25/11/2023, 22:48 Module II NCK-1 - nursing council notes
PAPER II
TABLE OF CONTENTS
UNIT ONE: INTRODUCTION TO REPRODUCTIVE HEALTH ............................................. 2
UNIT TWO PART ONE: PREGNANCY .................................................................................. 34
UNIT TWO PART TWO: PREGNANCY .................................................................................. 58
UNIT THREE PART ONE: LABOUR AND PUERPERIUM .................................................. 93
UNIT THREE PART TWO: ABNORMAL LABOUR AND PUERPERIUM......................... 152
UNIT FOUR: CONTRACEPTIVE TECHNOLOGY............................................................... 212
UNIT FIVE: GYNAECOLOGY................................................................................................. 234
UNIT SIX: UNDERSTANDING STIS AND HIV/AIDS .......................................................... 280
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UNIT ONE: INTRODUCTION TO REPRODUCTIVE HEALTH
In this unit you will cover the major reproductive care given to citizens over time. In other words,
health policies and their application in the you will find out why the government places
provision of quality reproductive health services. importance on reproductive health issues.
This will include policy guidelines and strategies You will also learn about the goals and
laid down by the Government of Kenya (GoK) to strategies the government has formulated to
guide the implementation of Reproductive make this service available, accessible and, to
Health (RH) programs in the country. You will some extent, affordable to all at every level of
also examine Adolescent /Youth health, Gender the service delivery system
Issues in relation to Reproductive Health Rights
and the Safe Motherhood Initiative (SMI). Objectives
This unit is composed of four sections: By the end of this section you will be able to:
Section One: Historical Background of Describe the evolution of reproductive
Reproductive Health Policies health programmes
Section Two: Adolescent and Youth Describe the national policy guidelines
Health on the implementation of reproductive
Section Three: Gender Issues and health programmes in Kenya
Reproductive Health Rights Define the concepts of integrated
Section Four: Safe Motherhood and comprehensive reproductive health
Child Survival Initiative services
Describe strategies for implementing the
Unit Objectives reproductive health plan components
Describe the structure of reproductive
By the end of the unit you will be able to: health servicesin Kenya
Describe the national policy/strategic
guidelines of reproductive health
Identify adolescent/youth health issues Evolution of Reproductive Health
Describe the provision of effective youth Programmes
friendly services
Explain gender issues in RH During a Kenyan population census conducted
Explain the Safe Motherhood Initiative in the late 1950’s, the fertility and growth rates of
Kenyans were found to be high. In response, the
According to the program of Action of the government adopted Family Planning (FP) as an
International Conference on Population and important component of socioeconomic
Development (ICPD) held in Cairo in 1994 development in the 1960’s.
Reproductive health is defined as: As early as 1965, when fertility control was a
‘A state of complete physical, mental and primary focus, the Government of Kenya (GoK)
social well-being and not merely the absence recognised population planning and family
of disease and infirmity, in all matters planning as part of the National Planning
relating to the reproductive system and to its Strategies of Sessional Paper No. 10 of 1965. In
functions and processes.’ 1967, the Family Planning Programme was
established (GoK/MoH, 1998).
Since then, the fertility rate, which was 7.9% in
1979, has decreased to 5.45% in 1993, and the
SECTION1: HISTORICAL population growth rate has reduced from 3.8% in
BACKGROUND OF 1979 to 3.4% in 1993 (CBS, 1995). You may
REPRODUCTIVE HEALTH argue that this is still high. The population of
Kenya was 15.3 million in 1979. By 1998, it has
POLICIES doubled to approximately 30 million (NCPD,
1998). Meanwhile, the growth of the economy
Introduction has not kept pace with the growth of the
In this section, you will discuss some of the population.
weaknesses identified by the Kenyan
Government concerning the quality of health
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,25/11/2023, 22:48 Module II NCK-1 - nursing council notes
ineffective in reaching critical target groups in
need of information and services, especially
adolescents and the youth.
