Factors associated with quality of intrapartum care in Kenya: a complex samples analysis of the 2022 Kenya demographic and health survey

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BACKGROUND: The provision of quality intrapartum care increases women's utilization of skilled birth attendants in health facilities and improves maternal and newborn health. This study aimed to investigate the factors associated with the quality of intrapartum care using the 2022 Kenya Demographic and Health Survey (KDHS). METHODS: Secondary data from the 2022 KDHS of 11,863 participants, who were selected by multistage stratified sampling, was used. Based on literature and the availability of indicators within the 2022 KDHS, the quality of intrapartum care was operationalized as receiving all the three clinical components of intrapartum care including a mother having a facility-based delivery, receiving skilled assistance during childbirth, and placing the newborn on the mother's breast within one hour from birth by the skilled birth attendant. Univariate and multivariate logistic regression analyses were used to analyze the data using SPSS (version 20). RESULTS: Of the 11,863 women who had recently given birth, about 52.6% had received quality intrapartum care. As part of the intrapartum care, 88.2% gave birth in a health facility, 90.4% obtained assistance from skilled birth attendants, and 59.8% had their babies placed on the breast by a birth attendant within 1 h after birth. Women who had attained secondary education (aOR = 1.46, 95% CI: 1.23-1.90), were working (aOR 1.24, 95% CI: 1.00-1.53), had 3-4 living children (aOR = 1.31, 95% CI: 1.02-1.68), took 31-60 min to reach the health facility (aOR = 1.49, 95% CI: 1.41-1.95), were assisted during childbirth by doctors (aOR = 19.86, 95% CI: 2.89-136.43) and nurses/midwives/clinical officers (aOR = 23.09, 95% CI: 3.36-158.89) had higher odds of receiving quality intrapartum care compared with their counterparts. On the other hand, women in the richest wealth index (aOR = 0.64, 95% CI: 0.42-0.98), those who gave birth through cesarean section (AOR = 0.27, 95% CI: 0.20-0.36) and those whose current age of their child was ≥ 2years (AOR = 0.76, 95% CI: 0.60-0.96) were less likely to receive quality intrapartum care compared with their counterparts. CONCLUSIONS: About half of the women received quality intrapartum care in Kenya, with demographic characteristics seeming to be the main drivers of quality intrapartum care. Although the Kenyan government abolished maternity services fees in all public facilities, there is still a need to empower women through increasing access to education and economic development initiatives for their economic independence. This will enable mothers to pay transport fares to health facilities for those in hard-to-reach rural settings and buy other hospital delivery requirements (e.g., surgical gloves) that may not be available in rural public health facilities, thus increasing access to skilled birth attendance and quality intrapartum care as a whole. Its also worth noting, since Kenya is moving towards provision of quality intrapartum care, more and proper indicators of clinical intrapartum care need to be captured in future DHS studies. This will enable comprehensive assessment of the quality of intrapartum in view of informing maternal health care policy in Kenya and other countries.

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