Abstract:
Background: Maternal mortality remains a major public health problem in developing countries. Maternal mortality rates (MMR) in Kenya declined from 362/100,000 live births in 2014 to 353/100,000 live births in 2021 as a result of improved utilization of skilled delivery services. Marsabit County, which despite the nation's decline still has a high MMR of 1,127/100,000 live births. In the North Horr sub-County in 2018, just 26% of expectant women had skilled births. The purpose of this study was to determine coverage and the factors associated with the low utilization of skilled birth attendant services.
Objectives: To estimate coverage for skilled delivery; determined the factors associated with the utilization of skilled birth attendant services and describe challenges experienced by pregnant women in the North Horr sub-County.
Methods: This was a cross-sectional study targeting women of reproductive age, women leaders, and healthcare workers from North Horr sub-County in November – December 2021. A total of 294 women were identified and interviewed using structured questionnaires at the household level. Twelve key informant interviews (KII) and three focused group discussions (FGD) were conducted with participants (health care workers and women leaders) selected purposively based on their expertise in maternal health care. Mean, median, and standard deviations were calculated for continuous variables; frequencies and proportions were calculated for categorical variables. Bivariate analysis and multivariate logistic regression analysis were used to identify factors associated with the utilization of skilled birth attendance services. A Chi-square test was used to assess statistical significance with a p-value set at p<0.05. The qualitative data collected were thematically analysed and used to support the quantitative results.
Results: Of 294 respondents interviewed the mean age was 28.5 years (SD±5.89 years); 170 (57.8%) either delivered at home, on the way to the health facility, or at the Traditional Birth Attendant (TBA); while 124 (42.2%) delivered under skilled birth personnel. Four factors; religion (adjusted Odds Ratio (aOR)= 3.70; 95% C.I 2.03 – 6.76; p<0.05); distance to the nearest health facility (aOR= 4.8; 95% C.I 1.99 – 12.02; p<0.001); Monthly income (aOR= 2.8; 95% C.I 1.28-6.27; p<0.01); and accompanied by the husband to the clinic (aOR= 9.4; 95% C.I 1.69-53.01; p<0.05); were independently associated with utilization of skilled birth attendance services. It was clear from the KIIs and the FGDs that respondents understood the significance of using skilled delivery services, although parity, birth order, insecurity, bad roads, and past experiences affected where the women went to give birth.
Conclusion: The proportion of women utilizing skilled birth attendance in the study area remained low compared to the national. Long distance to health facilities, religion, monthly income, and being accompanied by the husband to the health facility were associated with the utilization of skilled delivery services.
Recommendation: The county government should construct more health facilities to reduce the long distance. Religious and community leaders should be sensitized and allowed to take a leading role in advocacy for the utilization of skilled birth attendance. It should also be promoted for partners to attend prenatal appointments and delivery together.