Influence of organizational and access factors on adherence to appointments in antenatal clinics in Homa Bay and Kisumu County Referral Hospitals, Kenya

Abstract

Introduction: the world wastes about 40% of health resources, and African medical setting has about 42% missed appointment rate. Kenya has 44% missed appointment rate in antenatal clinics, wasting about 22% of health resources. Five hundred and two thousand eight hundred and sixty (502,860) children were not immunized in 2017. Homabay and Kisumu Counties with 91/1000 and 149/1000 under-five mortality rates, recorded 42% and 35% missed appointment rates in antenatal clinics respectively in 2019. This study assessed influence of organizational and access factors on adherence to appointments in antenatal clinics. Methods: the study adopted cross-sectional research design across two hospitals, purposively sampled (Homabay and Kisumu County Hospitals) because of high under-five mortality and high HIV prevalence rates. Stratified and proportionate sampling were used to sample patients, and purposive sampling for hospital managers. Yamane Formula was used to determine sample size. The study comprised 133 antenatal patients (Homabay County Hospital 70, Kisumu County Hospital 63) and two hospital managers per hospital. Self- administered structured questionnaire and key informant interview were used to collect data. Results: study revealed in Homabay and Kisumu County hospitals respectively, as follows: 55 (78.6%) and 35 (70%) antenatal clients missed their appointments because of waiting time; 55 (78.6%) and 30 (60%) due to facility operating hours; and 55 (78.6%) and 25 (50%) due to opportunity cost of seeking services; and 55 (78.6%) and 20 (40%) due to facility proximity. Conclusion: there is high missed appointment rates in antenatal clinics in Homabay and Kisumu County hospitals because of poor organization of antenatal services, opportunity cost and facility location.