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Present Beliefs in Relation to Antepartum, Intrapartum and Postpartum Periods in Kenya

Present Beliefs in Relation to Antepartum, Intrapartum and Postpartum Periods in Kenya

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Present Beliefs in Relation to Antepartum, Intrapartum and Postpartum Periods in Kenya

Brief Overview of Childbirth Culture in Kenya

Culture has always been at the center of the childbearing journey as cultural practices and beliefs tend to influence the childbearing decisions among women. According to World Health Organization 2018) each day, 830 women die every day, with Sub-Saharan Africa accounting for 546 in 100 000 live births and 66% globally. The Kenya Demographic Health Survey (KDHS, 2014), Kenya experiences 362 maternal deaths in every 100,000 live births, a number that is five times the target set for the Sustainable Development Goals for 2030, which is 70 maternal deaths in every 100 000 live births. Additionally, the World Health Organization points out that common causes of death include unsafe abortion, haemorrhage, obstructed labour, sepsis and eclampsia with 60-80% of the obstetric complications being preventable of women who seek help early in their pregnancy, birth, labour and motherhood. Kenya has 44 tribes and 13 ethnic groups, including European and Indian immigrant tribes. The rich history and unique culture of every tribe shape its diverse background. Despite efforts to improve healthcare access by the government, in Kenya 95% of expectant women receive antenatal care but only 40% access skilled birth care. Cultural impact is one of the notable factors causing the underutilization of intrapartum services.

Prenatal Care

Prenatal care in Kenya is offered by private and public hospitals with the latter being confusing and crowded. Private hospitals provide a prenatal package that includes tests and scans, prenatal consultations, delivery and hospital stay. This option is more cost-effective than paying for each visit individually but on the downside one is less likely to be assigned a dedicated obstetrician. Such packages cost up to 130, 000 including the cost of delivery. However, that is not all the costs. Common additional costs in the package might include care for the newborn, meals, additional interventions and even extended stays in hospitals. Individual prenatal visits will cost a few thousand Kenyan shillings and additional costs for scans and tests. An ultrasound costs up to 4000 Kenyan shillings. Worth noting, some hospitals in Mombasa and Nairobi provide maternity tours for expectant mothers early in the pregnancy that proves helpful in deciding the right hospital to deliver.

Labor

Labor occurs in two stages, with stage one being dilation and stage two being expulsion. Some women opt not to give birth via natural labor and prefer to be induced. In the first stage of dilation, the cervix tends to become thin as the head descends to the pelvis. The process is painful and long particularly for first-time mothers. The cervix dilates to 8 centimeters and the midwife keeps on checking progress. If the water has not broken at eight centimetres, nurses do it using a long thin tool. To ease pain, expectant mothers are guided to breathe slowly, stay in comfortable positions during contraction and breathe a bit slower than regular breathing. In the expulsion stage, the head moves towards the dilated cervix and contractions come every two to three minutes. Expectant mothers are advised to take every contraction at a time. They feel pressure in the bowel and most feel sick to their stomachs and their body shakes too. With the assistance of a medical team, the mother is guided to the delivery room. For first-time mothers, delivery can last up to 40 minutes, while that have given birth before takes about twenty minutes.

Caesarian Section

Recent reports by the Ministry of Health in Kenya indicate that the rate of cesarean section deliveries is nearly double the average for Africa and have been rising significantly to 16.4% in 2021 from 14.5% in 2017. The World Health Organization (WHO) recommends a 9.2% average c-section rate in Africa. Kenya’s numbers exceed the said number. WHO also noted that caesarian sections important in saving lives in incidences where vaginal deliveries pose a danger or risks. The Ministry of Health noted that the government initiative dubbed “Linda Mama” has informed the rising number of c-sections noting that the trend is not homogenous when compared to the 47 counties (Gitobu, Gichangi, & Mwanda, 2018). The health department also cautions facilities from taking advantage of vulnerable expectant women noting that among the reasons that they recommend caesarian section is that they earn more money as the procedure is more expensive.

