A community survey to evaluate the level of utilization of antenatal and delivery services in Teso District, Kenya
Background: Skilled delivery and antenatal services utilization are essential for the improvement of maternal and child health. However in rural Kenya settings and the country as a whole, utilization of this health service remains low even with the provision of the service by the government. KDHS 2008/9 shows that only 25.8% of pregnant women in western province are being delivered by a skilled attendant, which is very low compared to the poor national figures of 44%. The aim of this study is to determine the pattern of use of antenatal and delivery services and to assess factors that lead to low utilization of this service among women aged between 1549 years and whose children were one year old in Teso District. The findings of this study will help health planners, policy makers and program managers develop service delivery strategies that are responsive to the health needs of expectant mothers in Teso district. Research Objective: The broad objective was to determine the pattern of utilization of maternal health care services and identify factors that either enhance or constrain it’s utilization in Teso district. Study Setting. The study took place in Alomodoi Sub- location in Teso district, Western province. Study Design. A community based cross-section survey. Sample Size. A total of 296 women aged between 15-49 years whose children were less than one year were interviewed. Methodology: A community based cross-sectional survey of 296 women aged between 15- 49 years whose children were less than one year was carried out at Alomodoi Sub-location, Teso District between 1st July 2013 and 21st September 2013. Data was collected with structured Results: Majority of the women received antenatal care (96.7%) during their last pregnancy. 68.6% of the women who received Antenatal care presented for their first visit in the second trimester. Only 35.5% women had four and more antenatal visits as recommended by the Ministry of Health Kenya and WHO. Despite high antenatal attendance very few women delivered in a health facility 31.4%. Majority of the deliveries occurred at home 61.5%. Of the women who delivered at home 124 (41.9%) were assisted by a traditional birth attendant while 7.1% gave birth on their own. The factors identified as predictors of utilization of maternal health services are family economic status, prior history of pregnancy with antenatal clinic attendance, maternal level of education, being married and women independence in decision making on place of delivery. The reasons given for home delivery include women experiencing short labor, high cost of health facility fee and high cost of transport. Women with a high level of educational, high level of income and with autonomy in decision making were more likely to use skilled delivery services (p<0.05). Conclusion: Based on the study findings Coverage for antenatal services was high among mothers during their last pregnancy. However, only less than a half of the mothers interviewed utilized health facilities for delivery. Observed contributing factors for a home delivery included the fast progression of labor, high cost of transport, high cost of health facility fee and poverty. Maternal education was an important factor in influencing women to utilize skilled delivery services, with education women are empowered in decision making. High economic status was associated with utilization of skilled delivery services. Recommendation: All health care providers should be encouraged to discuss a birth plan with women at the first contact in the antenatal clinic and should emphasize the importance of subsequent antenatal visits in the monitoring of pregnancy and encourage women to deliver at a health facility. The government should ensure universal utilization of antenatal and delivery services care irrespective of their ability to pay. Universal access to education should be encouraged for the girl child as it will help them make a more informed decisions concerning their health as well as raise their income level. Development of community programs to sensitize mothers on the importance of initiating the first antenatal visit early enough and also on the frequency of visits for a maximum uptake of the care content. A follow-up study needs to be done to determine the impact of free maternity health care in the utilization of antenatal and delivery services in Teso district or any other rural setting. questionnaires using the snow-bowl and convenient sampling methods.