i

A STUDY TO ASSESS THE CHALLENGES FACED

IN LABOUR WARD AT NAROK DISTRICT

HOSPITAL.

BY

SHEILA C. SAWE

(BMS/7060/62/DF)

A RESEARCH REPORT SUBMITTED TO FACULTY OF CLINICAL

MEDICINE AND DENTISRY IN PARTIAL FULLFILMENT OF THE

REQUIREMENT

FOR THE AWARD OF BACHELOR’S DEGREE IN MEDICINE AND

BACHELORS OF SURGERY OF KAMPALA INTERNATIONAL

UNIVERSITY

DECEMBER 2013.

ii

DECLARATION I declare that this report is my original work based on facts and figures collected in Narok

District Hospital.

NAME: Sheila C. Sawe

SIGNATURE: ……………………….. DATE……………………..

SUPERVISOR SIGNATURE DATE

PROF. BEGUMYA YOVAN ………………… ………………

iii

ACKNOWLEDGMENT

I acknowledge the staff at Narok District Hospital, in particular the Medical Superintendent for

allowing me to carry out this research and staff in the obstetric wards participating in carrying

out of this study.

I acknowledge my supervisor, Prof. Begumya (Department of Physiology), for his guidance and

assistance in the preparation of this report.

I acknowledge the members of the Narok District Health Management Team for their invaluable

assistance during the carrying out of this research.

Lastly, I acknowledge the guardians interviewed for their contribution to this research.

iv

DEDICATION

I dedicate this report to my dear mother and to the mothers of Narok.

v

LIST OF ABBREVIATIONS

DHMT - District Health Management Team

DMOH – District Medical officer of Health

COBES - Community Based Education and Service

MCH – Maternal and Child Health

MCH/FP – Maternal and Child Health/ Family Planning

NGO – Non Governmental Organizations’

POPC – Pediatric Out-Patient Clinic

SOPC – Surgical Out-Patient Clinic

MOPC – Medical Out-Patient Clinic

GOPC – Gynecology Out-Patient Clinic

FGM Female Genital Mutilation

HMB Health Management Board

HIV/ AIDS Human Immuno-Deficiency Virus/ Acquired Immuno-Deficiency Syndrome

GOK Government of Kenya

PMTCT Prevention of Mother To Child Transmission

MTRH Moi Teaching and Referral Hospital

KNH Kenyatta National Hospital

vi

Contents

DECLARATION .......................................................................................................................................... ii

ACKNOWLEDGMENT .............................................................................................................................. iii

DEDICATION ............................................................................................................................................. iv

LIST OF ABBREVIATIONS ....................................................................................................................... v

ABSTRACT ................................................................................................................................................ vii

CHAPTER ONE ........................................................................................................................................... 8

1.1 Background information ..................................................................................................................... 8

1.2 Study objectives ................................................................................................................................ 10

Broad objective ................................................................................................................................... 10

Specific objectives .............................................................................................................................. 10

1.3 Justification for the study .................................................................................................................. 10

CHAPTER TWO ........................................................................................................................................ 11

2.0 LITERATURE REVIEW ................................................................................................................. 11

Introduction. ............................................................................................................................................ 11

CHAPTER THREE .................................................................................................................................... 13

3.0 METHODOLOGY ........................................................................................................................... 13

CHAPTER FOUR ....................................................................................................................................... 14

4.0 FINDINGS ........................................................................................................................................ 14

APPENDIX I .............................................................................................................................................. 25

APPENDIX II ............................................................................................................................................. 29

1.1 map of the DISTRICT: SHOWING the health services and facilities in the district .................... 29

vii

ABSTRACT

Title:

Assess challenges faced in the labour ward at Narok District Hospital

Broad objective:

To determine challenges faced in the labour ward at Narok District Hospital.

Methodology:

A cross sectional study was done at Narok District hospital on staff and women attended to in

labour ward. Convenience sampling patients was used with a sample size of 75, data collected

using interviewer administered questionnaires, entered and analyzed on Microsoft excel and

presented as tables, pie charts and graphs.

