Abstract:
According to WHO, maternal health refers to the health of a woman during pregnancy,
childbirth and postpartum periods. In the year 2013, an estimated 289,000 maternal deaths
occurred worldwide, of which 99% occurred in developing country; sub- Saharan Africa
alone accounted for 62% (179,000) followed by Southern Asia at 24% (69,000) of the global
maternal deaths in 2013. Skilled assistance during childbirth is central to reducing maternal
mortality yet the proportion of deliveries taking place in health facilities where such
assistance can reliably be provided has remained below 50% in many countries. In the
formers North Eastern Province of Kenya, the utilization of skilled attendants during child
delivery remains low despite having the highest maternal mortality in the country. The
purpose of this study was therefore to identify the factors that are associated with uptake of
skilled delivery services during child-birth among women of reproductive age in Garissa
town. This was a cross sectional study where primary data were collected at one point in
time. The study population was women aged 15-49 years who had had at least one delivery
in the past two years and have lived in Garissa for at least two years. Multistage cluster
sampling was used to identify respondents for the study. Both qualitative and quantitative
data were generated. Bivariate and multivariate analysis was performed where by Odds
Ratio (OR) and 95% Confidence Interval (CI) were used to estimate the strength of
association between the various factors and skilled delivery service uptake. The study found
that 47.6% of the last deliveries among child bearing women were attended by skilled
persons and 52.4% by TBAs. The predictors of skilled delivery uptake in this study were
found to be: having knowledge on skilled delivery services (AOR=17.2; 95% CI: 1.05 –
281.12; p=0.046), 1-3 (AOR=116.95; 95% CI: 26.68 – 512.64; p=0.001) and 4-6
(AOR=16.75; 95% CI: 4.44 – 62.87; p=0.001) child births, encounters with previous
delivery complications (AOR=11.71; 95% CI: 3.96 – 34.60; p=0.001), disapproval of TBA
services (AOR=27.19; 95% CI: 6.67 – 110.76; p=0.001), lack of preference for gender of
skilled delivery service provider (AOR=6.51; 95% CI: 1.08 – 39.37; p=0.041), and positive
view on service related factors such as time to nearest facility (AOR=3.91; 95% CI: 1.24 –
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12.34; p=0.020), hygiene (AOR=5.03; 95% CI: 1.49 – 17.05; p=0.009) and operation time
of health facility (AOR=4.67; 95% CI: 1.59 – 13.76; p=0.005). It is therefore clear from the
findings that cultural and maternal factors as well as quality of services at facility level play
major role in determining uptake of skilled services among women in Garissa as compared
to social demographic and economic factors.The findings lead to the recommendation that
adequate maternal health education be provided to improve the attitudes and subjective
value placed on skilled delivery service among women as well as improve services at health
facility to enhance utilization of skilled delivery services. Additionally, a further reserch on
the role male counterparts in SBAs’ service uptake was also recommended. The findings of
the study will help formulate appropriate policies and programs that will help develop better
strategies to address the high maternal morbidity and mortality observed in North Easter
Kenya.