Factors Influencing Adherence to National Guidelines on Emergency Obstetric Care and Associated Outcomes among Pregnant Mothers and Newborns in Samburu Central Sub-County, Kenya

Maternal mortality in Kenya stands at about 500 deaths per 100,000 live births. This suggests that Kenya’s efforts towards reducing maternal mortality ratio has not yielded gains and still remains unacceptably high whereas the government has been providing free maternity services in the last three years. This has failed to deliver substantial reduction in high maternal and perinatal mortality in the country. This means that government efforts to attain MDG’s target of reducing MMR by 75% by 2015 were not possible. However it was not quite clear how this had influenced adherence to National Guidelines on Emergency Obstetric Care and Associated Health outcomes among pregnant Mothers and Newborns in Samburu Central Sub-county among parents, politicians and other stake holders in Health sector. The broad objective of the study was to determine factors associated with adherence to national guidelines on emergency obstetric care and the associated health outcomes among pregnant mothers and newborns in Samburu central sub-County. The study adopted a descriptive cross-sectional design. Six public health facilities offering maternity services were involved in this study. A total of 990 files of mothers who had delivered between June and September 2016 were surveyed. This included an average of 165 per month .The questionnaires used in the study were piloted and validated before use. The data collected was analyzed using statistical package for social sciences. The results of the study showed that out of the six health facilities the were five Basic emergency obstetric care (83.3%) namely Kisima Model Health centre, Loosuk health centre, Porror dispensary,Lolmolog dispensary and Suguta Marmar health centre while Maralal county referral hospital(16.7%) provided Comprehensive emergency obstetric cares services within the sub county and the whole county. Maralal county referral hospital had many personnel compared to other health facility. In addition it was the main facility where there many midwives and personnel trained on EMOC.The national and county government in implementation of free maternity by provision of waiver fee, medicines , incubators, delivery coaches, sanitary towels , other non-pharmacologic equipment to the facilities and 24 Hours Free Ambulance Services. The main challenges faced by the health workers in provision of services in their facilities was shortage of staff, long distance for mothers who live far from the facility attributed by poor means of communication and referral fee to the main hospital. There was need for further improvement of the emergency obstetric care services within the sub-County are needed by regular training and updating staff on new protocols in emergency obstetric care , provision of maternity equipment, regular/consistent supply of drugs and upgrading another facility to provide comprehensive emergency obstetric care services.Out of 990 pregnant mothers who delivered in the six health facilities the main health outcomes encountered were obstructed labour, antepartum and postpartum hemorrhage. The National/county government level has a mandate and an obligation to employ more staff and collaborate with other stakeholders and encourage ensuring that the health facilities have enough trained staff to provide services to the respective locations or areas of their operations. The government through the free maternity countrywide should support in supply of maternity equipment to every facility with maternity services. The sub- County ward administrators together with the political fraternity should be in the fore front of encouraging the community to utilize the existing facilities within their locality to encourage pregnant mothers to come to and deliver in the health facility.