Health facility factors associated with targeted postnatal care implementation in health facilities across Kakamega County, Western Kenya

Resumo

The postnatal period is a critical window for reducing maternal and neonatal morbidity and mortality; however, the quality and completeness of postnatal care remain suboptimal in many low- and middle-income countries. Targeted postnatal care (TPNC), as recommended by the World Health Organization, emphasizes structured, timely, and comprehensive interventions for both the mother and newborn. Despite increased facility-based deliveries in Kenya, gaps persist in the implementation of recommended postnatal care interventions, particularly at the facility level. This study aimed to assess facility factors influencing the implementation of TPNC in selected health facilities in Kakamega County, Kenya. A descriptive and analytical cross-sectional study was conducted among 160 midwives in selected public health facilities. Data were collected using structured interviewer-administered questionnaires and facility assessment checklists. Quantitative data were analyzed using SPSS version 25. Descriptive statistics summarized facility characteristics and levels of TPNC implementation, while linear regression analysis was used to determine the influence of facility-level factors. Statistical significance was set at p < 0.05. The results showed that facility capacity factors significantly influenced TPNC implementation (F(7,2)=27.36, p=0.038, R²=0.99). Availability of essential equipment, drugs, and supplies (B=0.58, p=0.026), as well as capacity for laboratory services (B=0.48, p=0.014), were positively associated with improved implementation. Similarly, management and staffing factors significantly predicted TPNC implementation (F(9,150)=14.67, p<0.0001, R²=0.467), with the number of midwives providing services (B=7.14, p=0.001) and supportive supervision with feedback (B=5.50, p=0.003) emerging as key determinants. It was concluded that high workload and space inadequacy were not statistically significant predictors. This study recommended that strengthening health facility capacity through improved resource allocation, workforce optimization, and enhanced supervision mechanisms is essential to improve adherence to postnatal care guidelines and maternal–newborn outcomes.