Institutional factors associated with preconception care in Kenya

Background/Aims Preconception care aims to address issues that could affect pregnancy outcomes. However, in Kenya, many women do not seek care until after conception and so do not receive the benefits of these services. The aim of this study was to determine institutional factors correlated with the use of preconception care at Thika Level Five Hospital. Methods This descriptive cross-sectional mixed-methods study collected data from 316 systematically sampled women of reproductive age and 16 purposively sampled key informants (healthcare professionals) at Thika Level Five Hospital in Kenya. Quantitative data were collected using an interviewer-administered questionnaire and analysed using multivariate analysis. Qualitative data were gathered through in-depth interviews and analysed thematically. Results Half of the women of reproductive age were unaware that the hospital offered preconception care services (50.3%), although the majority had received one or more interventions (62.0%). These participants highlighted that use of preconception care was influenced by long queues (67.4%), lack of awareness (50.3%), the cost of reproductive health services (52.8%) and the distance to the health facility (52.2%). Those who were unaware of the preconception care services offered (P=0.005) and who believed that long queues impacted use (P=0.049) were less likely to use preconception care services. Healthcare professionals reported a lack of knowledge about preconception care and felt they would require training before they could provide these services. These participants reported that factors influencing the provision of preconception care included staff shortages, as well as a lack of dedicated space and clear policies/guidelines. Conclusions Healthcare professionals' lack of knowledge is a major barrier to the provision of preconception care services and needs to be addressed, as does the lack of awareness of these services among women of reproductive age. Institutional factors, such as the long queues and cost of services in hospitals, also prohibit women from engaging with preconception care services. Implications for practice Healthcare professionals should be trained on preconception care to bridge the knowledge gap and promote awareness among women of reproductive age. Human resource and infrastructure challenges must be addressed to reduce long queues at the hospital and enhance use of preconception care. Specific guidelines on preconception care for healthcare professionals will also have an important role in implementation of services.