Reproductive health issues have caused great
concern not only in Kenya but also the world
over. As a result, governments and other
stakeholders came together in Cairo in 1994 to
address these concerns and to look for solutions
to problems being experienced worldwide. At the
International Conference on Population and
Development (ICPD), 179 countries endorsed a
Reproductive Health Agenda. The ICPD
Programme endorsed a shift in development
strategies, urging member countries to review
and revise health policies to focus on meeting
the needs of an individual, and on the provision
of basic as well as comprehensive and quality
RH services.
The comprehensive concept of RH is based on
the World Health Organisation (WHO) definition
of RH, which recognises the fact that RH is
closely interrelated with policies to empower
women, strengthen families, stabilise population
If the population growth rate is higher than the growth, and eradicate poverty. In response to
economic growth rate, it creates a burden on ICPD recommendations, the concept of
available land, health facilities, educational integrated RH services was developed and
resources and the job market. These factors launched to meet the revised policy on RH care.
often impact more on mothers and children, Integrated RH creates demand for, and ensures
whose mortality and morbidity rates are high, provision of RH services, defined for each level
mainly due to complications associated with of the health care system, everyday, during the
pregnancy and childbirth and HIV/AIDS same visit, under one roof, and where possible
prevalence. by the same provider ’the supermarket
approach’.
In 1974, further evaluation of reproductive health Kenya is signatory to the Cairo Declaration of
services established that the child health 1994, which marked a turning point in the field of
services were running parallel to those of family population and health development, not only for
planning and antenatal care. This arrangement Kenya but the whole world. As a response to the
was viewed as inefficient. As a result, these 1994 ICPD in Cairo, the Kenya government
services were integrated to offer a more developed and launched the Health Policy
consolidated package. Following this, the Framework Paper of 1994. This policy document
Maternal/Child Health Care and Family Planning provides the blueprint for strategies for the
(MCH/FP) Programme was established. development and management of health
In 1987, the Safe Motherhood Initiative (SMI) services in this country.
was launched at the Conference on Better A notable policy document is the National
Health for Women and Children, held in Nairobi, Reproductive Health Strategic Plan of 1996,
Kenya. The Government of Kenya endorsed the covering the period 1997 - 2010. This document
Plan of Action to reduce maternal mortality and guides the implementation of a comprehensive
morbidity rate, which was developed at that and integrated RH programme in Kenya for the
conference. next decade. In order to operationalise the 1997
Despite this policy shift, many reproductive - 2010 Strategic Plan, the Ministry of Health
health programmes continued to run as vertical (MoH), in collaboration with various
entities at all levels of the health service delivery stakeholders, designed and launched a series of
system. The vertical approach to service policy documents to spearhead the long term
provision proved somewhat wasteful and reform process.
inefficient in terms of utilising resources The MoH and its development partners have
including health manpower. It also proved since used this policy document to review,
Page 3 of 316
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revise and develop a series of guidelines related As mentioned earlier, the GoK responded to the
to reproductive health services. 1994 Cairo ICPD Agenda and approved the
Kenya Health Policy Framework (KHPF) as the
National Policy and Guidelines in blueprint for the development and management
Reproductive Health of health services in this country. To
operationalise the document, the MoH
A policy is an official statement issued by the developed the National Health Policy
government, a company or a non-governmental Framework (NHPF) Implementation and Action
organisation (NGO) to guide the workers on Plan, and facilitated the establishment of a
what to do. It is a statement on the ‘course of Health Sector Reform Secretariat in 1996. The
action decided on by the government.’ Secretariat has since provided an enabling
Policy guidelines are written instructions that environment for the implementation of various
give directives with regard to the practices that activities to meet the objectives of the RH
should be followed in the provision of services to implementation plan.
