Factors Associated with Uptake of Skilled Birth Attendants’ Services among Women of Reproductive Age in Garissa Town, North Eastern Kenya

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 – xiv 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.