Determinants and fetomaternal outcomes for home births among child bearing age women in Marakwet East in Elgeyo Marakwet County -Kenya

Abstract

Introduction: Health status of mothers and children is an important indicator of the overall economic health and well-being of a country. Maternal deaths commonly occur in fragile and humanitarian settings outside the hospital. In Elgeyo Marakwet county 35% of births took place at home. These home births are associated with high risk of morbidity and mortality which is preventable if attended by skilled birth attendants. Objectives: To establish the reasons for home births, to determine fetomaternal outcomes and to assess perceptions of mothers towards free maternity care policy. Methodology: The study was conducted in Marakwet East; Elgeyo Marakwet County.A Cross-sectional descriptive study that used mixed method design. Purposive and consecutive sampling procedures were used. Sample size of 236 mothers aged (15-49) years were interviewed using questionnaires. Thirty eight mothers participated in four focused group discussions. Mixed methods of data collection were used. Percentages, frequencies and logistic regression models were derived using STATA version 13. Data was presented in tables and prose. A p-value of 0.05 was considered statistically significant at 95% confidence interval. Results: Most women (83%) had home deliveries. Some of the reasons found were; poor birth preparedness 150 (65.2%) coupled with mothers not involving their partners on decision on place of delivery 153 (66.52%), trust for TBAs 102 (44.35%) and 103 (44.78%) distance to health facility. Fetomaternal outcomes included sustained perineal tears 141 (61.3%), blood loss after delivery 53 (23.04%) and birth asphyxia 49 (21.30%). Logistic regression findings showed that single women were 8.9 times more likely to give birth at home (COR1.60 95%CI 0.62-3.78 p ≥value >0.05).Women who made self-decisions on place of delivery were 0.51 times highly likely to deliver at home (COR 0.51 95% CI 0.11-2.33 p-value ≥0.05) .Women perceived free maternity policy as the major cause of congestion in the few health facilities, thus affecting their privacy and confidentiality. Conclusion: Most women in Marakwet East had home births. Main reasons for home births were; poor birth preparedness coupled with women not involving of their partners on place of delivery and trust for traditional birth attendants. Most women walked to the health facilities due to lack of means of transport. Coupled with poor topography, this made it hard for the women to get to the health facilities on time. Fetomaternal outcomes associated with home delivery included; perineal tears, bleeding after delivery and birth Asphyxia. Introduction of free maternity policy was perceived as the main source of congestion due to increased number of mothers and inadequate infrastructure in the health facilities. Recommendations: County government to invest more on health education of the mothers on birth preparedness, dangers associated with pregnancy, child birth, postpartum period and importance of hospital delivery. To deploy trained midwives in the community to act as agents of evidence based practice. To improve road networks for availability of means of transport for easy access to health facilities. Improve beyond zero campaign initiative to reach hard to reach areas of the county. Traditional birth attendants be educated to act as ambassadors in referring patients in labor to deliver in a hospital setting.