Uptake and Emerging Issues Surrounding Hospital Deliveries Services. Perspective of One General Hospital Located in Arid and Insecure Garissa County of North Eastern Kenya

Abstract

Background: Increasing the percentage of births delivered in health facilities is important for reducing the relatively high maternal mortality ratio in Kenya. Despite the increasing availability in awareness, affordability, modernization of formal obstetric care in Kenya, the majority of births in Garissa County still occur at home assisted by unskilled traditional birth attendants (TBAs). The objective of this study was to determine the factors affecting uptake of hospital delivery services by attending or receiving various services at Garissa Provincial General Hospital (GPGH). Methodology: Data on place of delivery, reasons for place of delivery, and a range of potential explanatory factors affecting choice of place of delivery were collected by interviewer-led questionnaire among 338 women attending GPGH. Predictors of place of delivery were explored in an exploratory risk factor analysis using multiple logistic regression. Results: The mean age of the 338 women respondents was 27.03 (SD± 4.66) years, ranging from 17 to 48 years. The majority of the women, 71.6%, were aged between 21 to 30 years, 32.8% had tertiary level education, 86.1% were married, 62.4% attended the GPGH for antenatal care services, and 56.2% were currently pregnant. Three quarters (76.3%) had previously delivered at the GPGH. In multivariate analysis, women who were nulliparous (OR 0.2, 95% CI 0.09 to 0.6), delivered in the hospital in the last 2 years (OR 12.8, 95% CI 5.1 to 32.4) or 3 years ago (OR 13.1, 95% CI 4.9 to 34.4) or those who liked the cleanliness of the hospital (OR 1.9, 95% CI 1.1 to 3.7) and appreciated hospital due to availability of medical supplies (OR 1.8, 95% CI 1.1 to 3.3) were independently associated with utilization of the health facility.Conclusion: A high proportion of women from the county embraced hospital delivery. Among the factors positively affecting uptake of health services in the facility antenatal were hospital cleanliness, equipment and medical supply availability and improved privacy.