Genetic Defects

`Major external birth defects are typical and have been linked with childhood mortality, morbidity, and lifelong disabilities that are resource-intensive. While birth defects continue to take place in Kenya, they are yet to be considered a public health issue. Birth defects or congenital anomalies are deemed critical causes of childhood and infant deaths, disability, and chronic illness. According to the World Health Organization, birth defects are functional or structural anomalies taking place in intrauterine life. While the conditions develop prenatally, they can be identified after or before birth and, in some instances, much later in life. Examples of birth defect include Down’s syndrome, sickle cell, cleft lip, congenital heart defects, spina bifida and club foot. According to the World Health Organization the coding and gene mutations cause gene defects and the risk of childhood death, intellectual disability, neonatal death and other birth defects doubles if the parents are blood relatives.

New Born and Sick Baby

According to recent 2019 statistics about the main causes of neonatal death in Kenya the following factors are responsible for newborn deaths; diarrhoea (1%), tetanus (0%), pneumonia (9%), preterm complications (39%), intrapartum vents (26%), sepsis (6%), congenital abnormalities (7%) and other conditions (12%). Additionally, mortality rates for newborns are t 21 per every 1 000 live births, with the proportion of deaths below the age of five standing at 50%. The annual reduction of mortality between 2000 and 2020 was 1.6%, skilled birth attendance rate of 70% and a stillbirth rate of 20 deaths in every 1000 births. The maternal mortality ratio stands at 342 deaths in every 100,000 live births. With new born deaths contributing to a rising childhood mortality, increased access to inpatient care is a key contributor for boosting child health.

Breastfeeding

Exclusive breastfeeding (EBF) is recommended for the first half a year in a child’s life. It is also recommended for up to two years couples with timely incorporation of complementary feeding from six months. These are critical for optimal child development and growth. Exclusive breast feeding has various social, economic, and financial benefits. The Global Breastfeeding Scorecard of 2019 only 41% of children below six months are breastfed exclusively (Oluoch- Smith-Oka, Milan, & Dowd, 2018). Across Kenya, the exclusive breastfeeding rates stand at 61%. While this is a notable improvement from 2008, there is still a need to further push for exclusive breastfeeding.

Post Partum

The World Health Organization recommends having a minimum of four postnatal clinics scheduled for within 24 hours of delivery, at 10-14 days, at 4-6 weeks, and at 4-6 months of delivery. In Kenya post, natal care visits are scheduled as follows after 48 hours of delivery, after 1-2 weeks, at 4-6 weeks, and at 4-6 months (Warren, Njue, Ndwiga, & Abuya, 2017). In the event of home delivery, newborns and mothers should be directed to the closest health facility as fast as possible before 48 hours collapse. Postnatal care is important as it supports the mother and the baby and facilitates the early diagnosis, prevention and treatment of complications, referral for specialized care, counseling on baby care, counseling on contraception, immunization, support of exclusive breastfeeding and maternal counseling and support.

References

Gitobu, C. M., Gichangi, P. B., & Mwanda, W. O. (2018). The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC pregnancy and childbirth, 18(1), 1-11.

Oluoch-Aridi, J., Smith-Oka, V., Milan, E., & Dowd, R. (2018). Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reproductive health, 15(1), 1-14.

Warren, C. E., Njue, R., Ndwiga, C., & Abuya, T. (2017). Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy and Childbirth, 17(1), 1-14.

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The employment discrimination law

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Employment law

The employment discrimination law intends to do away with cases of discrimination when employers are hiring. It prevents employers from hiring individuals due to their race, their age, disability, nationality and on sexual orientation. In the situations where intentional discrimination has been done when hiring the jury has the right to award compensatory and also punitive damages to such companies who engage in those practises. Debs waterpark hires its employees according to age and looks which is intentional discrimination. There is sexual harassment in the working area and employees are made to put on indecent uniforms which include swimsuits and t-shirts. The owner Deb and Mark O’Nare sexually harass their employees and demand to be satisfied by having sex with them. This is illegal and unethical but in their defence the couple can argue that it is done between willing parties as some of the employees agree to the practise. It is however unlawful for an employer to ask for sexual favours from their employees and this is regarded as harassment which is punishable by law.

