Psychosocial Determinants of Elective Cesarean Section Deliveries in Selected Obstetric Facilities in Nairobi, Kenya

摘要: Psychosocial Determinants of Elective Cesarean Section Deliveries in Selected Obstetric Facilities Nairobi, Kenya by Tom Joseph Oguta MS, University 2002 BS, Kenyatta University, 1995 Dissertation Submitted Partial Fulfillment the Requirements for Degree Doctor Philosophy Public Health Walden July 2015 Abstract section (CS) rates have generally increased across world past decade. Reducing elective cesarean (ECS) is imperative as many countries aim to maintain threshold CS at or below 15%, level recommended United States’ National Institutes Health. Women are believed consider ECS various interconnected psychosocial reasons, but few quantitative studies investigated theseCesarean these factors. This prospective cohort study was based on social ecological model (SEM) and theory planned behavior (TPB) models, identified predictors among 1,268 expectant women 2 hospitals Nairobi. Participants completed a structured questionnaire consisting 10 validated scales were followed actual mode delivery (MoD) from hospital records postnatal telephone interviews. The overall prevalence 16.0% 6.4%, respectively; rate not statistically higher than 15% (p > 0.05). combined incidence 83 per 1,000 births month. Autonomy, fear childbirth, pregnancy related anxiety, perceived support friends, outcome expectancy birth significant ECS, given parity age first pregnancy, χ (df = 19) 77.735, p<.001; Nagelkerke R .170. results change implications finding ways reduce tocophobia managing expectations negative outcomes improving friends during labor. Recommendations include greater consideration status prenatal lessons more accurate information risks benefits both spontaneous vaginal delivery. Dedication To my mother father, Mama Jenipher Anyango Jaduong’ Ezekiel Kiria, who set me forth into struggles this life: Although learned yourselves, ember you lit kept burning. Your conviction that knowledge power, it possible reach premiere heights, propelled finale. It distant dream fulfilled. immediate family dear wife Hellen, girls Laura Valerie, boys Jeremy Rabala; your invariable emotional provided compelling solace impetus towards success long expedition all stages. life-long teachers different levels Odida Togo primary, Odhiambo Charly Secondary, Dr. Kuloba Undergraduate Omwega Postgraduate; prepared level. kins Ooro, Owadi, Owago, Odundo, Nanga, Bando, King’ori, Obiny, Ouma, Ochieng, Ongoro, Agido, Odongo, Jossy, Okoth, Pamela, Akinyi, Adiko, Ahono, Borle; valuable encouragement period. Acknowledgments I express sincere thanks providing with such an opportunity be scholar-practitioner, program wonderful. constructive facilitation University’s faculty made coursework interesting rich knowledge. thank former current employersKenya Industrial Research & Development Institute (K.I.R.D.I.), Food Security Nutrition Analysis Unit (FSNAU), Agriculture Information System (AFIS) Organization (FAO), source income financed placing food table. environment facilities offered journey most appreciated. am indebted diligent Committee members Rodney Lemery, Cassandra Arroyo Aaron Mendelsohn their technical guidance scholarly advice stages work. equally thankful Prof. Koigi Kamau Nairobi Hospital (UoN/KNH) supervising research. In spite busy office, curative lecturing duties they could always attend when called upon. Their mentorship, stewardship hints entire work possible. grateful Directors, Matrons, Nurses Workers Pumwani Maternity Clinics; cooperation assistance getting participants interviews commendable.