Health-System Predictors of Maternal and Perinatal Health Outcomes among Perinatal Women in Public Health Facilities in Mombasa County, Kenya
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Abstract
Maternal and perinatal outcomes in low- and middle-income countries remain poor despite increased service coverage, reflecting health system constraints in service delivery. This study examined health system-related predictors of reported outcomes in public health facilities in Mombasa County, emphasizing responsiveness, access, clinical practices, and resources. A cross-sectional mixed-methods study was conducted across three public facilities (tertiary, secondary, and primary levels). Responses were obtained from 157 perinatal women, 23 healthcare providers, and 12 key informants out of 208 targeted (92.3% response rate). Quantitative data were analyzed using descriptive statistics, Mann–Whitney U tests, chi-square tests, and multivariable logistic regression. Qualitative data were analyzed thematically. Adjusted odds ratios (AORs) indicated the likelihood of favorable outcomes. Perinatal complications were common (69% of women), and over half reported recent facility-based maternal deaths. In adjusted analyses, favorable perinatal outcomes were significantly associated with culturally responsive care (AOR = 2.60; p = 0.040), timely access (AOR = 3.91; p = 0.012), geographical accessibility (AOR = 3.92; p = 0.011), adequate clinical care/decision-making (AOR = 4.50; p = 0.013), and availability of medical supplies and equipment (AOR = 3.23; p = 0.006). Supply and equipment availability was also associated with reduced likelihood of reported maternal deaths (AOR = 3.15; p = 0.003). Qualitative findings corroborated these results, highlighting emergency care delays, essential supply shortages, and inconsistent respectful care as key health system barriers. Maternal and perinatal outcomes in public facilities are strongly associated with health system performance, particularly timeliness, clinical competence, and resource availability. Strengthening these domains alongside culturally responsive delivery may substantially improve outcomes in similar urban settings.
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