Promotion in job areas should be given due to merit; it should be as a result of one’s hard work, better skills or attainment of a higher education level. It is illegal to offer promotions to the employees due to the sexual favours gained as that has nothing to do with job performance. This was definitely what Deb’s waterpark was practising only those employees who agreed to their sexual advances got promotions and raised pays in the work areas. The company can be sued for such practises. Greg Summers was demoted from his position due to refusal to agree to offer sexual favours to the Deb O’Nare. The young man can sue the company for sexual harassment and get compensated according to the law. This was wrongful termination as Gregg was fired for not participating in an illegal act when asked by his employer to have sex with her.

When two other employees complained to their employers that what had happened to the young man was unfair and unethical they were also wrongfully fired. They can sue the company as it is against the law to fire employees due to complaining of an unfair act. They were against the fact that it was not good to discriminate on those who did not offer sexual favours to the employers.

According to the law when employees commits the same mistake requiring both to be fired there should be no discrimination if there is firing to be done it should be to both. There should also be no discrimination when it comes to reinstating the fired employees based on sex, race or age as was with the case in Deb’s waterpark where after the two employees were fired one was reinstated due to their race which was African American so that the company cannot appear as being discriminative against the African Americans as that was the only employee of that race.

A contract between the employer and employee is legally binding and failure to fulfil can lead to one party suing the other. The long term employees had a contract with the company that they would get one year’s pay in case they had to be fired due to reduction in workforce and they claimed to be paid after the company went bankrupt and was sold. The contract had specified on the terms on which they would be paid and hence could not be paid after the company was sold. The new company however should have retained the permanent employees and continue with the contracts that had been made with the old employers as required by the law.

Deb’s had also sent letters to the company’s permanent employees assuring that that they would get health and life insurance for life if not terminated for cause. The sale of the company was not termination for something they had done and hence Deb’s is required by law to keep her word and pay for their insurance. This is because Mark had changed the agreement without the participation of the permanent employees and hence without their consent. The employees also need to be compensated for the money gambled by Mark that was meant for the retirement savings plan. If the new management had continued with the employees they would have been the ones to cater for the retirement savings plan but on new terms but in this situation Deb’s water park would have to pay the employees.

QUESTION TWO

AA plumbing’s has some practises that violate the employment law. The company has certain employees that it pays more than the others. They get more benefits than the other employees. This practise violates the equal pay act that states that employers should not pay different wages to employees based on certain characteristics and that all employees who are performing equal work in a certain field that requires certain skills and they all have those skills and apply the same effort and responsibility should be paid the same amount. It is illegal and the company can be sued and forced to compensate the discriminated employees as unequal pay is only justified if certain employees have more skills than the others or better education skills.

The law is clear on the hours that employees should work. The company’s practise of making employees work overtime with no pay is one that violates the law. Any employer that requires the workers to work overtime should be ready to pay them at rate of per hour. The normal working hours are 40 hours and in cases where they work more than the required hours they should be paid more. The company risks being sued by the employees for been overworked with no pay and the company cannot fire the employees for suing them.

AA has a practise of deducting from its employees’ wages expenses incurred during work with the company’s tools actually without the consent of the employees. The fair labour standard acts against employees been made to pay for tools that actually benefit the employer, tools like uniforms and other working tools. The FLSA requires that if a company requires it’s workers to be in uniform then they have to cater for all its expenses and maintenance of the uniform and in the case where they need to include the employee in payment they should not reduce the wages to below the minimum wage. AA plumbing actually go to the extent of cutting the expenses until the worker’s wage goes below the minimum wage. The FLSA act is actually against employees of the company working at home if AA has no certification from the department of labour. The habit also of paying those workers working at home who produce specialized parts below the minimum wage is an illegal practise. They claim workers produce substandard parts and also make them pay for the tools and materials they use making the worker get less than the minimum wage required by law.

