Measures adopted by indigent mothers in Kilifi County to tackle maternal health challenges during the COVID-19 pandemic: A qualitative study

  • African Journal of Reproductive Health, Volume 26, No. 12, Year 2022

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Study Justification:
– The COVID-19 pandemic has had a significant impact on access to maternal health services in sub-Saharan African countries, including Kenya.
– There is a lack of information on how expectant mothers in Kilifi County have been able to access maternal health services during the pandemic.
– Understanding the measures adopted by indigent mothers in Kilifi County is crucial for developing effective interventions to address maternal health challenges during and after the pandemic.
Highlights:
– The study focuses on 15 purposefully selected mothers in Kilifi County who were either pregnant or had newborn babies during the COVID-19 pandemic.
– The study found that these mothers used various alternatives to access maternal health services, including relying on traditional birth attendants, substituting breastfeeding with locally available food supplements, and relying on limited resources and neighbors for delivery.
– Urgent measures are needed to ensure the provision of high-quality maternal and child health services during and after the COVID-19 pandemic.
– The study highlights the importance of developing special interventions for pregnant women in emergencies and establishing trust between communities and individuals through traditional birth attendants.
Recommendations:
– Develop and implement special interventions for pregnant women during emergencies, ensuring their access to maternal health services.
– Strengthen the role of traditional birth attendants in the community and establish trust between communities and individuals.
– Increase resources and support for indigent mothers to ensure they have access to necessary maternal health services.
– Improve coordination and collaboration between healthcare providers, community organizations, and policymakers to address maternal health challenges during and after the COVID-19 pandemic.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies and interventions to address maternal health challenges.
– County Government: Provides resources and support for maternal health services at the local level.
– Healthcare Providers: Deliver high-quality maternal health services and collaborate with other stakeholders.
– Traditional Birth Attendants: Play a crucial role in providing maternal health services in the community.
– Community Organizations: Support and advocate for the needs of indigent mothers and facilitate community engagement.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers and traditional birth attendants.
– Provision of necessary medical equipment and supplies.
– Community outreach and awareness campaigns.
– Support for indigent mothers, including financial assistance and access to transportation.
– Monitoring and evaluation of interventions to ensure their effectiveness.
Please note that the cost items provided are general categories and not specific budget figures. Actual costs would depend on the context and specific interventions implemented.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is based on qualitative data collected from purposefully selected mothers in Kilifi County, Kenya during the COVID-19 pandemic. Thematic analysis was used to analyze the data. The study provides insights into the measures adopted by indigent mothers to tackle maternal health challenges during the pandemic. However, the sample size is small (15 mothers) and the findings may not be generalizable to other populations. To improve the strength of the evidence, future studies could consider increasing the sample size and using a more diverse population. Additionally, incorporating quantitative data and conducting a longitudinal study could provide a more comprehensive understanding of the topic.

Many sub-Saharan African countries have experienced various challenges that threaten the quality of health services offered to the population. The COVID-19 pandemic disrupted access to healthcare services in many countries as they grappled with implementing measures to curb its spread. The consequences of COVID-19 have been catastrophic for maternal and newborn health. There is a dearth of information on expectant mothers’ negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 15 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county in Kenya. Data were analyzed thematically and presented in a textual description. Women used the following alternatives to access maternal health: giving birth at the homes of traditional birth attendants (TBAs), substituting breastfeeding with locally available food supplements, relying on limited resources and neighbours for delivery and local savings and rotating credit associations. This study shows that urgent measures are needed to provide high quality maternal and child health services during and after the COVID-19 pandemic. These include but are not limited to developing special interventions for the pregnant women for any emergency and establishing trust between communities and individuals through the TBAs.

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Based on the described study, the following innovations can be recommended to improve access to maternal health:

1. Collaborating with traditional birth attendants (TBAs): Recognizing the role of TBAs in providing maternal health services and establishing partnerships to ensure their training, supervision, and integration into the formal healthcare system.

2. Enhancing emergency response for pregnant women: Developing and implementing special interventions to address emergency situations during pregnancy, such as complications or sudden health issues. This can include establishing emergency transport systems, providing access to emergency obstetric care, and ensuring timely referrals to higher-level healthcare facilities.

