Assessment of factors determining the choice of birth attendant in Kisau division, Makueni district, Kenya
Mutea, Nduku Lilian
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The Kenya Demographic Health Survey (KDHS) 2008 showed that maternal mortality in Kenya is estimated at 488/100,000 live births, and that pregnancy related complications are the leading cause of death (27%) among women of childbearing age (CBS, 2008). Although 92% of women receive antenatal care at least once during pregnancy, a skilled attendant assists only 44% of mothers during childbirth. Therefore, the purpose of this study was to assess the factors determining the choice of birth attendant in Kisau Division, Makueni District. The specific objectives of the study were to: establish the level of utilization of Skilled Birth Attendants (SBAs) and Traditional Birth Attendants (TBAS) in the study population, examine the effects of socio-economic and demographic characteristics on choice of birth attendant, establish the role of TBAS in choice of a birth attendant and determine strategies that can be used to improve skilled birth attendance in the study population. The study adopted a descriptive survey design and the eligible respondents were women who had delivered in the previous 12 months. All women who delivered in health facilities and at homes in the previous 12 months were listed down in a sequential order from the latest to the oldest date of delivery, using records from the health facilities, chiefs, assistant chiefs, Community Health Workers (CHWs) and TBAs. Systematic random sampling method was used to identify participants for the study. Data was collected using interview schedules and Focus Group Discussions (FGD). CHWs, TBAs, religious leaders and the provincial administration assisted the researcher in tracking the study participants in their homes. A total of 315 women from Kisau division were interviewed, and 3 focus group discussions composed of health professionals, TBAs and local opinion leaders conducted. Secondary data was also obtained from health facility records in the study population. Data analysis was done using descriptive statistics and by applying Statistical Package for Social Sciences (SPSS). Data was then organized and presented by use of tables, bar graphs, pie charts and prose forms. The study established that majority of women (52.7%) in the study population delivered with TBAs assistance, and that utilization of SBAs was low (42.9%). A Chi-square test to establish if there was a relationship between household income and choice of birth attendant generated x2 =4.229 and a P value of 0.004 at 3 degree of freedom. Education level was also found to be a determinant of choice of birth attendant as the chi square test generated x2 =9.886 and a P value of 0.001 at 2 degree of freedom. The study also established a relationship between distance to health facility and women's choice of birth attendant. The chi square test generated x2 =2.905 and a P value of 0.001 at 2 degree of freedom. The study established that higher utilization of TBAs was because they (TBAs) lived closer to the women, charged lesser fees and allowed different modalities of payment, including payment in kind. SBA utilization was mainly due to perceived safety for both mother and baby. The study also established that TBAs and husbands to married women influenced the women's' decision on choice of birth attendant. The study recommends that government and other stakeholders introduce intense awareness programmes on the benefits of skilled birth attendance and reinforce the policy or, free maternity services at lower levels. The government should also bring maternity services closer to the community and support empowerment of girls and women through education.