Abstract:
Postpartum haemorrhage is the blood loss of not less than 500 ml in 24 hours after birth. In Kenya, 34% of maternal deaths are because of postpartum haemorrhage. In Homa Bay County, postpartum haemorrhage remains the number one contributor of maternal mortality. Thirty eight percent of all maternal deaths are attributed to postpartum haemorrhage despite several strategies by the ministry of health to reduce its occurrence. Poor health care provision have been cited in some studies as contributing factor to high postpartum haemorrhage. No study, however, has explored the possible determinants, impacts, and challenges of health system management on occurrence of postpartum haemorrhage in the County. The main objective of this study was to establish the influence of health system management on the occurrence of postpartum haemorrhage. The specific objectives were to: determine the prevalence of postpartum haemorrhage, identify the determinants; determine the association; and lastly describe the challenges of health system management on occurrence of postpartum haemorrhage among women of reproductive age 15-49 years in Homa Bay County. The study was cross-sectional design in which mixed research methods were used. The study population were women who had childbirth at level four public hospitals in Homa Bay County. A sample size of 400 was arrived at using Cochran 1977 formula. The instruments for data collection were: questionnaire, observation checklist, and key informant interview guide. Information was gathered on: socio-demographics, maternal health characteristics, postpartum haemorrhage occurrences, health system determinants, effects, and challenges of health system management. Key informant interview guide was administered to the eight sub county medical officers of health and the county gynecologist. Observation checklist was filled by the researcher assisted by the hospital matrons and maternity in-charges. Information from key informant interview guide was managed thematically per objective, while quantitative data was analyzed using statistical package for social sciences stata version 13, and logistic regression method. The tests done were chi-square, bi-variate and multivariate logistic regression. The study bad 90.75% response rate. Respondents were between 15 years to 44 years of age. The mean age was 27 years while standard deviation of the ages was ±11.18. Socio-demographic profile of respondents was as follows; 77.8% were married; 20.5% had monthly income less than Ksh.1,000; salaried respondents were 8%; while 69.6% of respondents were protestants. The prevalence of postpartum haemorrhage was 9.9% with 95% CI (7.2% - 13.5%). Statistically significant determinants of occurrence of postpartum haemorrhage were: previous experience of postpartum haemorrhage (p-value=0.01 ), parity (p-value=0.004), trimester of initiation of antenatal care visit (p-value=0.0494), health care provider to client level of attention (p-value=0.046), change of work station by health care providers (p-value=0.0 17), and availability of quality healthcare services (p-value=0.017). Health systems associated with occurrence of postpartum haemorrhage were: health :financing (p-value=0.049); medicines and technologies (p-value=0.027) and; health service delivery (p-value=0.001) while the challenges of health system management were: inadequate number and skilled human resource for health (p-value=0.01); low quality and insufficient diagnostic services: lack of essential tests (p-value=0.01), venereal disease research laboratory (p-value=0.003). Inadequate essential obstetric and perinatal drugs, obstructed labour (p-value=0.001), and traditional birth attendants (p-value=0.034). The findings of this research therefore fills the gap on documentation and knowledge on prevalence of postpartum haemorrhage in Homa Bay County, identified determinants of health system management on occurrence of postpartum haemorrhage, determined functionality of health systems and their association with occurrence of postpartum haemorrhage, and established the challenges of health system management on occurrence of postpartum haemorrhage. Given the findings, the researcher recommends change of practice and development of policy on consumer centered approach on prevention of occurrence of postpartum haemorrhage detailing clear framework for improving socio-demographic determinants, maternal characteristics, health systems, and reduction of challenges of health system management.