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Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya
Thesis (PhD)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867613823430557696 |
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| access_status_str | Open Access |
| author | Mulongo, Samuel Mmbasu |
| author2 | Kaura, Doreen Kainyu |
| author_browse | Kaura, Doreen Kainyu Mulongo, Samuel Mmbasu |
| author_facet | Kaura, Doreen Kainyu Mulongo, Samuel Mmbasu |
| author_sort | Mulongo, Samuel Mmbasu |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/128354 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:42:15.919Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/128354 Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya Mulongo, Samuel Mmbasu Kaura, Doreen Kainyu Mash, Bob Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery. Maternal health services -- Kenya Continuity of patient care -- Kenya Pregnancy -- Complications -- Kenya Labor (Obstetrics) -- Complications -- Kenya UCTD Thesis (PhD)--Stellenbosch University, 2023. ENGLISH SUMMARY: Background: For every woman who dies during birth, approximately 20 women will experience a near-death experience. The highest determinants of this experience include morbidities such as eclampsia, severe pre-eclampsia, severe postpartum hemorrhage, and sepsis. These survivors often come from socio-economically disadvantaged families and backgrounds, yet what is less discussed is the impact that severe maternal illnesses have on a woman’s overall physical, mental, and social health, as well as her ability to participate in activities for social and economic gain. More critically, these experiences represent an opportunity for maternal healthcare providers, policymakers, and researchers to design interventions that are based on an understanding of the pathways that lead to the near-death experience and, ultimately, to mortality. Such an approach is based on the principles of experience-based participatory design (EBPD) and co-design in health systems. Central in this pathway are continuity and coordination of care. Continuity and coordination are considered central elements for person-centered care in the WHO operational framework for primary health care. They represent a re-orientation of behavioral and organizational practices to prevent fragmentation of health services and foster person-centered care. Therefore, this research contributes to the development of maternal health systems by drawing on the experiences and perspectives of women and health care providers to understand the difficulties that women experience in obtaining health care, with specific emphasis on continuity for effective coordination. Research aim: The aim of this doctoral research was to analyse the determinants of obstetric near-miss cases while exploring the activities that influenced the continuity and coordination of care processes during pregnancy, birth, and postpartum in the rift valley region of Kenya. Further, to use this information to develop a conceptual framework that informs continuity for effective care coordination. Methods: The overall design was mixed methods explanatory sequential design. The first phase comprised two quantitative studies. The first study assessed the burden and determinants of near obstetric miss in a major referral hospital within the study area. The second quantitative study compared self-reported continuity and coordination between near-miss and non-near-miss cases. Findings from the two studies informed sampling and development of the interview guide for data collection in the qualitative strand. The second phase comprised a single qualitative study that assessed the perceptions of near-miss survivors and health care providers on continuity and coordination of care. The third phase involved mixed methods integration and the development of a conceptual framework that depicts areas of intervention for enhancing continuity and coordination of care based on the obstetric near-miss approach. Integration of results enabled a deeper understanding of continuity and coordination elements that lead to the occurrence of obstetric near misses within and between the care facilities. Findings: Integration of quantitative and qualitative results enabled the development of a conceptual framework for continuity for effective coordination of care. The framework consists of the following core concepts (1) Obstetric near-miss results from a network of activities and service relationships (2) The mode of operation influences the network of activities (3) Collective actions should be emphasized in equal measure as individual actions (4) Material mediators are more critical for parallel coordination (5) Immaterial mediators influence sequential coordination and continuity of care (6) Socio-economic context influences continuity and coordination (7) Relational and longitudinal continuity are complementary (8) Continuity impacts on coordination of care (9) Behavioural and cognitive aspects are as important as technical and infrastructural aspects (10) Community follows up is an important element of parallel coordination (11) Inequitable distribution of resources at the subnational level is ubiquitous and should be addressed. Conclusion and recommendations: Based on the results of this study, the following are recommended for enhancing continuity and coordination based on the obstetric near-miss experience: (1) Reduce or eliminate out-of-pocket costs for specialist consultation (2) strengthen emergency transport services and discourage ineffective workarounds (3) promote situational awareness, teamwork, and collaboration among nurses and midwives during emergencies (4) pilot novel care coordination roles in maternal health care such as case and care managers, and system navigators (5) effectively manage maternal anemia (6) encourage contextualized accommodation strategies such as telephone hotlines (7) strengthen community-based follow up for identified high-risk women as part of parallel coordination (8) address resource inequities at sub-national level (8) promote antenatal care by the same team of providers across pregnancy and (10) optimize workloads, staffing, and task shifting. AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar. Doctoral 2023-01-30T08:02:22Z 2023-08-30T13:05:30Z 2023-03-30 2023-01-30T08:02:22Z 2023-08-31T09:18:27Z 2023-01-30T08:02:22Z 2023-08-31T09:18:27Z Thesis https://scholar.sun.ac.za/handle/10019.1/128354 en Stellenbosch University application/pdf vi, 221 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Maternal health services -- Kenya Continuity of patient care -- Kenya Pregnancy -- Complications -- Kenya Labor (Obstetrics) -- Complications -- Kenya UCTD Mulongo, Samuel Mmbasu Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title | Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title_full | Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title_fullStr | Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title_full_unstemmed | Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title_short | Evaluating coordination and continuity of care for obstetric near miss cases : a mixed methods study in Kenya |
| title_sort | evaluating coordination and continuity of care for obstetric near miss cases a mixed methods study in kenya |
| topic | Maternal health services -- Kenya Continuity of patient care -- Kenya Pregnancy -- Complications -- Kenya Labor (Obstetrics) -- Complications -- Kenya UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/128354 |
| work_keys_str_mv | AT mulongosamuelmmbasu evaluatingcoordinationandcontinuityofcareforobstetricnearmisscasesamixedmethodsstudyinkenya |