Determinants of utilization of health facility during child birth by women aged 15-49 years in Matinyani sub-county in Kitui County, Kenya
A demographic health survey done in Kenya in the year 2009 revealed that 54% of births in Eastern Province are conducted at home by TBAs and relatives and obstetric care services are unavailable in most of the rural health facilities. A report by Kitui District Development Plan 2008-2012 indicates that despite 20% of women delivering in a health facility, over 80% deliver at home with 70% of the deliveries being assisted by TBAs. Across the County, the majority of maternal death and disabilities occur from preventable causes that can be averted through skilled attendance at birth, backed up with emergency care. This precisely indicate that the uptake of the health services of skilled attendance at birth is low; this also posed a lot of questions as to why 93% of women in Eastern province would seek ANC services yet 70% deliver in the hands of unskilled attendants. This study was aimed at identifying the determinants of utilization of health facility during childbirth by women aged 15-49 years in Matinyani Sub county, in Kitui county. It was a facility- based study conducted in Matinyani Sub county where 376 women and 6 health facilities were included. It was a descriptive cross-sectional study. The variables tested were utilization of health facility during child birth, client related factors, provider related factors and health facility related factors. Data collection was done using focused group discussions guide, interview schedule guide, observation and analysis was done using SPSS version 17. Chi test was used to show association between the variables Majority of the respondents 138 (36.7 %) were between 25-30 years, 125 (33.2 %) betweenZfl-Zfiyears, 58 (15.4 %) between 30-35 years, 31 (8.2%) between 15-20 years and 24 (6.4%) above 35 years. At least 66.2%(n=249) of the respondents highest level of education was primary school,30.3% (n=114) had secondary education and only 3.5%(n=13) had tertiary education.Fifty eight percent (n=218) of the respondents deliver at home,while 42% (n=158) deliver in health facilities. About 33.8% (n=127) of the respondents deliver under TBAs, 18% (n=68) are assisted by relatives, 6% (n=23) are unassisted. Some of the major reasons for home delivery included distance to health facility, travel cost and weak referral systems. There was a significant relationship between marital status and utilization of health facility during child birth (x2=0.040 1; df=2; p<0.05). There was a significant relationship between religion and utilization of health facility during child birth (x2=0.0401; df=l; p<0.05).At least 99% (n=373) of the respondents attended antenatal clinic during pregnancy but only 53% (n=202) managed to attend the four recommended visits. Eighty six percent (n=324) had health education on maternal-health. Only 43% (n=164) of the respondents made own decision on where and who to assist them during delivery. The proportion of women not utilizing SBA were58%, with 33.8% being assisted by traditional birth attendant. Ninety nine percent attended ANC but only 53.7% made the recommended four visits. Majority of health workers were trained on FANC but not trained on comprehensive RH. Despite availability of some essential drugs for management of obstetric complications, in majority of the facilities they were expired. From the study findings it is recommended that community to be health educated on importance of hospital delivery, dangers associated with home delivery by the government. All health workers to be educated on drug storage to avoid expiry hence wastage of drugs. The government and the community should strengthen the referral systems in the sub county.