Effectiveness of midwives in reducing maternal mortality rates in Tharaka district, Kenya

Abstract

Introduction: Midwives have the ability to effectively reduce maternal mortality using competencies and proficiency in midwifery skills. The purpose of this study was to investigate effectiveness of midwives in reducing maternal mortality in order to give insight into the current practices in obstetric care in Tharaka District, Kenya. Study Objective: This study was to determine the effectiveness of midwives in reducing maternal mortality in Tharaka District. The study focused on quality of care practices, knowledge, institutional and patient characteristics as well as midwives' attitude. Methodology: A cross-sectional descriptive study was carried out in the public and faith based health facilities that provide maternity services in Tharaka District. Facilities were selected by multistage sampling. Purposive sampling of the midwives (N= 48) was done. Ethical clearance was obtained from the Kenyatta National Hospital Standards and Ethics Committee, the Ministry of Education Science and Technology, and the District Medical Officer of health Tharaka. Midwives gave a written consent to participate in the study. A structured self-administered questionnaire was used. Quantitative data was analyzed using SPSS version 16. Descriptive statistics and Chi square were used to bring out relationships ~between study variables. Eight Key Informants were interviewed to obtain in-depth information. Content analysis was done for qualitative data. Results: Few midwives 4(9.1%) listed the correct components of a partograph. There is no positive correlation between respondents experience and competence in plotting a partograph (p value = 0.229). Midwives are not well prepared in handling critical obstetric activities like severe preeclampsia 9 (20.5%), eclampsia 9 (20.5%). Poor transport, lack of referral facilities and low economic status of patients contributed to delay in accessing care. Conclusions: The results revealed moderate performance rating in knowledge and clinical competencies among midwives in Tharaka District. Midwives indicated need for coaching in very critical skills that have an immediate impact on maternal outcome. Recommendations: There is need to carry out an observational study to evaluate the specific midwifery skills that have a direct influence on maternal mortality in Tharaka District. These will reveal the gaps in midwives' competencies that require updating in order to enhance effectiveness.