THE EFFECTIVENESS OF THE BEYOND ZERO CAMPAIGN IN THE REDUCTION

OF MATERNAL MORTALITY RATE IN THIKA SUB-COUNTY.

CHAPTER ONE: INTRODUCTION

Background of study

Maternal mortality is a sentinel event that is used around the world to monitor maternal
health, the overall quality of reproductive health care, and countries' progress toward
international development goals. Maternal mortality refers to deaths occurring among pregnant
mothers during pregnancy or postnatal which are from any cause related to or aggravated by the
pregnancy or its management, but not from accidental or incidental causes. Maternal death
occurs when a woman dies while pregnant or within 42 days of having her pregnancy terminated.
Every year, approximately 140 million babies are born (Geller et al., 2018).
Complications during and after pregnancy and childbirth claim the lives of women. The
majority of these complications occur during pregnancy and are either preventable or treatable.
Other complications may exist prior to pregnancy but are exacerbated during pregnancy,
particularly if not managed as part of the woman's care. Severe bleeding, postpartum
hemorrhage, puerperal sepsis, and hypertensive disorders of pregnancy, pre-eclampsia and
eclampsia, complications from delivery, and unsafe abortion account for nearly 75 percent of all
maternal deaths. The remainder are caused or associated with infections such as malaria, or with
chronic conditions such as cardiac disease or diabetes (WHO, 2019).
Beyond Zero is a charitable organization founded in January 2014. Inspired by the
realization and knowledge that maternal and child deaths are avoidable, Beyond Zero is a call to
action for policy prioritization and formulation, increased resource allocation, improved service
delivery, and improved individual health seeking behaviors and practices. Beyond Zero uses its
convening power to bring to light key issues confronting Kenyans and to build strategic
partnerships to address these issues through this high-level advocacy platform (Muriuki, 2016).
The Beyond Zero campaign aimed to increase access to maternal care for mothers in
outlying areas, villages, and remote regions where mothers did not have easy access to maternal
care. The beyond zero trucks were outfitted with proper observation facilities, allowing mothers
to have safe deliveries. It is also equipped to provide both pre-natal and post-natal care. Beyond
zero collaborated on this project, which was then handed over to county governments. A total of
47 units have been handed over to the 47 county governments (Wairoto et al., 2020).

Problem statement
Maternal mortality remains one of the world's most pressing public health issues. In
2017, approximately 295,000 women died during and after pregnancy and childbirth. The vast
majority of these deaths (94 percent) occurred in low-resource settings, and the vast majority of
them could have been avoided. Kenya's government abolished maternity fees in all government
hospitals in June 2013. While this increased access to hospitals, cost is not the only factor
impeding the use of health-care delivery services. Maternal and neonatal deaths in Kenya have
been blamed on a variety of factors, including a lack of transportation, long distances to health
centers, inadequately equipped health facilities, poor quality of care in health facilities, and
traditional and cultural practices. The Beyond Zero campaign was intended to address, among
other issues, transportation accessibility.

Study Justification
The Beyond Zero campaign, like other interventions, was founded on the idea that "no
woman should die while giving birth." Six years later, this research aims to determine the
effectiveness of the campaign in reducing maternal mortality while also informing policy
decisions that can be made to improve the program's effectiveness.

Objectives
Broad Objective
1. To investigate the effectiveness of the beyond zero campaign in the reduction of maternal
mortality rate

Specific Objectives
i. To investigate the role of beyond zero campaign in reduction of maternal
mortality rate.
ii. To determine the preventive health strategies employed by the Beyond Zero
Campaign.
 iii. To find out the effectiveness of strategies employed by beyond zero campaign in
reduction of materiality rate.
Research questions
i. What is the role of beyond zero campaign in reduction of maternal mortality rate?
ii. How effective are the strategies employed by beyond zero campaign in reduction
of materiality rate?
iii. What are the preventive health strategies employed by the Beyond Zero
Campaign?
 CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
According to UNAIDS journal titled “New “Beyond Zero Campaign” to improve maternal and
child health in Kenya,” fifteen of women die everyday due to pregnancy related complications
and 20% of all deaths among mothers in the country are AIDs-related. In order to reduce such
high maternal mortality rate in Kenya, Kenya’s first lady, Margaret Kenyatta launched an
initiative dubbed as “Beyond Zero Campaign” in 2014. This initiative was also aimed at
reducing HIV prevalence. The initiative was also launched as part of the Millennium
development goals towards achieving a Vision 2030, (Beyond Zero Foundation 2015).