Findings

Average age of respondents was 24 years, majority (56%)of respondents were of the Maasai

community. All care providers (12) used a partograph for each delivery and all respondents said

that partographs were readily available in labour ward. Few healthcare providers (33%) checked

all vitals according to standard protocol. 33% of those who didn’t attributed this to lack of

instruments, and 33% to being overwhelmed by number of patients.

All healthcare providers managed labour using a partograph and (83%) performed active labour.

A number of care providers (41%) did not feel motivated to work in labour ward, (34%) felt

overworked and 25% contented. Each respondent attended to an average of 8 patients per day.

Many healthcare providers (89%) said language barrier hindered service delivery and all stated

culture and traditional practices of women in Narok district hindered services delivery in labour

ward.Majority (68%) attributed it to FGM, (42%) to gender inequality.

Only (33%) of health care providers felt there were adequate supplies in labour ward. Majority

(67%) said laboratory results were available on time.

Majority of patient (54%) respondents were Primigravidae. Of the multiparous respondents,

(58%) had had home delivery using traditional birth attendants.

Respondents took an average of 3.6hrs to deliver after arriving at the hospital

Majority of respondents rated services at the labour ward as Affordable.

Many patient respondents (65%) rated service offered as Good and 35% thought it was

Excellent.

Conclusion

i. Patients in labour ward are young adults with an age average of 24years.

ii. Staff in labour ward are not motivated and feel overworked.

iii. There is inconsistency in availability of supplies in labour ward.

iv. Culture and traditional practices in Narok hinder optimum service delivery in labour

ward.

8

CHAPTER ONE

1.0 Study Introduction

Maternal mortality is a major health problem in Kenya. Most recent estimates by Kenya

Demographics Health Survey 2003 are 414 maternal deaths per 100,000 live births.

Deteriorating public health service and the HIV/AIDS epidemic are contributing factors.

Kenyan women face a 1 in 20 lifetime risk of maternal death, which is the leading cause

(27%) among women of childbearing age in Kenya. There are five major causes of maternal

death: hemorrhage, infection, hypertensive disease in pregnancy, unsafe abortion and

obstructed labour. Many of these deaths could be averted if women had access to essential

obstetric care when they need it.

This research aims at assessing the challenges faced in the labour ward at Narok district

hospital.

1.1 Background information

Narok District hospital is located in Narok North district, Narok County. It was founded in

1969. Narok district covers an area of 15087.8 square kilometers and has an approximate

population of 365,750 people. It’s bordered by Bomet District, Nakuru District, Kajiado

District, and Transmara District.

The district hospital attends to approximately 400,000 people some of who are from the

neighboring districts.

The district hospital has an outpatient department in which several clinics are run. They

include the Dental clinic, Eye clinic, POPC, SOPC, MOPC, GOPC, the mother and

child/family planning clinic (MCH/FP) and the diabetic clinic. The hospital also has an

inpatient department with a capacity of 155 beds with surgical, medical, paediatric,

gynaecology and maternity wards.

9

There are a number of health facilities in the district. They are summarized below.

Table 1 number of facilities in the district

GOK

NGO No. Health_ Facility_ Name

No. Health_ Facility_ Name

Agency

1

Narok District

Hospital

D.

Hos

1

Ereto Project H/C CCF

/Comm.

2 Olokurto H/C

2 Siyapei Disp. AIC

3 Enabel bel H/C

3 Enoosupukia Disp. Catholic

4 Nairagie Enkare H/c

4 Olenkasurai Disp. Mission

5 Ololpironito H/C

5 Olendeem Disp. ACK

6 Sakutiek H/C

6 Nturumeti Disp. ACK

7 G K Prison Disp.

7 Oloropil Disp. Catholic

8 Nkareta Disp.

8 Olasiti Disp. AIC

9 Naisoya Disp.

9 Olokirikirai Disp. Catholic

10 oletukat Disp.

10 fauntain medical services Disp. Mission

11 Ewaso Ngiro Disp.

11 Nairasirasa Disp. Mission

12 enteyani Disp.

12 Olooltoto

13 Olpusimoru Disp.

13 PCEA Nairasirasa

14 Olchorro Disp. 15 Entol tol Disp. 16 Kojonga Disp. 17 Mosiro Disp. 18 Enaibor Ajijik Disp. 19 Ongata naado Disp. 20 Ilaiser Disp. 21 Ntulele Disp.

