Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2015. Kenya Demographic and Health Survey 2014. Nairobi, Kenya: KNBS.
Magadi MA, Madise NJ, Rodrigues RN, 2000. Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med 51: 551–561.
Hollander D, 1997. Prenatal benefits improve birth outcomes among working Mexican women. Int Fam Plan Perspect 23: 94–95.
Fawcus S, Mbizvo M, Lindmark G, Nystrom L, 1996. A community-based investigation of avoidable factors for maternal mortality in Zimbabwe. Stud Fam Plann 27: 319–327.
Van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA, 2006. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health 3: 2.
Hodgkin D, 1996. Household characteristics affecting where mothers deliver in rural Kenya. Health Econ 5: 333–340.
Mwaniki PK, Kabiru EW, Mbugua GG, 2002. Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya. East Afr Med J 79: 184–187.
Freeman MC, Quick RE, Abbott DP, Ogutu P, Rheingans R, 2009. Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya. J Water Health 7: 527–534.
Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134: 1029–1036.
Blanton E, Wilhelm N, O'Reilly C, Muhonja E, Karoki S, Ope M, Langat D, Omolo J, Wamola N, Oundo J, Hoekstra R, Ayers T, De Cock K, Breiman R, Mintz E, Lantagne D, 2015. A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya. J Water Health 13: 714–725.
Alekal PY, 2005. Appropriate Water Treatment for the Nyanza Province of Kenya. Massachusetts Institute of Technology. Available at: http://web.mit.edu/watsan/Docs/Student%20Theses/Kenya/PragnyaAlekal-Thesis%205-18-05.pdf. Accessed May 10, 2016.
Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP, 2006. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ 84: 28–35.
Fleming E, Oremo J, O'Connor K, Odhiambo A, Ye T, Oswago S, Zeh C, Quick R, Kamb ML, 2013. The impact of integration of rapid syphilis testing during routine antenatal services in rural Kenya. J Sex Transm Dis 2013: 674584.
Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, Pool R, 2013. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One 8: e53747.
Filmer D, Pritchett LH, 2001. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38: 115–132.
Hounton S, Chapman G, Menten J, De Brouwere V, Ensor T, Sombie I, Meda N, Ronsmans C, 2008. Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso. Trop Med Int Health 13 (Suppl 1): 44–52.
Anson O, 2004. Utilization of maternal care in rural Hebei Province, the People's Republic of China: individual and structural characteristics. Health Policy 70: 197–206.
Fleming E, Gaines J, O'Connor K, Ogutu J, Atieno N, Atieno S, Kamb ML, Quick R, 2017. Can incentives reduce the barriers to use of antenatal care and delivery services in Kenya? Results of a qualitative inquiry. J Health Care Poor Underserved 28: 153–174.
Brown CA, Sohani SB, Khan K, Lilford R, Mukhwana W, 2008. Antenatal care and perinatal outcomes in Kwale district, Kenya. BMC Pregnancy Childbirth 8: 2.
Wood S, Foster J, Kols A, 2012. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program. Soc Sci Med 75: 634–642.
Sheth AN, Russo ET, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, 2010. Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi. Am J Trop Med Hyg 83: 1315–1321.
Morris SS, Flores R, Olinto P, Medina JM, 2004. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 364: 2030–2037.
De Allegri M, Marschall P, Flessa S, Tiendrebeogo J, Kouyate B, Jahn A, Muller O, 2010. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care. Health Policy Plan 25: 28–38.
Gathigah M, 2013. Kenya's Mothers Shun Free Maternity Health Care. AllAfrica: Inter Press Service. Available at: http://allafrica.com/stories/201307091754.html. Accessed May 10, 2016.
Graham WJ, Bell JS, Bullough CH, 2001. Can skilled attendance at delivery reduce maternal mortality in developing countries? SHSOP 17: 97–130.
Peabody JW, Nordyke RJ, Tozija F, Luck J, Munoz JA, Sunderland A, DeSalvo K, Ponce N, McCulloch C, 2006. Quality of care and its impact on population health: a cross-sectional study from Macedonia. Soc Sci Med 62: 2216–2224.
Lule GS, Tugumisirize J, Ndekha M, 2000. Quality of care and its effects on utilisation of maternity services at health centre level. East Afr Med J 77: 250–255.
Onyango L, 2012. Mothers Face Abuse in Clinics. Daily Nation. Available at: http://www.nation.co.ke/news/Mothers-face-abuse-in-clinics-/1056-1371710-gyampk/index.html. Accessed May 10, 2016.
