| dc.description.abstract | Background
Developing countries of Asia and Africa account for 99% of the yearly 536,000 maternal mortalities, most of which are avoidable. It is for this reason, among others, that MDGs were developed. Understanding why women still do not use antenatal care services. health facility delivery and postnatal care services is crucial towards achievieng MDGs and addressing the tragedy of high maternal mortality in the developing countries.
Turkana central and Loima districts are one of the districts in Kenya with low utilisation of ANC and skilled care during delivery. The two districts had only 8.1 % of deliveries assisted by skilled personnel in 2008. Hence the need to understand reasons for poor utilisation of these crucial maternity services. It is for this purpose that this study is designed.
Objective
To determine the factors that intluence antenatal care attendance. skilled assistance during delivery and postnatal care among the women of Loima and Central districts of Turkana County.
Study Design: This was a cross-sectional household survey that sought to determine factors associated with maternity services utilisation by comparing those women who had delivered at home with those who delivered in a health facility in the preceding 2 to 36 months in Turkana central and Loima districts of Turkana County.
Main outcome measures: Information on sociodemographic,sociocultural. socioeconomic characteristics among ANC attendants, mothers who delivered at home or a health facility and PNC attendants was collected. Information on physical access and perceived quality of maternity services was also collected to correlate ANC attendance. health facility delivery and post natal clinic attendance among mothers who had home and health facility deliveries.
Results:
Mother's education (p value <0.0001) was strongly associated with choice of place of delivery; Mothers who had post-primary school were 17 (OR= 17.2 CI 3.0-98.8) times likely to deliver in a health facility than those with less formal education. Having a monogamous spouse (p value= 0.006. OR= 2.7 CI 1.3-~.?), a health facility having been place of previous delivery (p value < 0.000 I, OR=5.5 CI 2.1-14.4) and satisfaction with a previous birthing position (p value 0.015, OR= 14.3 CI 1.7-122.3) were also significant in determining place of delivery. If birth plan was discussed in ANC during pregnancy (p value <0.0001 and OR 7.8 CI 2.9- 21) had significant intluence on where mothers delivered. Means of transport to a health facility determined place of d~ivery (p value < O.OOOI).
A mother who had access to a vehicle was 31 times (OR 31 CI 7.0-142.3) likely to deliver in a health facility than one who walked to the facility during labour. Community perception of quality of maternity services was crucial: mothers who perceived health facilities to promptly attend to them were 8 times (OR 7.5 CI 2.3-24.7) likely to deliver in a health facility. Perceived adequacy of equipment and medical supplies was also significant (p value = 0.010 and OR 15.9 CI 1.9-131.7). ANC attendance for at least four visits was 68.1 % and 63.2% for health facility and home users respectively. PNC attendance was 95.7% and 85.3% for health facility users and home users respectively.
Conclusions:
Education of women. discussion of the birth plan during ANC, polygamy. birthing position and place of initial delivery were critical in determining place of delivery in this area
Recommendation
Education of the girl child and highlighting the benefits of monogamy to the community need to be focused on. There is need to focus on and especially target primigravidae to have deliveries in health facilities by promoting advocacy,education on danger signs and emphasizing to the community the importance of health facility delivery.
Other safe birthing positions apart from recumbent position need to be discussed with health workers and allowed in health facilities. A birth plan needs to be discussed in ANC.The government needs to deliberately open up the area economically for these two districts to realise improved reproductive health indicators. | en_US |