The top ten diseases in the district according to the health records are

1. Malaria

2. Diarrhea

3. Pneumonia

4. Dehydration

5. Anaemia

6. Tuberculosis

7. Typhoid

8. HIV/AIDS

9. Diabetes mellitus

10. Meningitis

10

1.2 Study objectives

Broad objective

To determine challenges faced in the labour ward at Narok District Hospital.

Specific objectives

1. To assess practices of staff in labour ward at Narok District Hospital.

2. To assess the availability and reliability of equipment in labour ward at Narok

District Hospital

3. To assess the influence of gender inequality and traditional practices and beliefs on

procedures in labour ward at Narok District Hospital.

1.3 Justification for the study

In Kenya bearing children is still considered as a primary purpose of marriage. While there

are 10 maternal deaths per 100,000 live births in developed countries, in Kenya the ratio is

alarmingly high at 488 per 100,000 live births as of 2010 an increase from 414 per 100,000

in 2003.

25years after the launch of Kenya Safe Motherhood Program, maternal and neonatal

mortality ratio remain high. It currently stands at 488 per 100,000 a mere drop compared to

657 per 100,000 live births in 1987. Several factors have played a role in the poor health

indicators. The major factors are HIV/AIDS pandemic, shortage of trained nursed and

midwives, inadequate resources in the hospitals and gender inequality and traditional

practices.

11

CHAPTER TWO

2.0 LITERATURE REVIEW

Introduction.

Labour is the culmination of a human pregnancy or gestation period with the birth of one or

more newborn infants from a woman's uterus. It is a process that requires careful monitoring

of both the mother and the fetus due to their vulnerability at the time. An efficient, well-

staffed and equipped labour ward plays a key role in achieving this goal.

Hemorrhage, sepsis, hypertension disorders of pregnancy, obstructed labour, complications

of induced labour are the top five killers. [1]

The global dimension.

A comparison of labour and birth outcomes in Jordan with WHO guidelines found: the rates

of a number of labour and birth practices were inappropriately high, and differed from WHO

guidelines and evidence-based recommendations. [2]

Majority of hospitals do not have written policies or standard birth procedures and lack

mechanisms for evaluation. Generally, minimal prenatal information is given to women.

The reported configuration of professional care during labour and delivery is favorable to

high quality care. 31 hospitals set an i.v. drip to all women and some use continuous fetal

monitoring method. Nearly all hospitals give intra-muscular anesthesia whereas epidurals

are used less frequently. [3]

About 63% of births were attended by a skilled attendant: from 47% in Africa to 88% in

Latin America/Caribbean. In 16 of 23 countries with data, less than 50% of the

recommended levels of emergency obstetric care had been fulfilled. Countries with maternal

mortality ratios of 750+ per 100,000 live births shared problems of high fertility and

unplanned pregnancies, poor health infrastructure with limited resources and low

availability of health personnel. [4]

The African dimension.

In a study on the challenges facing nurse-midwives in working towards Safe Motherhood in

Malawi, it was noted that public hospitals were running with critical shortage of medical

supplies and equipment. This could have contributed to considerable delays in provision of

care and poor quality care, unnecessary deaths from emergencies and frustration of nurse-

midwives. Sometimes an attendant had to leave to go to another ward in search of supplies.

There was also a shortage of nurse-midwives leading to a high client to nurse-midwife ratio,

this contributed to poor quality of care.

Gender inequality also played a big role; there were some delays in seeking maternity care

due to the fact that women couldn’t make independent decisions to seek care when sick.

Majority of women were not economically empowered and this put them in a situation

whereby they could not do much to improve their wellbeing. [5]

12

A study in Burkina Faso on quality of antenatal care and obstetrical coverage in rural

Burkina Faso Health facilities were poorly equipped, and the availability of qualified staff

remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14

to 33. [6]

A study on how a midwife can change attitudes showed The midwife employs the services

of a good interpreter and gives Somali women the information they require to plan a

delivery. All but one of the women had undergone female genital mutilation, and the

midwife urged the women to become de-infibulated early in the pregnancy. The midwife

also used this opportunity to discuss the health problems that follow female genital

mutilation in an effort to dissuade the couple from having any female children subjected to

this practice. Most of her clients reported their intention to keep their daughters intact.

