SERVICE PROVIDER PERCEPTION ON THE DETERMINANTS OF PERINEAL TEARS AMONG MOTHERS HAVING FIRST DELIVERY IN KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA.
By ODHIAMBO VINCENT OMONDI, LUSWETI PROTUS OLUTENDE, MUSYOKI ELIZABETH, BII FAITH CHEPKOECH
ABSTRACT
This was a cross-sectional descriptive institutional based qualitative and quantitative study toestablish service provider perception on the determinants of perennial tears among mothershaving first delivery in Kenyatta national hospital, Nairobi, Kenya.
The main purpose of this study was to find out what caused these perennial tears from theservice providers' point of view and the influential factors behind them. Perennial tear refers to the rending of tissues between the vulva and the anal canal. Thiscommonly occurs among mothers having first delivery and the degree of tear ranges from lesssevere tears (first degree) to very severe tears (fourth degree).
The study was composed of 47 randomly selected service providers giving services in KNHdelivery unit. A self administered pretested structured questionnaire was used by two researchassistants to collect data from them.Cleaned data was then stored in SPSScomputer package for analysis using descriptive andinferential statistics.Ethical considerations and study limitations were taken into account. The study tookapproximately 16 weeks at a cost of Ksh. 56,200.
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Majority of the service providers (89.3%) were aged above 30 years hence more experienced.60% stated that they were motivated to work. The motivating factors included locums, day-offs,seminars and personal gratification. Most respondents were nurses (76.6%). The numbers ofdoctors was higher than the number of Clinical Officers. Those with Diplomas were the majority(55.3%) though there were also a significant number of those with Bachelors (40.4%) and Postgraduate Degrees (4.3%).70.2% of the respondents had special training in pregnancy care related fields or obstetrics andgynecology. There were challenges associated with these tears such as extensive tears,difficulty in repair of the tears and delayed episiotomies. These challenges are mainlyassociated with the overwhelming number of patients and inefficient supplies.Poor communication among the service providers or between the service providers and thepatients contribute to high incidence of perennial tears. 62% of the service providers believe thatthe policies put in place by the hospital and the Ministry of Health are not effective when itcomes to dealing with perennial tearsMajority of the health workers had a negative perception on the determinants of perennial tearsamong mothers having first deliveries. This is attributed to inadequate resources, lack ofmotivation, inefficient communication channels and client cultural factors such as FGM.
Multiparity, accessibility to ANC services and education were perceived to minimize theincidence of perennial tears.
To improve the quality of services and ensure that health workers have a positive perception,we recommend that more specialized service providers be hired and emphasis be put onfactors which can help reduce the incidence of the perennial tears.