According to the Guardian (2013), an estimated mortality rate of 488 deaths per 100,000 live
births was recorded in 2008. It is also estimated that between 20 and 30 women suffer fatal
injuries or disabilities during pregnancy or delivery (Kenya National Commission for Human
Rights 2014).

Role of beyond zero campaign in reduction of maternal mortality rate

The Beyond Zero campaign was intended to spearheading the execution of the national plan
towards the eradication of new HIV infections among children while promoting maternal and
child health in Kenya. Beyond Zero campaign has helped create awareness on the importance of
seeking medical care to delivering in hospital or under the care of a trained midwife through
pregnancy stage, and also ensuring baby’s growth rate is monitored to reduce maternal and child
mortality.

According to Kenya Demographic and Health Survey 2014, there was a reduction in the rate of
childhood deaths compared with the rates in the KDHS of 1998, 2003, 2008 and 2009. There
was also a decrease in the infant mortality rate by 13 per 1,000 lives births in 2014 from 52 in
2008 and 2009 while a reduction of 22 deaths per 1,000 under-five live births from 74 in the
same period. The reductions in the numbers can be attributed to the role of Beyond Zero
Campaign that offered mosquito nets to families, as well as improvement of maternal health.
This trend mirrors other trends in countries such as Ethiopia, Uganda, etc. (UNICEF, 2013)
The infant mortality rate decreased to 39 deaths per 1,000 live births in 2014

from 52 in 2008-09, also the under-five mortality rate decreased to 52 deaths per 1,000 live

births in 2014 from 74 in 2008-09. These improvements in child survival can be attributed to

increase in treated mosquito net use among children and improvements in maternal health,

including an increase in the proportion of births assisted by a skilled provider and delivered in a

health facility and increase in postnatal care. The downward trend in childhood mortality mirrors

trends seen in other countries, for example: Ethiopia, Rwanda, and Uganda (UNICEF, 2013).
 CHAPTER THREE

3:0 RESEARCH METHODOGY

3.0: Introduction
The study techniques used in this study are described in this chapter. It includes the
research design, the study's location, the participants, the method used to calculate the sample
and sample size, research artifacts, research instrument piloting, data collection, and ethical
considerations.
3.1: Study design
In this study, a retrospective study design will be used. It will provide various
information about the relationship of the variables being tested in relation to the effectiveness of
the beyond zero campaign in the reduction of maternal mortality rate. A retrospective study
makes use of previously recorded data for reasons other than research. A retrospective case
series is a group of cases with a new or unusual disease or treatment that are described
retrospectively (Ranganathan & Aggarwal, 2018).
3.2: Study area

This study will be carried out in healthcare facilities in Thika Sub-county of Kiambu County
offering maternal health services.
3.3: Study population
This study was carried out amongst all the nurses working within the A&E department who sum

up to 120 according to departmental employee records and the ones that met the criteria. This is

the number who were chosen to undertake the study.

3.4: Inclusion and exclusion criteria

3.4.1: Inclusion criteria

i. All the nurses at Kenyatta National Hospital, A&E department who consent into being

part of this study.

3.4.2: Exclusion criteria

i. Nurses who do not consent into being part of this study.

3.5: Sampling technique

Simple random sampling was employed to avoid sampling bias and ensure that every single
A&E nurse had an equal chance of being included in the study. The method of participant
selection involved drawing up 120 small sheets of paper, writing numbers (1-120) and shuffling
them in small folded pieces. Every nurse who consented was requested to pick a piece of paper
and all those who selected the numbers between 1 and 53 were included in the study.

