Factors influencing uptake of skilled deliveries among women of reproductive age in Nyatike sub-county, Kenya

Abstract

Globally and in Kenya, Maternal Mortality Ratio remain high at 546/100,000 and 362/100,000 live births respectively. In Kenya, skilled birth attendants (SBA) are estimated at 62% and 68% in Nyatike. Factors influencing skilled birth attendants in still unknown in Nyatike. The specific objectives of this study were to assess the level of knowledge on safe motherhood, sociodemographic characteristics, health workers’ attitude, quality of skilled delivery services and association with uptake of skilled birth attendance among women of reproductive age in Nyatike Sub-County. This was a mixed methods cross-sectional study involving a sample 367 women aged 15-49 years old who had a live birth and living in Nyatike Sub-county. Quantitative data were collected using structured questionnaires, 20 key informant interviews and 6 Focus Group Discussions (FGDs) were conducted. Qualitative data were analysed using content analysis while quantitative data were analysed using chi-square test and binary logistic regression. The prevalence of skilled delivery was 32.2% (118/367). Of the 367 women interviewed, 293 (80.3%) were aware of the nearest health facility. Amongst those who were aware of nearest health facility, (32%, n=94) utilized SBA. Students were less likely to utilize SBA compared to farming women (40.2% vs 27.3%; OR=0.3; 95% CI=0.1-0.8, p=0.023). Women with high school education were 2.9 times more likely to use SBA (high school vs primary; OR=2.9; 95% CI=1.18.2, p=0.039). Women who perceived health workers’ attitude to be ‘very friendly’ were 2.8 times more likely than those with no opinion to use SBA (40.5% vs 19.7%, OR=2.8; 95% CI=1.3-6.1, p=0.010). Only 40% of health facilities surveyed provided quality care Choice of place of delivery was perceived to be due to availability of free professional care for both mother and baby, high standard of hygiene and equipment, free referral services if complications arise and privacy and confidentiality at the health facilities. Health education in girls’ schools, a reversal of health worker attitudes towards pregnant women and making the delivery processes respond to women needs would improve uptake. The study recommends prioritizing interventions and strategies aimed at up-scaling uptake of skilled deliveries in Nyatike SubCounty and beyond