[7]

In evaluation on the affordability of labour ward services in district hospitals a study done in

South Africa concluded that the Unit costs of inpatient days in district hospitals for

maternity patients was more than double the average unit cost for medical patients. [8]

In East Africa, Using practical quality improvement approaches and tools in reproductive

health services resulted in high-quality care, including management and supervision, safety,

and information and client--provider interactions. For example, maternity ward staff learned

how to pass on to their clients’ information about clients' rights and family planning

methods through posters, pamphlets, sample contraceptives, and health talks. However

Quality Improvement requires considerable staff development and capacity building at all

levels. [9]

The Kenyan perspective.

In a report by Kenyan Ministry of Health titled Safe Motherhood Demonstration Project

Western Province 2004, Provider knowledge and experience was to seen to improve over

the project period. More providers used partographs to manage labour and improved

management of complications. More providers monitored labour more effectively and

referred earlier. Fewer women gave birth after more than 12 hours of labour. Significantly

more women delivered with Skilled Attendance at home. Health care providers were more

knowledgeable about obstetric problems and had more experience to manage them.

Management and organizational issues had improved including an improvement in systems

for procurement of equipment, drugs and supplies. Fewer women had to bring in drugs and

supplies during labour. More health facilities were now using guidelines and protocols. [10]

13

CHAPTER THREE

3.0 METHODOLOGY

Study area

The study area was Narok District Hospital.

Study setting

Labour ward.

Study design

Cross sectional study.

Study population

Doctors, clinicians and nurses in labour ward.

Women attended to in labour ward at Narok District Hospital.

Sampling technique

Purposive sampling was used.

Data collection

Data was collected using interviewer administered questionnaires and observational check

list

Data analysis and presentation

Microsoft excel was used to generate percentages from findings entered for easy

comparison, and drawing of conclusions. Qualitative data was analyzed intelligently then

organized and presented as thematic issues in narrative form. Pie charts were used for

presenting quantitative data.

Inclusion criteria

Medical staff working in labour ward at Narok District Hospital

Women attended to in labour ward .

Limitation of the study

Time was limited.

Ethical considerations

Obtaining informed consent from the participants.

Observing confidentiality by not disclosing the names of the participants who took

part in the study.

Information obtained from the participants was treated with confidentiality.

Consent was sought from the hospital administration to carry out the study.

14

CHAPTER FOUR

4.0 FINDINGS

4.1Demographic data

Average age of respondents was 24 years

Table 1 Average age of patient respondents.

AVERAGE AGE 24YEARS

Majority (56%)of respondents were of the Maasai community.

Fig 1 Bar graph showing the community of patients interviewed (n=34)

0

2

4

6

8

10

12

14

16

18

20

COMMUNITIES

15

4.2 Management of patients in labour ward

All care providers n=12 (100%) used a partograph for each delivery.

All (100%) respondents said that partographs were readily available in labour ward.

Few healthcare providers (33%) checked all vitals according to standard protocol.

Fig 1 Bar graph showing care providers who checked all vitals according to

Protocol (n=12)

n=4 (33%) of those who didn’t check all vitals attributed this to lack of instruments, and

33% to being overwhelmed by number of patients.

Fig 2 Factors for not checking all vitals according to protocol (n=12)

LACK OF INSTRUMENTS

OVER-WHELMED BY

PATIENTS

FACTORS FOR NOT CHECKING ALL VITALS

0% 10% 20% 30% 40% 50% 60% 70%

CHECKED ALL VITALS

ALL VITALS NOT CHECKED

VITALS

16

All (100%) healthcare providers managed labour using a partograph.

Majority of healthcare providers (83%) performed active labour.

Fig 3 Pie Chart showing type of labour management used (n=12)

41% of care providers did not feel motivated to work in labour ward.

A few (34%) felt overworked.

Each respondent attended to an average of 8 patients per day.

