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Midwife factors associated with targeted postnatal care implementation in health facilities across Kakamega County, Western Kenya
Ruth Shitabule
Abstract
The postnatal period is a critical window for reducing maternal and neonatal morbidity and mortality; however, the quality and completeness of postnatal care remain suboptimal in many low- and middle-income countries. Targeted postnatal care (TPNC), as recommended by the World Health Organization, emphasizes structured, timely, and comprehensive interventions for both mother and newborn. Despite these recommendations, there is limited evidence on the implementation of TPNC and its influencing factors in Kenya. This study aimed to assess the level of TPNC implementation and examine midwife-related factors influencing its delivery in selected health facilities in Kakamega County. A descriptive cross-sectional study design was employed involving 160 midwives. Data were collected using structured interviewer-administered questionnaires and key informant interviews and analyzed using SPSS version 25. Descriptive statistics summarized participant characteristics and levels of TPNC implementation, while regression analysis examined associations between midwife factors and implementation outcomes. The mean age of midwives was 36.76±7.64 years, with the majority being female (76.25%) and diploma-trained (71.25%), and 62.5% having received Emergency Obstetric and Newborn Care (EmONC) training. The mean level of immediate postnatal care implementation was 65.09% (±16.99), indicating suboptimal adherence to recommended guidelines. While moderate proportions of midwives reported performing uterine palpation (56.88%) and supporting early initiation of breastfeeding (61.88%), critical gaps were observed in maternal danger sign assessment (48.13%) and provision of HIV-related health education (20%). Linear regression analysis revealed no statistically significant association between midwives’ sociodemographic characteristics and TPNC implementation (F (5,154) = 0.66, p = 0.650, R² = 0.021), suggesting that individual-level factors may not adequately explain variations in care delivery. This study found that the implementation of targeted postnatal care (TPNC) among midwives in selected health facilities in Kakamega County is suboptimal, particularly in critical components such as maternal danger sign assessment and health education. The study further established that midwives’ sociodemographic characteristics were not significant predictors of TPNC implementation. There is a need for the Ministry of Health and county health departments to strengthen health system capacity by addressing structural barriers such as staffing shortages, workload, and availability of essential resources.