AA company does not train its supervisors and pay them on salary which makes it legal for them to work overtime but there is no justification as to why they get the bonuses.

The maintenance employees are restricted by geographical factors that the company does not seem to cater for effectively. The workers when on duty should be compensated for the time they use to work when they are supposed to be taking a break.

The company also has a habit of firing employees due to complaining and has recently fired ten employees. This is against the employment law and the company can face certain consequences due to the action such as compensating the wrongfully terminated employee. AA also fired ten of its employees who asked about their pension benefits and this is illegal termination too. The company should pay pension to their employees once they attain the age of retirement despite the fact that it will have an impact in their financial position.

QUESTION THREE

Ranger goes against the required business conduct and behaves unethically when it goes against it’s signage to deliver good services. After the new management they stop doing background checks the employees that it was recruiting for XYZ. In their defence however they can say that the new management in XYZ stopped to acknowledge the agreement that required Ranger to do a background check on all the employees that it was recruiting for XYZ. This had consequences as the new employee who was hired took advantage of their position to steal from one of the patients of XYZ.

XYZ hired an incompetent worker and also offered no training to them. This means that any loss that may be incurred due to the incompetence of the employee would be blamed on XYZ and not on the employee and the company would have to compensate anyone who suffers in the hands of the employee. It is however illegal for the employee Barkman to go through employee’s history including their credit history even though he never disclosed the results to any individual.

It is a general rule that the information that should be obtained before hiring anyone should be only that information that determines whether someone is qualified for the job. Barkman as the employer went against the law when he asked about the disability income from potential employees. He also did not have a justified reason as to why there was need for the potential employees to give details on their religion, sex and race. It was purely personal because he had a hatred for a specific group of people those who were blonde and also those of Swedish descent which is illegal since the law states that an employer should not make an employment decision based on people’s race or genetic information.

QUESTION FOUR

A breach of employment occurs when one party does not perform what is expected of them in the contract. When an employee resigns without giving notice to the employer that is accounted as breach of agreement as notice is required from both sides when employee is resigning and when employer wants to fire employee. In some cases an employer has the right to deduct the employees’ wages for the period they were required to give a notice for their resignation. James Jones, Jonas Schmidt and Prissy Parsons resigned without giving notice. Jones had an agreement with the company that when resigning he would give a one year’s notice and there was penalty to be paid in case of breach of contract. Jones in this case has to pay the penalty for resigning with no notice.

Non-disclosure agreement is a confidentiality agreement that is used to protect a company’s business ideas. It is a legal contract where the business partner or employee should not disclose certain information to others. There was a breach of the non-disclosure contract because they started using the AMA’s information about their customers, the buying habits, and a summary of the customers. They even used information on manufacturing process in AMA, vendor records, payroll records and even attempted to take customers with them. They bought all the machines that AMA used and came with all the memos that had manufacturing process so as to be able to compete with their previous employers.

Jones had signed a covenant that after he left AMA he would not immediately start competing with the company but broke the covenant because immediately they resigned they started competition with AMA using all the information they had gone out with.

Jones being a member of the board was in a better position to gain all the secrets of the company on all new projects they were planning on undertaking and hence signing the non-disclosure agreement. AMA can sue Jones for taking the company’s secret into their new company and trying to use them for their own gain. Jones can also be used for competition with AMA immediately after leaving the company. Schmidt and Parsons had also signed the same agreement and also can be used for using the customer’s details to get them to go to their new company.

Schmidt, Parsons and Jones can however argue that what led to their resignation was unfair treatment by their employee where they were senior employees and made to take a drug test in a humiliating manner.