Abstract:
Background: Skilled birth attendance (SBA) is an important intervention for reducing preventable maternal and neonatal morbidity and mortality. It enables timely identification and management of complications during childbirth and referral for advanced care when required. However, utilisation of SBA remains uneven, particularly in remote and underserved settings. In Kenya, SBA was 89% nationally in 2022, compared with 53% in Turkana County. Despite the establishment of Maternal and Newborn Health Centres of Excellence (MNH CoEs) to improve access to quality maternal and newborn services, there is limited evidence on utilisation of SBA in Kibish Sub-County. This study therefore assessed utilisation of SBA and factors influencing its utilisation among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County.
Objectives: The broad objective of the study was to assess the determinants influencing the utilisation of SBA among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County. The specific objectives were to assess socio-demographic characteristics associated with utilisation of SBA; to assess obstetric factors associated with utilisation of SBA; to determine the influence of health facility accessibility on utilisation of SBA; and to explore perceived cultural factors influencing utilisation of SBA among women of reproductive age in MNH CoEs.
Methods: The study employed a cross-sectional mixed-methods design using a convergent parallel approach. The study involved 369 participants aged 15–49 years who had at least one delivery in the preceding two years and had lived in Kibish Sub-County for at least two years before the study. Quantitative data were collected through structured questionnaires, and qualitative data were collected through eight FGDs conducted in each of the catchment villages and four KIIs involving County and Sub-County RH coordinators and in-charges of the two health facilities. Quantitative data were entered into SPSS v20 and analysed using statistical tests such as frequencies, Prevalence, and Logistic regression, as applicable. Qualitative data were translated, transcribed, and thematically analysed both manually and with NVivo. Ethical approval was obtained from MTRH /Moi University IREC (Approval no: 0003543) and NACOSTI (License No. NACOSTI/P/20/5223).
Findings: Most of the respondents were aged 25-34 years (65.0%, n=240), had no formal education (93.2%, n=344), and lived within 5 km of a healthcare facility (59.9%, n=221). Hospital delivery was reported by 58.0% (n=214) of participants; 213 (57.7%) reported being attended by a skilled health professional at their last birth; 55.3% (n=204) had parity of ≥4, and 93.1% (n=344) had at least one ANC visit. Reduced utilization of SBA was associated with husbands who were herdsmen [95% CI: 2.35-20.91; p=0.001, AOR = 7.01], parity ≥5 [AOR = 8.86; 95% CI: 2.77–28.33; p<0.001], and transport cost ≥500 [AOR = 9.30; 95% CI: 3.08–28.09; p<0.001], while having ≥4 ANC visits [AOR = 0.092; 95% CI: 0.019–0.451; p=0.003] increased utilization of SBA. Six main themes emerged from the FGDs and five from the KIIs: highlighting cultural practices related to placenta disposal, umbilical cord care, preferred birthing position, gender of the birth attendant, domestic responsibilities, breastfeeding and naming practices, and the roles of husbands and mothers-in-law in childbirth decisions.
Conclusion: SBA utilisation in Kibish Sub-County was suboptimal. Higher parity, having a husband who was a herdsman, and higher transport costs were associated with increased likelihood of home delivery, while attending four or more ANC visits was associated with reduced likelihood of home delivery. Qualitative findings indicated that cultural practices, family decision-making, and challenges in accessing and using health facilities influenced childbirth decisions. Interventions to improve SBA utilisation should therefore address transport-related barriers, strengthen ANC engagement, and incorporate culturally responsive approaches to maternal and newborn care.
Recommendations: The findings highlight the need for community-based interventions to improve access to maternal and newborn health services in remote areas through strengthened health infrastructure, transport systems, and community-based ANC outreach. There is also a need to invest in operationalising and optimizing the use of Maternity Waiting Homes (MWHs) for expectant women residing away from health facilities. Culturally responsive and respectful maternity care should also be strengthened through community engagement and promotion of practices that do not compromise maternal and newborn safety.