Determinants of Utilization of Skilled Birth Attendance among Women Aged 18-49 Years in Bamba Division, Kilifi County, Kenya

Abstract

Improving maternal health through the provision of skilled care during delivery now falls in the Sustainable Development Goals (SDGs) number three which is to ensure healthy lives and promote wellbeing for all at all ages. However, the proportion of Skilled Birth Attendance (SBA) is generally poor in most developing countries, including Kenya with an estimate of 43%.This study was a population based cross sectional study conducted in Bamba division. It aimed at determining the factors associated with the utilization of SBA among women 18 to 49 years of age, who have delivered within the last 12 months. It used quantitative method (structured questionnaire) where random selection of households was done and qualitative data collecting methods where Focus Group Discussions and Key Informant Interviews were used. A total of 260 women participated in the quantitative survey and 47.7% of them sought skilled care in the health facilities while 52.3% delivered under unskilled care. The questionnaire identified; distance, prolonged labour, pregnancy problems, parity, maternal age, planned pregnancy, mosquito net use, maternal age, maternal education and place of residence as factors associated with SBA. Multiple factors were analyzed and factors such as living below 2km (OR=87.400, 95%CI=6.928-1102.645), pregnancy problems (OR=17.924, 95% CI=4.737-67.828), mosquito net use (OR=6.544, 95% CI=1.383-30.970) and prolonged labour (OR=148.494, 95% CI=30.208-729.449) were found to be positively significant with SBA. The FGDs and KIIs identified long distance, lack of transport, economic constraints, male dominance, ignorance, high illiteracy levels, insufficient health workers& health facilities as predictors of low utilization of SBA. This study concluded that the proportion of women seeking SBA was still low at 47.7%. Accessibility factors (long distances, poor roads, lack of transport), health facility factors and socio-cultural factors discouraged use of SBA. We recommend that more effort be put in addressing health facility shortages; more facilities to be established, the existing facility to be well equipped, more health workers to be employed. Also more sensitization on the benefits of SBA should be done in the locality, adult education programs should be encouraged to ensure that the residents of Bamba are literate so that they can be able to make informed decisions concerning their health.