1. Felarmine Muiruri Dr. Joachim Osur Prof. Okello Agina

2.  Kenya is 11 th country with the highest maternal mortality worldwide. (WHO, 2010).  MMR was 414 in 2003 and 488 in 2008 (KDHS).  More than a third of obstetric deaths are due to bleeding (Shakur et al., 2010).  The majority of these deaths occur within 4 hours of delivery. (Leduc at el., 2009)  AMTSL decrease PPH by 66%. (Khan et al., 2006).  Practice of AMTSL recommended by FIGO, ICM, WHO & DRH to prevent PPH.

3.  In Kiambu county 6 women die per month on average. (Districts quarterly reports,2011)  Information gap on implementation of AMTSL and factors necessary for the implementation.  73% of women deliver in health facilities.  AMTSL components Administration of oxytocin Controlled cord traction Immediate uterine massage Subsequent uterine massage

4. Broad : To assess the determinants of utilization of AMTSL by birth attendants in Kiambu County Specific:  To establish AMTSL utilization status in Kiambu County.  To determine the health facility factors that influence utilization of AMTSL in Kiambu County.  To determine the birth attendant factors that influence utilization of AMTSL in Kiambu County.

6. Study design: Cross-sectional study. Study population:431 Birth attendants working in maternity units in 52 maternity units. Area of study: Kiambu county maternity units. Sample Size:203 calculated using Fisher et al. formula Methodology

7. Sampling method: Multistage 1 st – Stratification by type and level of facilities 2 nd –Clustering by specific health facilities Data collection tools: Questionnaires and observation check lists. Data analysis: STATA version 11 software. Chi square, Fisher’s exact and logistic regression. Confidence level 95%. Methodology Cont…

9. VariableCategoryFrequencyPercent SexFemale16681.8 Male3718.2 Age in years21-306532.0 31-407135.0 41-505125.1 51-60167.9 ProfessionNurse/midwife18892.6 Clinical officer157.4 Level of education Certificate5627.6 Diploma14069 Degree73.4

10. Tanzania (7%) and Ethiopia (4.5%) (Stanton C., at el.,2009)

13. OR =0.502 p=0.006 LR (OR 0.502 P= 0.006)

14. χ² ( P<0.001) LR (OR=5.241 P<0.001)

15. (χ² ( P<0.001) LR (OR= 7.799 P=<0.001) Availability of a fridge

16. χ² (P<0.001) LR(OR=3.037, P<0.001)

17. Availability standards documents/ level Govt L3 (n=70) Govt L4 (n=53) FBO L3 (n=21) FBO L4 (n=34) PRV L3 (n=17) PRV L4 (n=8) Available 7.1%17.0%9.5%5.9%0.0% Not available 92.9%83.0%90.5%94.1%100.0%100%

18. (Fisher’s exact 0.040). LR (P=0.062)

19. LR(P =0.893)

20. Training/ Type of Training UtilizedDid not utilizeStatistical values Trained(n=120)44.2%55.8%Fisher’s exact 0.001 LR (OR=5.178, P<0.001) Not trained (n=83)13.2%86.8% In-service(n=92)39.1%60.9%χ² (P=0.044) LR (OR=2.404 P=0.047,) Pre-service (n=28)60.7%39.3%

23. Knowledge of AMTSL UtilizedNot utilizedStatistical values Knew (n=57)56.1%43.9%χ²( P<0.001) LR (OR=4.56, P<0.001) Did know(n=146) 21.9%78.1% Total31.5%68.5%

26.  Most of the birth attendants in Kiambu county do not utilize AMTSL.  There is discrepancy in utilization of AMTSL among birth attendants working in different facility levels and types.  Availability of AMTSL guidelines, Pre-service training and knowledge of AMTSL components have positive influence on utilization of AMTSL.

27.  The county government should put strategies to increase utilization of AMTSL in level three and private facilities.  Heads of facilities should ensure AMTSL standards documents are available in labour ward.  Stakeholders in health training should structure In-service training of birth attendants on AMTSL

28. Thank you!