3. Improving access to essential resources: Addressing the challenges faced by pregnant women in accessing essential resources for maternal health, such as nutritious food supplements and financial support. This can be achieved through community-based initiatives, such as local savings and rotating credit associations, to provide financial assistance and support for pregnant women.

4. Building trust and communication: Establishing trust and effective communication channels between healthcare providers, communities, and individuals. This can be done through community engagement programs, health education campaigns, and involving community leaders in decision-making processes related to maternal health.

These innovations aim to improve access to high-quality maternal health services during and after the COVID-19 pandemic, particularly in resource-constrained settings like Kilifi County in Kenya.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the described study is to establish and strengthen community-based maternal health interventions during and after the COVID-19 pandemic. This can be achieved through the following measures:

1. Collaborate with traditional birth attendants (TBAs): Recognize the role of TBAs in providing maternal health services and establish partnerships to ensure their training, supervision, and integration into the formal healthcare system. This can help ensure safe deliveries and appropriate care for pregnant women in communities.

2. Enhance emergency response for pregnant women: Develop and implement special interventions to address emergency situations during pregnancy, such as complications or sudden health issues. This can include establishing emergency transport systems, providing access to emergency obstetric care, and ensuring timely referrals to higher-level healthcare facilities.

3. Improve access to essential resources: Address the challenges faced by pregnant women in accessing essential resources for maternal health, such as nutritious food supplements and financial support. This can be achieved through community-based initiatives, such as local savings and rotating credit associations, to provide financial assistance and support for pregnant women.

4. Build trust and communication: Establish trust and effective communication channels between healthcare providers, communities, and individuals. This can be done through community engagement programs, health education campaigns, and involving community leaders in decision-making processes related to maternal health.

By implementing these recommendations, it is possible to improve access to high-quality maternal health services during and after the COVID-19 pandemic, particularly in resource-constrained settings like Kilifi County in Kenya.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach can be used. Here is a brief methodology:

1. Quantitative data collection: Conduct a survey or structured interviews with a representative sample of pregnant women and new mothers in Kilifi County. Collect data on their access to maternal health services, including their utilization of the alternatives mentioned in the study (e.g., giving birth at the homes of TBAs, relying on limited resources). Measure indicators such as the percentage of women utilizing these alternatives, satisfaction with the alternatives, and any adverse outcomes experienced.

2. Qualitative data collection: Conduct in-depth interviews or focus group discussions with a subset of participants from the quantitative survey. Explore their experiences, perceptions, and challenges related to accessing maternal health services during the COVID-19 pandemic. Specifically, inquire about the impact of the recommendations mentioned in the abstract, such as emergency interventions and trust-building measures.

3. Data analysis: Analyze the quantitative data using statistical methods to determine the prevalence and associations between the utilization of alternatives and access to maternal health services. Analyze the qualitative data thematically to identify common themes and patterns related to the impact of the recommendations on improving access to maternal health.

4. Simulation modeling: Develop a simulation model based on the findings from the quantitative and qualitative data analysis. The model should incorporate the main recommendations and their potential impact on improving access to maternal health. This can include estimating the potential increase in the utilization of formal healthcare services, reduction in adverse outcomes, and improvements in overall maternal health outcomes.

5. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model. Vary the input parameters, such as the percentage of women utilizing alternatives and the effectiveness of the recommendations, to determine the range of potential impacts on improving access to maternal health.

6. Interpretation and recommendations: Interpret the findings from the simulation model and provide recommendations based on the potential impact of the main recommendations. This can include policy recommendations, resource allocation strategies, and implementation guidelines for strengthening community-based maternal health interventions in Kilifi County and similar settings.

By following this methodology, researchers can gain insights into the potential impact of the recommendations on improving access to maternal health and inform evidence-based decision-making for maternal health interventions during and after the COVID-19 pandemic.


Identifiers:
DOI: 10.29063/ajrh2022/v26i12s.7
ISSN: 11184841
Research Areas:
Community Interventions, COVID, Disparities, Food Security, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Kenya
Study Design:
Cross Sectional Study
Study Approach:
Qualitative
Participants Gender:
Female
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