Assessing Childbirth-related Complications at the Community Level in Kenya
Condition: Puerperal Sepsis; Postpartum Hemorrhage; Preeclampsia and Eclampsia; Retained Placenta, Without Hemorrhage; Obstructed Labor Due to Breech Presentation
MeSH terms: Pre-Eclampsia; Postpartum Hemorrhage; Eclampsia; Breech Presentation; Placenta, Retained; Dystocia; Hemorrhage
Study type: Observational

Summary: 
      Kenya is one of the countries in sub-Saharan Africa that still experience high maternal
      mortality. For instance, in 2008/09 maternal mortality ratio was estimated to be 488/100,000
      live births. Direct obstetric complications such as puerperal sepsis, postpartum hemorrhage,
      pre-eclampsia and eclampsia, obstructed labor and indirect causes including HIV, malaria and
      anemia in pregnancy are responsible for the majority of these cases. Just under 44% of births
      in Kenya are delivered under the supervision of a skilled birth attendant.

      The overall objective of this study is to determine the effect of provider type in the
      occurrence and management of serious childbirth related complications among postpartum women
      at the community level in Bungoma and Lugari Districts of Western Province, Kenya.

      The proposed study will employ a case control study design in which women with obstetric
      complication(s)will be cases and women without obstetric complications will be controls.
      Controls will be sampled concurrently with the cases. Each time a new case is diagnosed, a
      control is selected from the population at risk in the neighborhood at that point in time.

      The study population will consist of women aged 15-49 years with a delivery in the past 12
      months. A woman who reports having experienced a birth-related complication will be recruited
      as a case while woman who reports having experienced no complication during child-birth will
      be recruited as a control.
    

Detailed description: 
      Evidence from published literature is scanty on the effect of various categories of health
      providers in averting serious child birth related complications at the community level. For
      instance, no one knows what happens to pregnancy outcomes for both the mother and the baby in
      a context where a significant proportion of women are delivered by neighbors, relatives or on
      their own. Literature is also scanty regarding the outcomes of child birth related
      complications in situations where Traditional Birth Attendants conduct a significant
      proportion of deliveries.

      A thorough understanding of factors that fuel disrespect and abuse as well as their effect on
      utilization of delivery services will help providers and programme managers to explore ways
      of addressing this issue. This study hypothesizes that since majority of deliveries take
      place at the household level, most complications and even deaths are likely to occur at this
      level.

      The overall objective of this study is to determine the effect of provider type in the
      occurrence and management of serious childbirth related complications among postpartum women
      at the community level in Bungoma and Lugari Districts of Western Province, Kenya. Specific
      objectives of the study are:

      To determine the quality of obstetric care given by community midwives and TBAs to clients
      seeking antenatal care, during delivery and post-partum care at the community level by
      assessing providers' preparedness and the range of services offered.

      To assess the nature of obstetric complications among those women who were delivered by
      skilled health providers, versus those who were delivered by TBAs, neighbors, friends or on
      their own To determine the role of socio-economic, demographic and health service related
      factors in the occurrence of child birth related complications at the community level To
      obtain views from key stakeholders on the extent and occurrence of child birth related
      complications at the community level
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        The study population consisted of women aged 15-49 years with a delivery within 12 months
        preceding data collection date. A woman who reported having experienced a birth-related
        complication was recruited as a case. A woman aged 15-49 years with a delivery within 12
        months preceding data collection who report having experienced no complication during
        child-birth was recruited as a control.
      
Biospecimen description: 
      This was a two-arm study (Cases and controls). Random identification of cases through
      cross-sectional survey was done. Then, a random sample of controls was drawn from the source
      population from which the cases were selected (i.e. from same study base except that they
      were not cases) through matching variables i.e. age and location. Individual matching of
      controls to the characteristics of the cases was done. A total of 585 clients (women) were
      recruited (294cases and 291 controls).
    
Keywords: complications