Fig 4 Bar Gragh showing attitude of healthcare providers (n=12)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

NOT MOTIVATED OVER WORKED CONTENTED

41%

34%

25%

ACTIVE LABOUR83%

CONSERVATIVE LABOUR

17%

LABOUR MANAGEMENT

17

Many healthcare providers (89%) said language barrier hindered service delivery

TABLE 2 Influence of language in service delivery in labour ward

LANGUAGE BARRIER HEALTHCARE PROVIDERS

HINDERED SERVICE DELIVERY 10

NO LANGUAGE BARRIER 2

All healthcare providers 100% said culture and traditional practices of women in Narok

district in labour ward hindered services delivery.

Majority (68%) attributed it to FGM, (32%) to gender inequality.

Fig 5 Pie Chart showing influence of culture and traditions in service delivery (n=12).

68%

32%

INFLUENCE OF CULTURE AND TRADITION

FGM

GENDER INEQUALITY

18

Table 3 Check List showing equipment and supplies available in labour ward

Equipment and Supplies Check/Remarks

Delivery beds 3

Number of delivery sets, vaginal specula, tear repair sets 1

Fridge, vaccine carrier with ice packs -N

Adult scale 1

Infant scale 1

BP machine 1

Stethoscope -N

Fetoscopes- Doppler 3

Thermometers -N

Suction machine 1

Resusitation tray -N

Vacuum extractor and set -N

Spotlight 3

Oxygen concentrator 1

Heater for neonates 1

Guidelines for management of obsteric complications,

PMTCT

-N

Drugs: Oxytocin, Magnesium Sulphate

Y

Antibiotics: Gentamicin, Pen G Y

Analgesics: Ibuprofen, Diclofenac Y

Antihypertensive drugs; e.g Hydralazine Y

Sutures and Local Anaesthesia -N

Disinfectant, 3 buckets, Skin didinfection of mothers Y

Autoclave -N

Long glaves Y

Referal system in place? Where? Kijabe

Mission Hosp, MTRH,

KNH

19

Only (33%) of health care providers felt there were adequate supplies in labour ward.

Fig 6 Pie Chart showing timely availability of laboratory results for labour ward.

(n=12)

Majority (67%) said laboratory results were available on time.

Fig 7 Pie Chart showing timely availability of laboratory results for labour ward.

(n=12)

33%

67%

SUPPLIES IN LABOUR WARD

ADEQUATE SUPPLIES INADEQUATE SUPPLIES

67%

33%

LABORATORY RESULTS

AVAILABLE ON TIME

DELAYED

20

4.3 Patient data

Majority (54%) of respondents were Primigravidae.

Fig 8 Pie Chart showing parity of patient respondents in labour ward. (n=34)

Of the multiparous respondents, many (58%) had had home delivery using traditional birth

attendants.

Fig 9 Pie Chart showing method of delivery in multiparous patients (n=15)

54%

46%

PARITY OF RESPONDENTS

PRIMIGRAVIDA

MULTIPAROUS

58%

42%

MODE OF DELIVERY AMONG MULTIPAROUS WOMEN

HOME DELIVERY

HOSPITAL DELIVERY

21

Respondents took an average of 3.6hrs to deliver after arriving at the hospital

Fig 10 Graph showing average number of hours to delivery after arriving at the

hospital (n=34)

Majority of respondents rated services at the labour ward as Affordable.

Table 4 Cost of labour ward services

COST CHEAP AFFORDABLE EXPENSIVE

PATIENTS 0 29 5

Many respondents (65%) rated service offered as Good and 35% thought it was Excellent.

Table 5 Quality of services in labour ward

QUALITY POOR AVERAGE GOOD EXCELLENT

PATIENTS 0 0 22 12

0

1

2

3

4

5

6

7

8

9

0 5 10 15 20 25 30 35 40

(HR

) TO

DEL

IVER

Y O

NC

E IN

HO

SPIT

AL

PATIENTS

22

CHAPTER FIVE

5.0 DISCUSSION

Majority of respondents were in their youth,24 years and were of the Maasai community.

