Timeliness and Appropriateness of Maternal Care and Its Influence on Perinatal Outcomes: A Community-Based Study in Kakamega County, Kenya

Background: Perinatal mortality remains a critical concern in Sub-Saharan Africa, with Kenya reporting rates above global targets. Lurambi and Butere sub-counties in Kakamega County exhibit perinatal mortality rates nearly double the national average, despite increased facility-based deliveries. Objectives: The study aimed to assess how the timeliness and appropriateness of maternal care influence perinatal outcomes in these high-burden settings. Methodology: A community-based cross-sectional design was employed. Quantitative data were collected from 520 mothers who delivered within the past two years using structured questionnaires, while qualitative data were gathered through key informant interviews with healthcare workers. Maternal care was assessed across the antenatal, intrapartum, and postnatal periods. Quantitative data were analysed using SPSS, and logistic regression was applied to identify predictors of perinatal mortality. Qualitative data from key informant interviews were manually analysed by coding responses into thematic categories. The resulting themes were organised and interpreted about the Three Delays Model, highlighting issues relevant to delays in receiving appropriate maternal and newborn care. Results: Revealed that while 78 percent of mothers attended four or more antenatal visits, only 39 percent received the full care package. Inadequate labour monitoring was significantly associated with perinatal death (AOR = 0.1; 95 percent CI: 0.04 to 0.43), as was lack of timely postnatal care (AOR = 51.2; 95 percent CI: 12.0 to 218.9). Newborns experiencing delayed or inappropriate facility care were nearly three times more likely to die (AOR = 0.3; 95 percent CI: 0.1 to 0.6). Systemic challenges included staff shortages, poor documentation, and weak referral mechanisms. Conclusions: The Third delay contributes to perinatal death. The quality and responsiveness of antenatal care are more critical than mere attendance. Intrapartum care showed poor labour monitoring, increasing the risk of adverse events. Delays in postnatal checkups and inadequate management of newborn complications raised the risk of death. Recommendations: Strengthen the quality and responsiveness of antenatal services, enhance intrapartum care and timely postnatal checkups and improve management of newborn complications, specifically during referrals