Center for Reproductive Rights and Federation of Women Lawyers–Kenya, 2007. Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities, 26–85. Available at: https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/pub_bo_failuretodeliver.pdf. Accessed May 10, 2016.
Nisar N, White F, 2003. Factors affecting utilization of antenatal care among reproductive age group women (15–49 years) in an urban squatter settlement of Karachi. J Pak Med Assoc 53: 47–53.
Kabakian-Khasholian T, Campbell OM, 2005. A simple way to increase service use: triggers of women's uptake of postpartum services. BJOG 112: 1315–1321.
World Health Organization (WHO), 2007. Malaria in Pregnancy: Guidelines for Measuring Key Monitoring and Evaluation Indicators. Geneva, Switzerland: WHO, 10–21.
World Health Organization (WHO), 2012. Updated WHO Policy Recommendation: Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine-Pyrimethamine (IPTp-SP). Geneva, Switzerland: WHO.
Gage AJ, 2007. Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med 65: 1666–1682.
Pallikadavath S, Foss M, Stones RW, 2004. Antenatal care: provision and inequality in rural north India. Soc Sci Med 59: 1147–1158.
Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S, 2010. Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis. Health Policy 97: 209–216.
Stockman LJ, Fischer TK, Deming M, Ngwira B, Bowie C, Cunliffe N, Bresee J, Quick RE, 2007. Point-of-use water treatment and use among mothers in Malawi. Emerg Infect Dis 13: 1077–1080.
Briere EC, Ryman TK, Cartwright E, Russo ET, Wannemuehler KA, Nygren BL, Kola S, Sadumah I, Ochieng C, Watkins ML, Quick R, 2012. Impact of integration of hygiene kit distribution with routine immunizations on infant vaccine coverage and water treatment and handwashing practices of Kenyan mothers. J Infect Dis 205 (Suppl 1): S56–S64.
Population Services International (PSI-Kenya), 2010. Quick Reference Guide to the HIV Basic Care Package. Nairobi, Kenya: PSI-Kenya, 14–19.
Dubois AE, Crump JA, Keswick BH, Slutsker L, Quick RE, Vulule JM, Luby SP, 2010. Determinants of use of household-level water chlorination products in rural Kenya, 2003–2005. Int J Environ Res Public Health 7: 3842–3852.
Harris JR, Greene SK, Thomas TK, Ndivo R, Okanda J, Masaba R, Nyangau I, Thigpen MC, Hoekstra RM, Quick RE, 2009. Effect of a point-of-use water treatment and safe water storage intervention on diarrhea in infants of HIV-infected mothers. J Infect Dis 200: 1186–1193.
Suchdev PS, Addo OY, Martorell R, Grant FK, Ruth LJ, Patel MK, Juliao PC, Quick R, Flores-Ayala R, 2016. Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in western Kenya. Am J Clin Nutr 103: 934–941.
O'Reilly CE, Freeman MC, Ravani M, Migele J, Mwaki A, Ayalo M, Ombeki S, Hoekstra RM, Quick R, 2008. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect 136: 80–91.
Matanock A, Anderson T, Ayers T, Likicho L, Wamimbi R, Lu X, Emeetai T, Kakande C, Mutabazi M, Quick R, 2016. Integrating water treatment into antenatal care: impact on use of maternal health services and household water treatment by mothers: rural Uganda, 2013. Am J Trop Med Hyg 94: 1150–1156.
Loharikar A, Russo E, Sheth A, Menon M, Kudzala A, Tauzie B, Masuku HD, Ayers T, Hoekstra RM, Quick R, 2013. Long-term impact of integration of household water treatment and hygiene promotion with antenatal services on maternal water treatment and hygiene practices in Malawi. Am J Trop Med Hyg 88: 267–274.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 283 | 247 | 12 |
Full Text Views | 345 | 14 | 0 |
PDF Downloads | 158 | 10 | 0 |
Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9–4.5), health facility delivery (OR = 5.3, 95% CI = 3.4–8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9–4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1–2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5–7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5–4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0–2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.
Financial support: This study was made possible by financial support from the Centers for Disease Control and Prevention, the P & G Fund, and the U.S. Agency for International Development.
