Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya
The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in weste...
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| description | The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya.
An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed.
During the study period, there was a significant increase in births attended by skilled attendants up to the 12th month (p |
| doi_str_mv | 10.1371/journal.pone.0216158 |
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An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed.
During the study period, there was a significant increase in births attended by skilled attendants up to the 12th month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12th and 18th months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1st to the 18th month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6th month (p<0.05).
The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0216158</identifier><identifier>PMID: 31067241</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Births ; Cesarean section ; Cesarean Section - statistics & numerical data ; Complications ; Delivery, Obstetric - statistics & numerical data ; Fees & charges ; Female ; Finance ; Health care ; Health care facilities ; Health care industry ; Health care reform ; Health facilities ; Health Policy ; Health Services Accessibility - economics ; Health Services Accessibility - organization & administration ; Hospitals ; Humans ; Information systems ; Interrupted Time Series Analysis ; Kenya ; Laws, regulations and rules ; Maternal health services ; Maternal Health Services - statistics & numerical data ; Maternal Mortality ; Medical care utilization ; Medical informatics ; Medicine and Health Sciences ; Midwifery - statistics & numerical data ; Mortality ; Obstetrics ; Patient Acceptance of Health Care - statistics & numerical data ; People and Places ; Pregnancy ; Primary health care ; Time series ; Time series analysis ; User fees ; Womens health]]></subject><ispartof>PloS one, 2019-05, Vol.14 (5), p.e0216158-e0216158</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Owuor, Amolo. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Owuor, Amolo 2019 Owuor, Amolo</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-490380aa1782569e5835e5c83d4f00a0c56768c71a4dd6d6027c126779e1a76b3</citedby><cites>FETCH-LOGICAL-c692t-490380aa1782569e5835e5c83d4f00a0c56768c71a4dd6d6027c126779e1a76b3</cites><orcidid>0000-0003-3659-7227</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506147/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506147/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31067241$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Owuor, Henry</creatorcontrib><creatorcontrib>Amolo, Asito Stephen</creatorcontrib><title>Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya.
An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed.
During the study period, there was a significant increase in births attended by skilled attendants up to the 12th month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12th and 18th months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1st to the 18th month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6th month (p<0.05).
The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.]]></description><subject>Births</subject><subject>Cesarean section</subject><subject>Cesarean Section - statistics & numerical data</subject><subject>Complications</subject><subject>Delivery, Obstetric - statistics & numerical data</subject><subject>Fees & charges</subject><subject>Female</subject><subject>Finance</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health care industry</subject><subject>Health care reform</subject><subject>Health facilities</subject><subject>Health Policy</subject><subject>Health Services Accessibility - economics</subject><subject>Health Services Accessibility - organization & administration</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Information systems</subject><subject>Interrupted Time Series Analysis</subject><subject>Kenya</subject><subject>Laws, regulations and rules</subject><subject>Maternal health services</subject><subject>Maternal Health Services - 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statistics & numerical data</topic><topic>People and Places</topic><topic>Pregnancy</topic><topic>Primary health care</topic><topic>Time series</topic><topic>Time series analysis</topic><topic>User fees</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Owuor, Henry</creatorcontrib><creatorcontrib>Amolo, Asito Stephen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Owuor, Henry</au><au>Amolo, Asito Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-05-08</date><risdate>2019</risdate><volume>14</volume><issue>5</issue><spage>e0216158</spage><epage>e0216158</epage><pages>e0216158-e0216158</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya.
An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed.
During the study period, there was a significant increase in births attended by skilled attendants up to the 12th month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12th and 18th months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1st to the 18th month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6th month (p<0.05).
The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31067241</pmid><doi>10.1371/journal.pone.0216158</doi><tpages>e0216158</tpages><orcidid>https://orcid.org/0000-0003-3659-7227</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Births Cesarean section Cesarean Section - statistics & numerical data Complications Delivery, Obstetric - statistics & numerical data Fees & charges Female Finance Health care Health care facilities Health care industry Health care reform Health facilities Health Policy Health Services Accessibility - economics Health Services Accessibility - organization & administration Hospitals Humans Information systems Interrupted Time Series Analysis Kenya Laws, regulations and rules Maternal health services Maternal Health Services - statistics & numerical data Maternal Mortality Medical care utilization Medical informatics Medicine and Health Sciences Midwifery - statistics & numerical data Mortality Obstetrics Patient Acceptance of Health Care - statistics & numerical data People and Places Pregnancy Primary health care Time series Time series analysis User fees Womens health |
| title | Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya |
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