the consumer. For our purposes, the services in
question are reproductive health services and The Implementation Plan for National
the consumer is the patient who makes use of Reproductive Health Strategy of 1998
the services. Covering the Period 1999 - 2003
The development of this national implementation
GoK Policy Guidelines for the plan represents Kenya’s determination not only
Implementation of Reproductive Health to operationalise the reproductive health
Services strategy but also to address the immediate
These guidelines aim to: causes and underlying factors that affect the
Create awareness among leaders, health status of the population.
communities and programme implementers This policy document provides a list of RH plan
of the need to promote high quality components in order of priority.
reproductive health services, in order to The MoH, in collaboration with provinces and
improve the well being of the people districts, set out to operationalise the RH policy
Make available quality and sustainable document by identifying and prioritising various
family planning services to all who need RH plan components with an emphasis on
them, in order to reduce the unsatisfied women and children, adolescents and youths
needs for family planning and other groups, who experience difficulties in
Reduce health and socioeconomic burdens accessing health care.
due to STDs/HIV/AIDS and their implications Among other priorities, all stakeholders
or effects expressed the need to train health care
Enhance the health and well being of providers at all levels in reproductive health
adolescents and youths issues. This led to the development of The
Reduce the incidence of infertility and National Reproductive Health Training Plan of
facilitate proper investigations and 2000.
management of infertile individuals and
couples The National Reproductive Health Training
Eliminate all forms of discrimination against Plan of 2000 Covering the Period 2000 - 2004
This policy document addresses the weakness
women and female children to enable them
to exercise their sexual and RH rights and to identified in relation to the various care providers
promote their equal representation in all at all levels of the care delivery system. The
levels of political and public life identified weaknesses included:
Enhance both men and women’s health Inadequate clinical skills
Poor knowledge
throughout their life cycle
Provide quality and sustainable Poor managerial skills
Poor communication and counselling
comprehensive RH services in all service
delivery points (SDP’s) and community skills
levels The reproductive health training plan document
focuses on the strengthening of pre-service and
in-service training activities to facilitate the
provision of integrated and comprehensive
reproductive health services.
Page 4 of 316
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PAPER II
TABLE OF CONTENTS
UNIT ONE: INTRODUCTION TO REPRODUCTIVE HEALTH ............................................. 2
UNIT TWO PART ONE: PREGNANCY .................................................................................. 34
UNIT TWO PART TWO: PREGNANCY .................................................................................. 58
UNIT THREE PART ONE: LABOUR AND PUERPERIUM .................................................. 93
UNIT THREE PART TWO: ABNORMAL LABOUR AND PUERPERIUM......................... 152
UNIT FOUR: CONTRACEPTIVE TECHNOLOGY............................................................... 212
UNIT FIVE: GYNAECOLOGY................................................................................................. 234
UNIT SIX: UNDERSTANDING STIS AND HIV/AIDS .......................................................... 280
Page 1 of 316
about:blank 1/316
,25/11/2023, 22:48 Module II NCK-1 - nursing council notes
UNIT ONE: INTRODUCTION TO REPRODUCTIVE HEALTH
In this unit you will cover the major reproductive care given to citizens over time. In other words,
health policies and their application in the you will find out why the government places
provision of quality reproductive health services. importance on reproductive health issues.
This will include policy guidelines and strategies You will also learn about the goals and
laid down by the Government of Kenya (GoK) to strategies the government has formulated to
guide the implementation of Reproductive make this service available, accessible and, to
Health (RH) programs in the country. You will some extent, affordable to all at every level of
also examine Adolescent /Youth health, Gender the service delivery system
Issues in relation to Reproductive Health Rights
and the Safe Motherhood Initiative (SMI). Objectives
This unit is composed of four sections: By the end of this section you will be able to:
Section One: Historical Background of Describe the evolution of reproductive
Reproductive Health Policies health programmes
Section Two: Adolescent and Youth Describe the national policy guidelines
Health on the implementation of reproductive
Section Three: Gender Issues and health programmes in Kenya
Reproductive Health Rights Define the concepts of integrated
Section Four: Safe Motherhood and comprehensive reproductive health
Child Survival Initiative services
Describe strategies for implementing the
Unit Objectives reproductive health plan components
Describe the structure of reproductive
By the end of the unit you will be able to: health servicesin Kenya
Describe the national policy/strategic
guidelines of reproductive health
Identify adolescent/youth health issues Evolution of Reproductive Health
Describe the provision of effective youth Programmes
friendly services
Explain gender issues in RH During a Kenyan population census conducted
Explain the Safe Motherhood Initiative in the late 1950’s, the fertility and growth rates of
Kenyans were found to be high. In response, the
According to the program of Action of the government adopted Family Planning (FP) as an
International Conference on Population and important component of socioeconomic
Development (ICPD) held in Cairo in 1994 development in the 1960’s.
