Abstract:
Background: Maternal health service coverage in Kenya remains low, especially in rural areas where 63% of women
deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the
present study were to (1) determine the association between the place of delivery and the distance of a household
from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a
demographic surveillance system (DSS).
Methods: Census sampling was conducted for 13,333 households in the Webuye health and demographic surveillance
system area in 2008–2009. Information was collected on deliveries that had occurred during the previous 12 months.
Digital coordinates of households and sentinel locations such as health facilities were collected. Data were analyzed
using STATA version 11. The Euclidean distance from households to health facilities was calculated using WinGRASS
version 6.4. Hotspot analysis was conducted in ArcGIS to detect clustering of delivery facilities. Unadjusted and adjusted
odds ratios were estimated using logistic regression models. P-values less than 0.05 were considered significant.
Results: Of the 13,333 households in the study area, 3255 (24%) reported a birth, with 77% of deliveries being at home.
The percentage of home deliveries increased from 30% to 80% of women living within 2km from a health facility.
Beyond 2km, distance had no effect on place of delivery (OR 1.29, CI 1.06–1.57, p = 0.011). Heads of households where
women delivered at home were less likely to be employed (OR 0.598, CI 0.43–0.82, p = 0.002), and were less likely to
have secondary education (OR 0.50, CI 0.41–0.61, p < 0.0001). Hotspot analysis showed households having facility
deliveries were clustered around facilities offering comprehensive emergency obstetric care services.
Conclusion: Households where the nearest facility was offering emergency obstetric care were more likely to have a
facility delivery, but only if the facility was within 2km of the home. Beyond the 2-km threshold, households were
equally as likely to have home and facility deliveries. There is need for further research on other factors that affect the
choice of place of delivery, and their relationships with maternal mortality.