Authors' addresses: Kirsten Fagerli, Katherine O'Connor, Sunkyung Kim, Benjamin Nygren, Mary Kamb, and Robert Quick, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: kfagerli@cdc.gov, ioy6@cdc.gov, wox0@cdc.gov, ghz8@cdc.gov, mlk5@cdc.gov, and rxq1@cdc.gov. Maureen Kelley, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, E-mail: makelle@emory.edu. Aloyce Odhiambo, Sitnah Faith, and Ronald Otieno, Safe Water and AIDS Project, Kisumu, Kenya, E-mails: racksalomex@yahoo.com, sitnahfaith@yahoo.com, and ronotien0@yahoo.com.
Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2015. Kenya Demographic and Health Survey 2014. Nairobi, Kenya: KNBS.
Magadi MA, Madise NJ, Rodrigues RN, 2000. Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med 51: 551–561.
Hollander D, 1997. Prenatal benefits improve birth outcomes among working Mexican women. Int Fam Plan Perspect 23: 94–95.
Fawcus S, Mbizvo M, Lindmark G, Nystrom L, 1996. A community-based investigation of avoidable factors for maternal mortality in Zimbabwe. Stud Fam Plann 27: 319–327.
Van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA, 2006. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health 3: 2.
Hodgkin D, 1996. Household characteristics affecting where mothers deliver in rural Kenya. Health Econ 5: 333–340.
Mwaniki PK, Kabiru EW, Mbugua GG, 2002. Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya. East Afr Med J 79: 184–187.
Freeman MC, Quick RE, Abbott DP, Ogutu P, Rheingans R, 2009. Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya. J Water Health 7: 527–534.
Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134: 1029–1036.
Blanton E, Wilhelm N, O'Reilly C, Muhonja E, Karoki S, Ope M, Langat D, Omolo J, Wamola N, Oundo J, Hoekstra R, Ayers T, De Cock K, Breiman R, Mintz E, Lantagne D, 2015. A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya. J Water Health 13: 714–725.
Alekal PY, 2005. Appropriate Water Treatment for the Nyanza Province of Kenya. Massachusetts Institute of Technology. Available at: http://web.mit.edu/watsan/Docs/Student%20Theses/Kenya/PragnyaAlekal-Thesis%205-18-05.pdf. Accessed May 10, 2016.
Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP, 2006. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ 84: 28–35.
Fleming E, Oremo J, O'Connor K, Odhiambo A, Ye T, Oswago S, Zeh C, Quick R, Kamb ML, 2013. The impact of integration of rapid syphilis testing during routine antenatal services in rural Kenya. J Sex Transm Dis 2013: 674584.
Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, Pool R, 2013. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One 8: e53747.
Filmer D, Pritchett LH, 2001. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38: 115–132.
Hounton S, Chapman G, Menten J, De Brouwere V, Ensor T, Sombie I, Meda N, Ronsmans C, 2008. Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso. Trop Med Int Health 13 (Suppl 1): 44–52.
Anson O, 2004. Utilization of maternal care in rural Hebei Province, the People's Republic of China: individual and structural characteristics. Health Policy 70: 197–206.
Fleming E, Gaines J, O'Connor K, Ogutu J, Atieno N, Atieno S, Kamb ML, Quick R, 2017. Can incentives reduce the barriers to use of antenatal care and delivery services in Kenya? Results of a qualitative inquiry. J Health Care Poor Underserved 28: 153–174.
Brown CA, Sohani SB, Khan K, Lilford R, Mukhwana W, 2008. Antenatal care and perinatal outcomes in Kwale district, Kenya. BMC Pregnancy Childbirth 8: 2.
Wood S, Foster J, Kols A, 2012. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program. Soc Sci Med 75: 634–642.
Sheth AN, Russo ET, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, 2010. Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi. Am J Trop Med Hyg 83: 1315–1321.
Morris SS, Flores R, Olinto P, Medina JM, 2004. Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 364: 2030–2037.
De Allegri M, Marschall P, Flessa S, Tiendrebeogo J, Kouyate B, Jahn A, Muller O, 2010. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care. Health Policy Plan 25: 28–38.
Gathigah M, 2013. Kenya's Mothers Shun Free Maternity Health Care. AllAfrica: Inter Press Service. Available at: http://allafrica.com/stories/201307091754.html. Accessed May 10, 2016.
Graham WJ, Bell JS, Bullough CH, 2001. Can skilled attendance at delivery reduce maternal mortality in developing countries? SHSOP 17: 97–130.