Reproductive health is defined as: As early as 1965, when fertility control was a
‘A state of complete physical, mental and primary focus, the Government of Kenya (GoK)
social well-being and not merely the absence recognised population planning and family
of disease and infirmity, in all matters planning as part of the National Planning
relating to the reproductive system and to its Strategies of Sessional Paper No. 10 of 1965. In
functions and processes.’ 1967, the Family Planning Programme was
established (GoK/MoH, 1998).
Since then, the fertility rate, which was 7.9% in
1979, has decreased to 5.45% in 1993, and the
SECTION1: HISTORICAL population growth rate has reduced from 3.8% in
BACKGROUND OF 1979 to 3.4% in 1993 (CBS, 1995). You may
REPRODUCTIVE HEALTH argue that this is still high. The population of
Kenya was 15.3 million in 1979. By 1998, it has
POLICIES doubled to approximately 30 million (NCPD,
1998). Meanwhile, the growth of the economy
Introduction has not kept pace with the growth of the
In this section, you will discuss some of the population.
weaknesses identified by the Kenyan
Government concerning the quality of health
Page 2 of 316
about:blank 2/316
,25/11/2023, 22:48 Module II NCK-1 - nursing council notes
ineffective in reaching critical target groups in
need of information and services, especially
adolescents and the youth.
Reproductive health issues have caused great
concern not only in Kenya but also the world
over. As a result, governments and other
stakeholders came together in Cairo in 1994 to
address these concerns and to look for solutions
to problems being experienced worldwide. At the
International Conference on Population and
Development (ICPD), 179 countries endorsed a
Reproductive Health Agenda. The ICPD
Programme endorsed a shift in development
strategies, urging member countries to review
and revise health policies to focus on meeting
the needs of an individual, and on the provision
of basic as well as comprehensive and quality
RH services.
The comprehensive concept of RH is based on
the World Health Organisation (WHO) definition
of RH, which recognises the fact that RH is
closely interrelated with policies to empower
women, strengthen families, stabilise population
If the population growth rate is higher than the growth, and eradicate poverty. In response to
economic growth rate, it creates a burden on ICPD recommendations, the concept of
available land, health facilities, educational integrated RH services was developed and
resources and the job market. These factors launched to meet the revised policy on RH care.
often impact more on mothers and children, Integrated RH creates demand for, and ensures
whose mortality and morbidity rates are high, provision of RH services, defined for each level
mainly due to complications associated with of the health care system, everyday, during the
pregnancy and childbirth and HIV/AIDS same visit, under one roof, and where possible
prevalence. by the same provider ’the supermarket
approach’.
In 1974, further evaluation of reproductive health Kenya is signatory to the Cairo Declaration of
services established that the child health 1994, which marked a turning point in the field of
services were running parallel to those of family population and health development, not only for
planning and antenatal care. This arrangement Kenya but the whole world. As a response to the
was viewed as inefficient. As a result, these 1994 ICPD in Cairo, the Kenya government
services were integrated to offer a more developed and launched the Health Policy
consolidated package. Following this, the Framework Paper of 1994. This policy document
Maternal/Child Health Care and Family Planning provides the blueprint for strategies for the
(MCH/FP) Programme was established. development and management of health
In 1987, the Safe Motherhood Initiative (SMI) services in this country.
