The Extended Role of Health Facility Cleaners in Maternity Care in
                    Kenya

Golub, Ginger; Sudhinaraset, May; Giessler, Katie; Dunlop-Korsness, Kendall; Stone, Allison

doi:10.1363/46e8320

Cited by 8 publications

(7 citation statements)

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“…Inadequate knowledge was a bigger issue among nonclinical providers, who were less likely to rate the practices as very important. All non-clinical providers reported they had never had a training on how to interact with patients-despite the evidence that they directly interacted with patients and played a role in shaping women's maternity experiences in that setting [16,30]. Non-clinical providers, therefore, essentially learned how to interact with patients by watching the clinical providers, whose communication skills they sometimes overestimated.…”

Section: Discussionmentioning

confidence: 99%

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Providers’ perceptions of communication and women’s autonomy during childbirth: a mixed methods study in Kenya

et al. 2020

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Background: Effective communication and respect for women's autonomy are critical components of personcentered care. Yet, there is limited evidence in low-resource settings on providers' perceptions of the importance and extent of communication and women's autonomy during childbirth. Similarly, few studies have assessed the potential barriers to effective communication and maintenance of women's autonomy during childbirth. We sought to bridge these gaps. Methods: Data are from a mixed-methods study in Migori County in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical). Providers were asked structured questions on various aspects of communication and autonomy followed by open ended questions on why certain practices were performed or not. We conducted descriptive analysis of the quantitative data and thematic analysis of the qualitative data. Results: Despite acknowledging the importance of various aspects of communication and women's autonomy, providers reported incidences of poor communication and lack of respect for women's autonomy: 57% of respondents reported that providers never introduce themselves to women and 38% reported that women are never able to be in the birthing position of their choice. Also, 33% of providers reported that they did not always explain why they are doing exams or procedures and 73% reported that women were not always asked for permission before exams or procedures. The reasons for lack of communication and autonomy fall under three themes with several sub-themes: (1) work environment-perceived lack of time, language barriers, stress and burnout, and facility culture; (2) provider knowledge, intentions, and assumptions-inadequate provider knowledge and skill, forgetfulness and unconscious behaviors, self-protection and comfort, and assumptions about women's knowledge and expectations; and (3) women's ability to demand or command effective communication and respect for their autonomy-women's lack of participation, women's empowerment and provider bias. Conclusions: Most providers recognize the importance of various aspects of communication and women's autonomy, but they fail to provide it for various reasons. To improve communication and autonomy, we need to address the different factors that negatively affect providers' interactions with women.

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Section: Discussionmentioning

confidence: 99%

“…This study seeks to extend the literature on communication and women's autonomy during childbirth using data from clinical and non-clinical (support staff) maternity providers. Prior studies in the setting have shown that both types of providers play a key role in women's birth experiences [16,30]. Our research questions are: 1…”

Section: Introductionmentioning

confidence: 99%

Providers’ perceptions of communication and women’s autonomy during childbirth: a mixed methods study in Kenya

et al. 2020

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“…We use the term maternity providers in this study to refer to both clinical staff such as nurses, midwives, doctors, and clinical o cers as well support staff, including nurse aides and cleaners working in maternity units (providing antenatal, intrapartum, and postnatal care and support services). We included support staff because they have been shown to play an important role in maternity care and women's experiences in other studies [42,43].…”

Section: Methodsmentioning

confidence: 99%

Psychological and Physiological Stress and Burnout Among Maternity Providers in A Rural County in Kenya: Individual and Situational Predictors

Afulani

Ongeri

Kinyua

et al. 2020

Preprint

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Background: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. Methods: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. Results: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD=33.0) and mean cortisol was 38.6 (SD=44.3). Greater satisfaction with life accomplishments was associated with reduced stress (𝛽=-2.83; CI=-5.47; -0.18), while motivation to work excessively (over commitment) was associated with both increased stress (𝛽=-0.61 CI: 0.19, 1.03) and burnout (𝛽=2.05, CI=0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. Conclusions: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.

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“…Furthermore, that women who were assisted by unskilled providers received poorer PCMC may indicate poorer knowledge of PCMC among this cadre of staff leading to poor PCMC provision [ 31 ]. Prior studies have shown that while these unskilled providers may sometimes serve as advocates for women, they can also be perpetrators of abuse [ 37 ]. However, given the very small proportion of women who were assisted by unskilled providers in our sample, this finding should be interpreted with caution and explored further in future studies.…”

Section: Discussionmentioning

confidence: 99%

Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya

et al. 2021

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Introduction Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women’s experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya. Methods and materials We analyzed data from a cross-sectional study with 307 women aged 18–49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women’s experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities. Results The average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (β = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (β = -5.030, p = 0.006) and third trimester (β = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (β = -8.962, p = 0.016). Women who were interviewed by phone (β = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person. Conclusions Factors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.

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The Extended Role of Health Facility Cleaners in Maternity Care in Kenya

Cited by 8 publications

References 0 publications

Providers’ perceptions of communication and women’s autonomy during childbirth: a mixed methods study in Kenya

Providers’ perceptions of communication and women’s autonomy during childbirth: a mixed methods study in Kenya

Psychological and Physiological Stress and Burnout Among Maternity Providers in A Rural County in Kenya: Individual and Situational Predictors

Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya

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