Uptake of skilled birth deliveries in women of reproductive age: Results of a cross-sectional survey following implementation of free maternal services in Nyatike Sub-County, Kenya

Abstract

Background: As is the trend globally, in Kenya, maternal mortality ratio remains high at 546/100,000 and 362/100,000 live births, respectively. Approximately 830 women die from pregnancy- or childbirth-related complications around the world every day, with 88% of these deaths occurring in Africa and Asia. In Kenya, skilled birth attendants (SBA) is estimated at 62% while in Nyatike Sub-County, it is 68%. The factors influencing skilled birth attendants are still largely unknown in Nyatike despite the government provision of free maternal services. Methods: Across-sectional study was carried among367 women aged 15-49 years old who had a live birth and living in Nyatike Sub-County. Quantitative data were collected using structured questionnaires, while qualitative data was collected from 20 key informant interviews and 6 Focus Group Discussions. Quantitative data were analysed using Chi-square test and binary logistic regression while qualitative data were analysed using content analysis. Results: The prevalence of skilled delivery was 32.2% (118/367). Of the 367 women interviewed, 293 (80.3%) were aware of the nearest health facility. Amongst those who were aware of nearest health facility, (32%, n=94) utilized SBA. Women with high school education were 2.9 times more likely to use SBA (high school vs primary; OR=2.9; 95% CI=1.1-8.2, p=0.039). Women who perceived health workers’ attitude to be ‘very friendly’ were 2.8 times more likely than those with no opinion to use SBA (40.5% vs 19.7%, OR=2.8; 95% CI=1.3-6.1, p=0.010). Only 40% of health facilities surveyed provided quality care. Choice of place of delivery was perceived to be due to availability of free professional care for both mother and baby, high standard of hygiene and equipment, free referral services if complications arise and privacy at the health facilities. Conclusion: The prevalence of skilled birth delivery was generally low. Women with secondary education or higher were more likely to utilize skilled birth delivery compared to those with primary education. Overall, the attitude of health workers was significantly associated with higher odds of skilled birth delivery and a higher percentage of the health facilities provided poor quality services.