This could be attributed to; Culture and society. Maasai girls are subjected to early

marriages and lack of girl child education [4]

Partographs are widely used to manage labour. This can be attributed to government policy

on protocal adherence, Nurses, doctors and clinicians are well versed with its use and

availability of partographs.[10]

Respondents took an average of 3.6hrs to deliver after arriving at the hospital. This agreed

with a report by Kenyan Ministry of Health titled Safe Motherhood Demonstration Project

Western Province 2004, which found that in: Intrapartum Care: Significantly more providers

are using partograph to manage labour and improved Management of complications. Fewer

women gave birth after more than 12 hours of labour. [10,12]

However few health care providers checked all vitals according to standard protocol citing

lack of instruments such as blood pressure machine, thermometers. [5,6]

Negligence by healthcare providers also played part. This agreed with a study that found

that; the rates of a number of labour and birth practices were inappropriately high, and

differed from WHO guidelines and evidence-based recommendations. [2]

Healthcare providers did not feel motivated to work in labour ward and felt overworked. [5]

Poor enumeration and lack of consistent availability of supplies to facilitate their work were

contributuing factors. There was lack of consistency of supplies in labour ward. This was as

a result of lack of prioritization in funding labour ward by the hospital and sharing of

equipment between different departments leading to inconviniences. [6,9]

Language barrier was a problem in labour ward. Less than half could communicate in both

Kiswahili and English.majority of respondents only apprehended mother-tongue. Maasai

language is widely spoken in Narok and there was lack of adequate formal education. [7]

Home delivery by traditional birth attendants is still widely practiced.[4] There was

availability of trained traditional birth attendants in the villages, influence of traditional

beliefs and practices and inaccessibility of health facility due to poor road

infrastructure.Language barrier hindered service delivery in labour ward. This led to

inaccurate patient history.[3]

Culture and traditional practices in Narok district in labour ward also hindered services

delivery. Consent could only be given by the patients’ husband and Female Genital

Mutilation led to prolonged labour due to altered physiology of delivery. [5,7]

Majority of respondents rated services at the labour ward as Affordable. This was in contrast

to a study done in South African district hospitals. [8]

23

CHAPTER SIX

6.0 CONCLUSION

1. Patients in labour ward are young adults with an age average of 24years.

2. Staff in labour ward are not motivated and feel overworked.

3. There is inconsistency in availability of supplies in labour ward leading to service

delivery inconveniences.

4. Culture and traditional practices in Narok hinder optimum service delivery in labour

ward.

7.0 RECOMMENDATIONS

To Ministry of Medical Services

1. Better pay for Nurses and clinicians

2. Post more doctors, nurses and clinicians to District Hospitals

3. Adequately fund budgets of District Hospitals

To Narok District Hospital

1. Allocate more funds to labour ward for consistent availability of supplies

2. Avail equipments to every department to avoid inconveniences of sharing

To Narok District Community leaders

1. Hold forums to empower women

2. Educate the public on adverse effects of female genital mutilation

3. Encourage women to deliver in hospitals

24

REFERENCES

1. Trends in mortality rate: 1990 to 2008 .Estimates developed by World Health

Organization, UNICEF, UNFPA and The World Bank (2010)

2. Khresheh R, Homer C, Barclays L: A comparison of labour and birth outcomes in

Jordan with W.H.O guidelines. Midwifery,2009 Dec, 25(6)

3. Khayat R, Campbell O: Hospital practices in maternity wards in Lebanon. Health Policy

Plan, 2000 Sep;15(3):

4. Shah IH, Say L (2007). Maternal mortality and maternity care from 1990 to 2005:

uneven but important gains. Reprod Health Matters Nov; 15(30):17-27.

5. M. Hami (2005). The Challenges Facing nurse-midwives in working towards Safe

Motherhood in Malawi. Malawi Medical Journal17 (4): 125-127

6. Nikiema L. (2010). Quality of antenatal care and obstetrical coverage in rural Burkina

Faso. J Health Popul Nutr Feb; 28(1):67-75.

7. Nybro L (1998) How a midwife can change attitudes. Entre Nous Cph Den. Spring

;(38):7.

8. Olukoga A (2007). Unit costs of inpatient days in district hospitals in South Africa.

Singapore Med J. Feb;48(2):143-7.