was launched at the Conference on Better A notable policy document is the National
Health for Women and Children, held in Nairobi, Reproductive Health Strategic Plan of 1996,
Kenya. The Government of Kenya endorsed the covering the period 1997 - 2010. This document
Plan of Action to reduce maternal mortality and guides the implementation of a comprehensive
morbidity rate, which was developed at that and integrated RH programme in Kenya for the
conference. next decade. In order to operationalise the 1997
Despite this policy shift, many reproductive - 2010 Strategic Plan, the Ministry of Health
health programmes continued to run as vertical (MoH), in collaboration with various
entities at all levels of the health service delivery stakeholders, designed and launched a series of
system. The vertical approach to service policy documents to spearhead the long term
provision proved somewhat wasteful and reform process.
inefficient in terms of utilising resources The MoH and its development partners have
including health manpower. It also proved since used this policy document to review,
Page 3 of 316
about:blank 3/316
, 25/11/2023, 22:48 Module II NCK-1 - nursing council notes
revise and develop a series of guidelines related As mentioned earlier, the GoK responded to the
to reproductive health services. 1994 Cairo ICPD Agenda and approved the
Kenya Health Policy Framework (KHPF) as the
National Policy and Guidelines in blueprint for the development and management
Reproductive Health of health services in this country. To
operationalise the document, the MoH
A policy is an official statement issued by the developed the National Health Policy
government, a company or a non-governmental Framework (NHPF) Implementation and Action
organisation (NGO) to guide the workers on Plan, and facilitated the establishment of a
what to do. It is a statement on the ‘course of Health Sector Reform Secretariat in 1996. The
action decided on by the government.’ Secretariat has since provided an enabling
Policy guidelines are written instructions that environment for the implementation of various
give directives with regard to the practices that activities to meet the objectives of the RH
should be followed in the provision of services to implementation plan.
the consumer. For our purposes, the services in
question are reproductive health services and The Implementation Plan for National
the consumer is the patient who makes use of Reproductive Health Strategy of 1998
the services. Covering the Period 1999 - 2003
The development of this national implementation
GoK Policy Guidelines for the plan represents Kenya’s determination not only
Implementation of Reproductive Health to operationalise the reproductive health
Services strategy but also to address the immediate
These guidelines aim to: causes and underlying factors that affect the
Create awareness among leaders, health status of the population.
communities and programme implementers This policy document provides a list of RH plan
of the need to promote high quality components in order of priority.
reproductive health services, in order to The MoH, in collaboration with provinces and
improve the well being of the people districts, set out to operationalise the RH policy
Make available quality and sustainable document by identifying and prioritising various
family planning services to all who need RH plan components with an emphasis on
them, in order to reduce the unsatisfied women and children, adolescents and youths
needs for family planning and other groups, who experience difficulties in
Reduce health and socioeconomic burdens accessing health care.
due to STDs/HIV/AIDS and their implications Among other priorities, all stakeholders
or effects expressed the need to train health care
Enhance the health and well being of providers at all levels in reproductive health
adolescents and youths issues. This led to the development of The
Reduce the incidence of infertility and National Reproductive Health Training Plan of
facilitate proper investigations and 2000.
management of infertile individuals and
couples The National Reproductive Health Training
Eliminate all forms of discrimination against Plan of 2000 Covering the Period 2000 - 2004
This policy document addresses the weakness
women and female children to enable them
to exercise their sexual and RH rights and to identified in relation to the various care providers
promote their equal representation in all at all levels of the care delivery system. The
levels of political and public life identified weaknesses included:
Enhance both men and women’s health Inadequate clinical skills
Poor knowledge
throughout their life cycle
Provide quality and sustainable Poor managerial skills
Poor communication and counselling
comprehensive RH services in all service
delivery points (SDP’s) and community skills
levels The reproductive health training plan document
focuses on the strengthening of pre-service and
in-service training activities to facilitate the
provision of integrated and comprehensive
reproductive health services.
Page 4 of 316
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