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      Association between person‐centered maternity care and newborn complications in Kenya

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          Abstract

          Objective

          Despite the recognized importance of person‐centered care, very little information exists on how person‐centered maternity care ( PCMC) impacts newborn health.

          Methods

          Baseline and follow‐up data were collected from women who delivered in government health facilities in Nairobi and Kiambu counties in Kenya between August 2016 and February 2017. The final analytic sample included 413 respondents who completed the baseline survey and at least one follow‐up survey at 2, 6, 8, and/or 10 weeks. Data were analyzed using descriptive, bivariate, and multivariate statistics. Logistic regression was used to assess the relationship between PCMC scores and outcomes of interest.

          Results

          In multivariate analyses, women with high PCMC scores were significantly less likely to report newborn complications than women with low PCMC scores (adjusted odds ratio [ aOR] 0.39, 95% confidence interval [ CI] 0.16–0.98). Women reporting high PCMC scores also had significantly higher odds of reporting a willingness to return to the facility for their next delivery than women with low PCMC score ( aOR 12.72, 95% CI 2.26–71.63). The domains of Respect/Dignity and Supportive Care were associated with fewer newborn complications and willingness to return to a facility.

          Conclusion

          PCMC could improve not just the experience of the mother during childbirth, but also the health of her newborn and future health‐seeking behavior.

          Abstract

          Higher person‐centered maternity care is associated with lower levels of reported newborn complications and higher levels of willingness to return to the health facility.

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          Most cited references9

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          Exploring the Prevalence of Disrespect and Abuse during Childbirth in Kenya

          Background Poor quality of care including fear of disrespect and abuse (D&A) perpetuated by health workers influences women’s decisions to seek maternity care. Key manifestations of D&A include: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in facilities. This paper describes manifestations of D&A experienced in Kenya and measures their prevalence. Methods This paper is based on baseline data collected during a before-and-after study designed to measure the effect of a package of interventions to reduce the prevalence of D&A experienced by women during labor and delivery in thirteen Kenyan health facilities. Data were collected through an exit survey of 641 women discharged from postnatal wards. We present percentages of D&A manifestations and odds ratios of its relationship with demographic characteristics using a multivariate fixed effects logistic regression model. Results Twenty percent of women reported any form of D&A. Manifestations of D&A includes: non-confidential care (8.5%), non-dignified care (18%), neglect or abandonment (14.3%), Non-consensual care (4.3%) physical abuse (4.2%) and, detainment for non-payment of fees (8.1). Women aged 20-29 years were less likely to experience non-confidential care compared to those under 19; OR: [0.6 95% CI (0.36, 0.90); p=0.017]. Clients with no companion during delivery were less likely to experience inappropriate demands for payment; OR: [0.49 (0.26, 0.95); p=0.037]; while women with higher parities were three times more likely to be detained for lack of payment and five times more likely to be bribed compared to those experiencing there first birth. Conclusion One out of five women experienced feeling humiliated during labor and delivery. Six categories of D&A during childbirth in Kenya were reported. Understanding the prevalence of D&A is critical in developing interventions at national, health facility and community levels to address the factors and drivers that influence D&A in facilities and to encourage clients’ future facility utilization.
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            Patient-centered care is associated with decreased health care utilization.

            This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization. Five hundred nine new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were their use of medical services and related charges monitored over 1 year. Controlling for patient sex, age, education, income, self-reported health status, and health risk behaviors (obesity, alcohol abuse, and smoking), a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care (P = .0209), less frequent hospitalizations (P = .0033), and fewer laboratory and diagnostic tests (P = .0027). Total medical charges for the 1-year study were also significantly reduced (P = .0002), as were charges for specialty care clinic visits (P = .0005), for all patients who had a greater average amount of patient-centered visits during that same time period. For female patients, the regression equation predicted 15.47% of the variation in total annual medical charges compared with male patients, for whom 31.18% of the variation was explained by the average percent of patient-centered care, controlling for sociodemographic variables, health status, and health risk behaviors. Patient-centered care was associated with decreased utilization of health care services and lower total annual charges. Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered.
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              Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population

              Background Person-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya. Methods We followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability. Results The exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity. Conclusions We present a 30-item scale with three sub-scales to measure person-centered maternity care. This scale has high validity and reliability in a rural and urban setting in Kenya. Validation in additional settings is however needed. This scale will facilitate measurement to improve person-centered maternity care, and subsequently improve reproductive outcomes. Electronic supplementary material The online version of this article (10.1186/s12978-017-0381-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                msudhinaraset@ucla.edu
                Journal
                Int J Gynaecol Obstet
                Int J Gynaecol Obstet
                10.1002/(ISSN)1879-3479
                IJGO
                International Journal of Gynaecology and Obstetrics
                John Wiley and Sons Inc. (Hoboken )
                0020-7292
                1879-3479
                09 October 2019
                January 2020
                : 148
                : 1 ( doiID: 10.1002/ijgo.v148.1 )
                : 27-34
                Affiliations
                [ 1 ] Jonathan and Karin Fielding School of Public Health University of California, Los Angeles (UCLA) Los Angeles CA USA
                [ 2 ] School of Medicine Institute for Global Health Sciences University of California, San Francisco (UCSF) San Francisco CA USA
                [ 3 ] Innovations for Poverty Action Nairobi Kenya
                Author notes
                [*] [* ] Correspondence

                May Sudhinaraset, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

                Email: msudhinaraset@ 123456ucla.edu

                Article
                IJGO12978
                10.1002/ijgo.12978
                6939318
                31544243
                2b9cdaf0-bb0a-4307-8b81-bec40095a87e
                © 2019 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 February 2019
                : 25 June 2019
                : 20 September 2019
                Page count
                Figures: 1, Tables: 5, Pages: 8, Words: 4885
                Funding
                Funded by: Bill and Melinda Gates Foundation , open-funder-registry 10.13039/100000865;
                Categories
                Clinical Article
                Clinical Articles
                Obstetrics
                Custom metadata
                2.0
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.3 mode:remove_FC converted:17.12.2019

                Obstetrics & Gynecology
                health‐seeking behaviors,kenya,neonatal health,person‐centered maternity care,quality of care

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