3.6: Sampling interval

The respondents included all the nurses at Kenyatta National Hospital on the chosen date for data

collection.

3.7: Sample size determination

Sample size was determined using the formula by Cochran (1977). This method is specifically

chosen as it has a higher level of accuracy, cuts down on cost that will be incurred to carry out

the research and covers a wider scope over a shorter period of time.

Cochran W G (1977) =
 2
z pq
2 Where:
e

no= the desired sample size

Z= the standard deviation usually set at 1.96, which corresponds to the

95% confidence interval.

e=desired level of precision

q=1-p

e=estimated proportion of an attribute that is present in the population

Assuming p=50% (0.5) and I desire a 95% confidence interval an 10% precision the sample size

will be:

1.962 × 0.5[1−0.5 ]
=
0.12

=96.04

Since the number of target population is less than 10,000 the sample adjustment was as; nf=

n
n−1
1+
N

nf= computed sample size when the target is 10,000

N= the total target population shall be 120 nurses working in the KNH A&E department.

96
Nf= 96−1 = 53
1+
120
 =53 nurses

3.8: Research instrument

Researcher-administered questionnaire containing structured and unstructured questions was

used to collect data. The questionnaire will have 4 sections grouped in accordance with the

research objectives.

3.9: Method of data collection

The principal researcher in this study was able to administer questionnaires to the nurses in the
A&E department. This entailed seeking consent from these research participants. The nurses who
consent to take part in this study will be explained on the essence and the methodology to be
employed. Matters involving privacy, anonymity confidentiality and voluntary participation in
the process of data they offer was clearly explained to them before handing over the
questionnaires; for those nurses who consent to voluntarily participate in the study.

3.10: Pretesting of the questionnaire

The questionnaire was pretested before the data collection and the necessary adjustments was
made to ensure validity and reliability.10% of the sample size, 6 nurses of the study population
who consent for the study was used for tool pretesting. These nurses did not participate in the
actual study.

3.11: Data management

The researcher collected the data obtained from the filled questionnaires, checked for
completeness and consistency and kept the data for data entry and analysis. The questionnaires
shall be edited so as to check for accuracy and uniformity. Organization will be done in order to
put together the questionnaires coding the data and finally to analyze them. The data obtained
was then be entered into a computer which is protected with password known to the researcher
for the purposes of confidentiality.
3.12: Data analysis and presentation
In order to summarize the socio-demographic data, descriptive statistics was used. Percentages,
frequencies, means and standard deviations for instance in the calculation of the mean age of
study participants. Statistical Package for Social Sciences (SPSS) software was used in the
process of statistical analysis and summary. The collected data was grouped, coded and
presented through tabular forms, various types of graphs and charts.

3.13: Study limitations and delimitations

For the uncooperative and dishonest respondents, the researcher was patient to explain to them in

details what needed to be done emphasizing the importance of providing honest responses to the

best of their ability.

The findings of study report may not be generalized as the truth regarding mental illness

attitudes, perceptions and knowledge.

Recommendation was made after the completion of the research for more related studies to be

conducted in other bigger and valid populations in Kenya before generalizing the findings

obtained.

3.14: Ethical consideration

A research approval to conduct the study was sought from the KNH-UoN Ethics and Research

Committee (ERC). The researcher was then required to seek permission from the administration

of the Kenyatta National Hospital in order to collect data prior to conducting the research, the

principal investigator will explain to the respondent the nature of the research and objectives and

purpose matters of anonymity, confidentiality, voluntary participation and privacy of the

participants will also be explained.

The researcher also obtained a voluntary consent of participation from the respondents, which

was be demonstrated by signing a consent certificate form of agreement before being recruited to

take part in the study.

3.15: Dissemination plan

The findings of the report shall be disseminated to the University of Nairobi School of Nursing
sciences and the Kenyatta National Hospital in the department in which study is
undertaken(A&E).
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