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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pregnancy and Childbirth 1/2015

Determinants of use of skilled birth attendant at delivery in Makueni, Kenya: a cross sectional study

BMC Pregnancy and Childbirth > Ausgabe 1/2015
Anne Gitimu, Christine Herr, Happiness Oruko, Evalin Karijo, Richard Gichuki, Peter Ofware, Alice Lakati, Josephat Nyagero
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AG: Participated in the origination of the study and its design. CH: conducted literature review, data analysis and writing of the paper. HO: participated in literature review, data analysis, interpretation of the results and writing of the paper. EK: contributed to literature review & drafting of the paper. RG participated in data analysis and interpretation of the results. PO: contributed to the refinement of the initial research idea and reviewing of drafts. AL: contributed to analysis, interpretation of results and writing of the paper. JN: participated in conceptualization, technical oversight and reviewing of the drafts. All authors read and approved the final manuscript.

Authors’ information

AG: is a public health specialist and researcher. CH is an intern and researcher. HO: is a monitoring and evaluation professional as well as a researcher. EK is a health development professional. GR is a statistician at Amref Health Africa in Kenya. PO is a social scientist and the Amref Health Africa in Kenya reproductive, maternal, newborn and child health lead. AL is an epidemiologist/biostatistician and researcher. JN is a public health professional and is the Amref Health Africa research lead.



Kenya has a maternal mortality ratio of 488 per 100,000 live births. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at delivery. Kenyan national statistics estimate that the proportion of births attended by a skilled health professional have remained below 50% for over a decade; currently at 44%, according to Kenya’s demographic health survey 2008/09 against the national target of 65%. This study examines the association of mother’s characteristics, access to reproductive health services, and the use of skilled birth attendants in Makueni County, Kenya.


We carried out secondary data analysis of a cross sectional cluster survey that was conducted in August 2012. Interviews were conducted with 1,205 eligible female respondents (15-49 years), who had children less than five years (0-59 months) at the time of the study. Data was analysed using SPSS version 17. Multicollinearity of the independent variables was assessed. Chi-square tests were used and results that were statistically significant with p-values, p < 0.25 were further included into the multivariable logistic regression model. Adjusted odds ratio (AOR) and their 95% confidence intervals were (95%) calculated. P value less than 0.05 were considered significant.


Among the mothers who were interviewed, 40.3% (489) were delivered by a skilled birth attendant while 59.7% (723) were delivered by unskilled birth attendants. Mothers with tertiary/university education were more likely to use a skilled birth attendant during delivery, adjusted OR 8.657, 95% CI, (1.445- 51.853) compared to those with no education. A woman whose partner had secondary education was 2.9 times more likely to seek skilled delivery, adjusted odds ratio 2.913, 95% CI, (1.337- 6.348). Attending ANC was equally significant, adjusted OR 11.938, 95% CI, (4.086- 34.88). Living within a distance of 1- 5 kilometers from a facility increased the likelihood of skilled birth attendance, adjusted OR 95% CI, 1.594 (1.071- 2.371).


The woman’s level of education, her partner’s level of education, attending ANC and living within 5kms from a health facility are associated with being assisted by skilled birth attendants. Health education and behaviour change communication strategies can be enhanced to increase demand for skilled delivery.
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