Influence of Traditional Birth Attendants’ Reorientation and Mother Packs Incentives on Choice of Place in Marsabit County, Kenya.
Arero, Christine Bokayo
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Globally, approximately 295,000 maternal fatalities were witnessed in 2017. About 86% of these reported in Asia and Sub-Saharan Africa. The rate of Skilled Birth Attendant in Sub-African region stood at 59%. Currently, maternal mortality rate in Kenya is 362/100,000 live births. Despite deliberate government interventions to increase hospital deliveries, still a substantial proportion of mothers give birth at home. To address this, Community Based Referral Systems were established by reorienting Traditional Birth Attendants shifting their focus to referring pregnant women to health facilities for delivery. This included provision of mother pack incentives to discourage home deliveries. The study sought to assess influence of community-based referral systems and mother packs incentives on place of delivery choice of among postnatal mothers in the County of Marsabit, Kenya. Specifically, the study focused on influence of community based referral systems, mother pack incentives, and individual and health facility factors linked to place of delivery choice. Analytical study design was adopted which utilized methods of data collection that were qualitative and quantitative. To collect data quantitatively from respondents, questionnaires which were structured helped in this while key informant interview and Focused Group Discussion guides helped in collecting data qualitatively. Respondents for interview were drawn from households picked through systematic random sampling with a 4th internal till attainment of 416 sample size. The recruitment of Focused Group Discussants and Key Informants was done purposively. All the necessary ethical and logistical approvals and informed consent were sought accordingly. Analysis of quantitative data was done by use of version 20 of Statistical Package for Social Sciences. Presentation of data was done by use of graphs, pie-charts and frequency tables. Qualitative data were presented as narrations. Calculation of inferential statistics was done using tests of Chi-Square tests at a confidence interval of 95% and an error of precision of 0.05 to show variable associations. Those variables significant at chi-square were subjected to further logistic regression to determine their relationship to the place of delivery. Results revealed that (233)56.7% of postnatal women in Marsabit County had delivered in health facilities. Skilled birth attendance rate was (241)58.6%. Instant labour pains was the main reason for home delivery at (75)42.1%. Community based referral agents predicted the choice of place of delivery. The person who person introduced women to community referral agents (t=3.879, df=3; p=0.000) predicted choice of place of delivery. Source of information on mother pack incentives (t=2.705, df=5; p=0.007) and receiving mother pack incentives (t=-6.151, df=1; p=0.000) predicted the provision of mother pack incentives on overall, predicted choice of place of delivery. The individual factors such as myths and misconceptions (t=-2.280, df=1; p=0.023), hospital delivery reduces complications (t=-3.987, df=2; p=0.000), hospital delivery time consuming (t=-2.625, df=1; p=0.009), risky to deliver at home (t=-2.999, df=2; p=0.000) and having medical insurance (t=-5.139, p=0.001) predicted choosing a delivery place. The health facility factors such nearness to the facility (t=-5.935, df=2; p=0.000), hindrances of hospital delivery (t=-2.277, df=5; p=0.023) and information provision (t=6.315, df=1; p=0.000) predicted choosing a delivery place. In conclusion, about 6 out 10 deliveries occur at the facility in Marsabit County. Community based referral agents (t=7.677, df=4, p=0.000), mother pack incentives (t=15.643, df=3, p=0.000); individual factors (t=12.785, df=6, p=0.000) and health facility factors (t=13.020, df=4, p=0.000) predicted the choice of place of delivery. The study recommends the Government of Marsabit County and relevant stakeholders to scale-up awareness, coverage and provision of more incentives to encourage hospital delivery.