Peabody JW, Nordyke RJ, Tozija F, Luck J, Munoz JA, Sunderland A, DeSalvo K, Ponce N, McCulloch C, 2006. Quality of care and its impact on population health: a cross-sectional study from Macedonia. Soc Sci Med 62: 2216–2224.
Lule GS, Tugumisirize J, Ndekha M, 2000. Quality of care and its effects on utilisation of maternity services at health centre level. East Afr Med J 77: 250–255.
Onyango L, 2012. Mothers Face Abuse in Clinics. Daily Nation. Available at: http://www.nation.co.ke/news/Mothers-face-abuse-in-clinics-/1056-1371710-gyampk/index.html. Accessed May 10, 2016.
Center for Reproductive Rights and Federation of Women Lawyers–Kenya, 2007. Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities, 26–85. Available at: https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/pub_bo_failuretodeliver.pdf. Accessed May 10, 2016.
Nisar N, White F, 2003. Factors affecting utilization of antenatal care among reproductive age group women (15–49 years) in an urban squatter settlement of Karachi. J Pak Med Assoc 53: 47–53.
Kabakian-Khasholian T, Campbell OM, 2005. A simple way to increase service use: triggers of women's uptake of postpartum services. BJOG 112: 1315–1321.
World Health Organization (WHO), 2007. Malaria in Pregnancy: Guidelines for Measuring Key Monitoring and Evaluation Indicators. Geneva, Switzerland: WHO, 10–21.
World Health Organization (WHO), 2012. Updated WHO Policy Recommendation: Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine-Pyrimethamine (IPTp-SP). Geneva, Switzerland: WHO.
Gage AJ, 2007. Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med 65: 1666–1682.
Pallikadavath S, Foss M, Stones RW, 2004. Antenatal care: provision and inequality in rural north India. Soc Sci Med 59: 1147–1158.
Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S, 2010. Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis. Health Policy 97: 209–216.
Stockman LJ, Fischer TK, Deming M, Ngwira B, Bowie C, Cunliffe N, Bresee J, Quick RE, 2007. Point-of-use water treatment and use among mothers in Malawi. Emerg Infect Dis 13: 1077–1080.
Briere EC, Ryman TK, Cartwright E, Russo ET, Wannemuehler KA, Nygren BL, Kola S, Sadumah I, Ochieng C, Watkins ML, Quick R, 2012. Impact of integration of hygiene kit distribution with routine immunizations on infant vaccine coverage and water treatment and handwashing practices of Kenyan mothers. J Infect Dis 205 (Suppl 1): S56–S64.
Population Services International (PSI-Kenya), 2010. Quick Reference Guide to the HIV Basic Care Package. Nairobi, Kenya: PSI-Kenya, 14–19.
Dubois AE, Crump JA, Keswick BH, Slutsker L, Quick RE, Vulule JM, Luby SP, 2010. Determinants of use of household-level water chlorination products in rural Kenya, 2003–2005. Int J Environ Res Public Health 7: 3842–3852.
Harris JR, Greene SK, Thomas TK, Ndivo R, Okanda J, Masaba R, Nyangau I, Thigpen MC, Hoekstra RM, Quick RE, 2009. Effect of a point-of-use water treatment and safe water storage intervention on diarrhea in infants of HIV-infected mothers. J Infect Dis 200: 1186–1193.
Suchdev PS, Addo OY, Martorell R, Grant FK, Ruth LJ, Patel MK, Juliao PC, Quick R, Flores-Ayala R, 2016. Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in western Kenya. Am J Clin Nutr 103: 934–941.
O'Reilly CE, Freeman MC, Ravani M, Migele J, Mwaki A, Ayalo M, Ombeki S, Hoekstra RM, Quick R, 2008. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect 136: 80–91.
Matanock A, Anderson T, Ayers T, Likicho L, Wamimbi R, Lu X, Emeetai T, Kakande C, Mutabazi M, Quick R, 2016. Integrating water treatment into antenatal care: impact on use of maternal health services and household water treatment by mothers: rural Uganda, 2013. Am J Trop Med Hyg 94: 1150–1156.
Loharikar A, Russo E, Sheth A, Menon M, Kudzala A, Tauzie B, Masuku HD, Ayers T, Hoekstra RM, Quick R, 2013. Long-term impact of integration of household water treatment and hygiene promotion with antenatal services on maternal water treatment and hygiene practices in Malawi. Am J Trop Med Hyg 88: 267–274.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 283 | 247 | 12 |
Full Text Views | 345 | 14 | 0 |
PDF Downloads | 158 | 10 | 0 |