9. Dohlie MB, Mielke E, Mumba FK, Wambwa GE, Rukonge A, Mongo W et al. Using

practical quality improvement approaches and tools in reproductive health services in

East Africa. Jt Comm J Qual Improv. 1999 Nov;25(11):574-87.

10. Wilson Liambila et al (2004). Kenya Ministry of Health: Safe Motherhood

Demonstration Project Western Province, 2004.

11. Routines in facility-based maternity care. BJOG, 2005 Sep; 112(9):1270-6

12. Spiby H, Green JM et al (2012). Early labour services: Changes, triggers, monitoring

and evaluation. Midwifery. Jul 26.

25

APPENDIX I

TOPIC: ASSESSMENT OF CHALLENGES FACED IN LABOUR

WARD AT N.D.H. MANAGEMENT OF PATIENTS DURING LABOUR AND DELIVERY

Questionnaire: #: To be filled by healthcare providers in labour ward

1. Do you use a partograph for each delivery?

Yes No

2. Are partographs readily available in labour ward?

Yes No

3. Are vital signs (BP, Temp, Pulse, and Respiration) observed according to stand

protocol?

Yes No

If No, why?

4. Are BP machines and thermometers readily available in labour ward?

Yes No

5. Is progress of labour (contractions, descent and dilation) observed according to

partograph?

Yes No

If No, why?

6. Are laboratory results available on time (urinalysis, blood work, GXM, DTC)?

Yes No

7. Do you feel motivated to work in labour ward?

Yes No

8. Are there adequate supplies (drugs, fetoscopes, long gloves, aprons, tear repair sets)

to aid in your efficiency in labour ward?

Yes No

9. Is active management practiced for 3rd stage of labour?

Yes No

If No, what hinders?

10. On average, how many patients do you attend to per day____?

11. Do you feel over-worked?

Yes No

12. Is language barrier a hindrance in service delivery in labour ward?

Yes No

13. Does culture and traditional practices of women in Narok district hinder service

delivery and efficiency in labour ward?

Yes No Give example

26

TOPIC: ASSESSMENT OF CHALLENGES FACED IN THE LABOUR

WARD AT NAROK DISTRICT HOSPITAL. Questionnaire: #: To be filled by patients in labour ward

PATIENTS SATISFACTION DURING LABOUR AND DELIVERY

Correspondent:

1. Name? Age? Address

2. What is your mother tongue?

3. Are you well versed in Kiswahili or English or both?

Kisw. Eng. Both

4. Is this your first delivery?

Yes No

Have you previously delivered at home?

Yes NO

If yes, what reason?

5. Did you face any challenges getting to hospital?

Yes No

If yes, state?

6. Once in maternity approximately how long did it take you before delivering___?

7. Were you able to access adequate pharmacological pain relief during labour?

Yes No

8. How do you rate services in labour ward: a) Expensive

b) Affordable

c) Cheap

9. How would you rate services rendered in labour ward: a) Excellent

b) Good

c) Fair

d) Poor

27

CHECK LIST

Equipment and supplies Check/

Remarks

Delivery beds

Number of delivery sets, vaginal specula

Tear repair sets?

Fridge? Or vaccine carrier with ice packs?

Adult scale

Infant scale

BP machines

Stethoscopes

Fetoscopes - Doppler?

Thermometers

Suction machine

Resuscitation tray

Vacuum extractor and sets

Spotlight

Oxygen concentrator

Heater for neonates

Guidelines for management of obstetric complications, PMTCT

Other guidelines or posters

Drugs: oxytocin (cold??)

Mg Sulphate

RL Other IV solutions

Antibiotics, (Ampi, Genta, Metronidazole, peni G, Chloramphenical)

Pain killers (Ibuprofen, Diclofenac, others)

Antihyertensive drugs p.e. hydralazine

28

Cleaning materials and disinfectant available Chlorine, 3 buckets

Skin disinfection of mothers?

Autoclave

Stove for boiling

Protective wear available? long gloves

Referral system in place?

How many? Why and where?

29

APPENDIX II

1.1 map of the DISTRICT: SHOWING the health services and facilities in the district

1