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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Pregnancy and Childbirth 1/2018

Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya

Zeitschrift:
BMC Pregnancy and Childbirth > Ausgabe 1/2018
Autoren:
Sarah Karanja, Richard Gichuki, Patrick Igunza, Samuel Muhula, Peter Ofware, Josephine Lesiamon, Lepantas Leshore, Lenny Bazira Kyomuhangi-Igbodipe, Josephat Nyagero, Nancy Binkin, David Ojakaa
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12884-017-1632-x) contains supplementary material, which is available to authorized users.

Abstract

Background

In response to poor maternal, newborn, and child health indicators in Magadi sub-county, the “Boma” model was launched to promote health facility delivery by establishing community health units and training community health volunteers (CHVs) and traditional birth attendants (TBAs) as safe motherhood promoters. As a result, health facility delivery increased from 14% to 24%, still considerably below the national average (61%). We therefore conducted this study to determine factors influencing health facility delivery and describe barriers and motivators to the same.

Methods

A mixed methods cross-sectional study involving a survey with 200 women who had delivered in the last 24 months, 3 focus group discussions with health providers, chiefs and CHVs and 26 in-depth interviews with mothers, key decision influencers and TBAs. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) using logistic regression were calculated to identify predictive factors for health facility delivery. Thematic analysis was done to describe barriers and motivators to the same.

Results

Of the women interviewed, 39% delivered at the health facility. Factors positively associated with health facility deliveries included belonging to the highest wealth quintiles [aOR 4.9 (95%CI 1.5–16.5)], currently not married [aOR 2.4 (95%CI 1.1–5.4)] and living near the health facility [aOR 2.2 (95%CI 1.1 = 4.4)]. High parity [aOR 0.7 (95%CI 0.5–0.9)] was negatively associated with health facility delivery. Barriers to health facility delivery included women not being final decision makers on place of birth, lack of a birth plan, gender of health provider, unfamiliar birthing position, disrespect and/or abuse, distance, attitude of health providers and lack of essential drugs and supplies. Motivators included proximity to health facility, mother’s health condition, integration of TBAs into the health system, and health education/advice received.

Conclusion

Belonging to the highest wealth quintile, currently not married and living near a health facility were positively associated with health facility delivery. Gender inequity and cultural practices such as lack of birth preparedness should be addressed. Transport mechanisms need to be established to avoid delay in reaching a health facility. The health systems also need to be functional with adequate supplies and motivated staff.
Zusatzmaterial
Additional file 1: Household questionnaire. The questionnaire used to collect data from women of reproductive age and also heads of the household. (DOC 114 kb)
12884_2017_1632_MOESM1_ESM.doc
Additional file 2: Interview Guide: Women who recently delivered at health facility. Interview guide for women who recently delivered at health facility. (DOCX 41 kb)
12884_2017_1632_MOESM2_ESM.docx
Additional file 3: Interview Guide: Women who recently delivered at home. Interview guide for women who recently delivered at home (DOC 59 kb)
12884_2017_1632_MOESM3_ESM.doc
Additional file 4: Interview Guide: Key Birth Decision Influencer. Interview guide for Key Birth Decision Influencer (DOCX 26 kb)
12884_2017_1632_MOESM4_ESM.docx
Additional file 5: In-depth Interview guide: Village elder. In-depth Interview Guide for Village elder (DOCX 24 kb)
12884_2017_1632_MOESM5_ESM.docx
Additional file 6: In-depth Interview Guide: Traditional Birth Attendants. In-depth Interview Guide with Traditional Birth Attendants (DOCX 25 kb)
12884_2017_1632_MOESM6_ESM.docx
Additional file 7: Focus Group Guide for Nurses, Midwives. Focus Group Guide for Nurses and Midwives (DOCX 19 kb)
12884_2017_1632_MOESM7_ESM.docx
Additional file 8: Focus Group Guide for Chiefs . Focus Group Guide for Chiefs (DOCX 18 kb)
12884_2017_1632_MOESM8_ESM.docx
Additional file 9: Focus Group Guide with CHVs. Focus Group Guide for CHVs (DOCX 19 kb)
12884_2017_1632_MOESM9_ESM.docx
Literatur
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