Statistical analysis of the determinants of maternal mortality and impact of voucher for health in Kisumu sub-county, Kenya
Mirasi, Tom Benard Mboya
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Globally in 2010, about 800 women died daily due to complications of pregnancy and child birth (WHO, 2010). Out of the 800 deaths, 440 deaths occurred in sub-Saharan Africa, 230 in Southern Asia and only five in high-income countries. In Kenya, maternal death is the leading cause of death amongst women of child bearing age, overall maternal mortality ratio in Kenya remain high at 488/100,000 and could even be higher in rural sub-counties. In response to the rising burden of MMR, the government of Kenya abolished user fees in all public health facilities. Consequently, targeted intervention for the poor pregnant mothers in the form of voucher for health meant to increase access to maternal health services is being piloted in few Counties. Based on this massive investment by the government to address maternal mortality, it is valuable to assess whether an impact is being realized. The purpose of this study was therefore to assess the determinants of maternal mortality, maternal service utilization and in particular find out whether the use of voucher for health has had an impact in reduction of maternal deaths as well as increasing utilization of maternal services in Kisumu Sub-County. A total of 293 pregnant women from 31 health facilities selected through purposive sampling were randomly interviewed while 210 maternal delivery outcomes were reviewed using questionnaires and structured checklist respectively. Data collected was analyzed using STATA version 11.0 Software and presented in tables and graphs. COX proportional Hazard regression model and Logistic regression model were used to estimate determinants of maternal mortality while general linear regression model was performed to predict the factors influencing maternal service utilization. The result of the study showed that overall women who attend maternal clinic and those who succumb to maternal related deaths are young. Utilization of maternal service is on the rise while maternal deaths are drastically decreasing. The factors that influence maternal service utilization in Kisumu Sub-County include level of education (χ2=20.52, p=0.015), voucher for health (χ2=30.69, p=0.000), payment for service (χ2=8.94, p=0.030) and knowledge on maternal visits (χ2=62.70, p=0.000), while the determinants of maternal mortality include age (Cox PH=1.039, OR=1.033), marital status (Cox ph = 1.063, OR=.977), Wealth index ( Cox ph = 1.18, OR = 1. 047), voucher for health (Cox ph = 3.075, OR=2.589) and presence of other diseases (Cox ph= 1.065, OR= 1.090). Maternal service utilization and maternal deaths in Kisumu Sub-County are determined by several factors that include background characteristics, socio-economic characteristics and institutional factors. Otherwise, voucher for health and women level of education stand out distinctively to influence the outcomes in both scenarios, therefore for maternal mortality ratio to come down, there is need to invest in women education and empower them economically which has desirable effects on decision making on maternal health.