Determinants of utilization of health facility during child birth by women aged 15-49 years in Matinyani sub-county in Kitui County, Kenya
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Date
2014-08-27
Authors
Maingi, Nancy
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Abstract
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.
Description
Department of Environmental Health, 100p. 2014