in the community. Reports indicated that there were issues of understaffing in the study facilities, in addition; patients had a poor health seeking behavior. These factors underscore the need for the Ministry of health to provide funds that will develop an enabling environment for awareness creation and hygiene education in this area. Policy makers and planners should also consider integrating Hygiene education and Puerperal sepsis awareness into ANC services as a strategy to prevent and control the infection.