Determinants of choice of place of delivery by women with infants in Kakamega county, Kenya

Abstract

Maternal mortality is unacceptably high in Kenya with 8,000 women dying every year from obstetric complications. Kakamega county is ranked fifth among counties with highest maternal death burden in Kenya. Increasing the proportion of skilled delivery is one of the most important interventions in averting maternal deaths. However, 53% of women in Kakamega still deliver at home attended by unskilled assistants contributing to high maternal deaths. The choice of childbirth place is influenced by interaction of diverse determinants within the contextual environment. The study was thus carried out with the main objective of assessing the determinants of women’s choice of delivery place in Kakamega County. A cross-sectional design was adopted. A total of 363 women aged 15-49 years who had given birth one year prior to the study were included from a target population of 27,439. Multistage sampling was used to select study participants. A structured questionnaire on fifteen variables was used to collect quantitative data. Qualitative data was obtained using focus group discussions with four groups of women who were not interviewed. Furthermore, in-depth interviews with four key informants including traditional birth attendant, midwife, facility-in-charge and sub county reproductive coordinator were done. The outcome variable was place of delivery measured as health facility or home. Data was analyzed using SPSS v20. Descriptive statistics and logistic regression were used for statistical analysis. Relationship between determinants and place of delivery were analyzed at 95% confidence interval. Factors with �� value < 0.05 were considered statistically significant. The result showed that 85% of births occurred at health facility and 15% in different locations at home. In this study, women who attended four or more antenatal visits were twice more likely to deliver at health facility (OR 2.180; 95% CI 1.126-4.219; P=0.021). Women with knowledge on dangers associated with home delivery were seven times more likely to deliver in the health facility (OR 6.798; 95% CI 2.385-19.376; P=<0.001). In addition, an increase in the number of children delivered reduced the likelihood of delivering at health facility by 18.1% (OR 0.819; 95% CI0.709-0.945; P=0.006). In conclusion, results from this study indicate that number of ANC visits, maternal knowledge on dangers of home delivery and parity influenced choice of place of delivery. It is recommended that to improve hospital deliveries, health education on importance of at least four ANC visits during pregnancy should be prioritized. In addition, counselling on risks associated with home delivery should be intensified. Finally, women with four or more children should have enhanced focus for health facility delivery