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

  • BMC Pregnancy and Childbirth, Volume 18, No. 1, Year 2018

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Study Justification:
– The study was conducted in response to poor maternal, newborn, and child health indicators in Magadi sub-county, Kenya.
– The “Boma” model was implemented to promote health facility delivery, but the rates were still considerably below the national average.
– The study aimed to determine the factors influencing health facility delivery and describe the barriers and motivators to the same.
Study Highlights:
– The study used a mixed methods approach, combining quantitative and qualitative research methods.
– A survey with 200 women who had delivered in the last 24 months was conducted, along with focus group discussions and in-depth interviews.
– Adjusted odds ratios were calculated to identify predictive factors for health facility delivery.
– Barriers to health facility delivery included lack of decision-making power, lack of birth plan, gender of health provider, distance, and attitude of health providers.
– Motivators included proximity to health facility, mother’s health condition, integration of traditional birth attendants (TBAs) into the health system, and health education/advice received.
Study Recommendations:
– Address gender inequity and cultural practices that hinder health facility delivery.
– Establish transport mechanisms to avoid delays in reaching a health facility.
– Improve the functionality of health systems by ensuring adequate supplies and motivated staff.
Key Role Players:
– Community health units
– Community health volunteers (CHVs)
– Traditional birth attendants (TBAs)
– Health providers
– Chiefs
– Mothers
– Key decision influencers
Cost Items for Planning Recommendations:
– Training programs for health providers, CHVs, and TBAs
– Transportation infrastructure improvement
– Provision of essential drugs and supplies
– Health education and awareness campaigns
– Staff motivation and retention strategies

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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.

This was a cross sectional study using mixed methods approach to assess factors that influence health facility delivery. Quantitative research methods were used to assess coverage of facility births by various equity-related characteristics, while qualitative research methods identified motivators and barriers to health facility delivery. This study was conducted in Entasopia community, which is located in Magadi sub-county of Kajiado County, Kenya. The area is one of the arid and semi-arid lands (ASALs) in Kenya, which are classified by the Kenya government as disadvantaged with respect to equitable distribution of national resources, infrastructure and access to essential social services including healthcare. ASAL regions are home to nomadic and semi-nomadic communities such as the Maasai and Turkana who have poor MNCH indicators. The poor MNCH indicators among these communities are attributed to a complexity of factors including inadequate, ill-equipped and poorly staffed health facilities; long distances to health facilities; migratory lifestyles; conservative cultural practices; and gender biases [10]. Magadi County was chosen as a study location because initially the “Boma” model was implemented there prior to extending it to Samburu County. The county has eight community units (Oldonyonkie, Shompole, Olkeri, Olkiramatian, Oloika, Pakase, and Entasopia, which contains two community units). Entasopia was the only community unit that had a relatively better quality health facility with 24-h obstetric care, and since the purpose of the case study was to understand why some women use and others do not use health facilities for delivery beyond lack of geographic access, it was decided to limit the case study to this unit. Data was collected from September 22 to October 3, 2014.

The study titled “Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya” aimed to identify factors that influence health facility delivery and describe barriers and motivators to the same. The study used a mixed methods approach, including a survey with 200 women who had delivered in the last 24 months, focus group discussions with health providers, chiefs, and community health volunteers (CHVs), and in-depth interviews with mothers, key decision influencers, and traditional birth attendants (TBAs).

The study found that belonging to the highest wealth quintiles, currently not being married, and living near a health facility were positively associated with health facility delivery. On the other hand, high parity was negatively associated with health facility delivery. Barriers to health facility delivery included women not being the final decision-makers on the place of birth, lack of a birth plan, gender of health providers, unfamiliar birthing positions, disrespect and/or abuse, distance, attitude of health providers, and lack of essential drugs and supplies. Motivators included proximity to a health facility, the mother’s health condition, integration of TBAs into the health system, and health education/advice received.

Based on the findings, the study recommends addressing gender inequity and cultural practices such as lack of birth preparedness. It also suggests establishing transport mechanisms to avoid delays in reaching a health facility and ensuring that health systems are functional with adequate supplies and motivated staff.

The study was published in BMC Pregnancy and Childbirth in 2018 and was conducted in the Entasopia community, located in Magadi sub-county of Kajiado County, Kenya. The area is classified as an arid and semi-arid land (ASAL) and is home to nomadic and semi-nomadic communities such as the Maasai and Turkana, who have poor maternal, newborn, and child health (MNCH) indicators. The study focused on Entasopia community because it had a relatively better quality health facility with 24-hour obstetric care, allowing for a deeper understanding of the factors influencing health facility delivery beyond geographic access.

Overall, the study provides valuable insights into the factors influencing health facility delivery in a rural Maasai community and offers recommendations to improve access to maternal health services.
AI Innovations Description
The study titled “Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya” aimed to identify factors that influence health facility delivery and describe barriers and motivators to the same. The study used a mixed methods approach, including a survey with 200 women who had delivered in the last 24 months, focus group discussions with health providers, chiefs, and community health volunteers (CHVs), and in-depth interviews with mothers, key decision influencers, and traditional birth attendants (TBAs).

The study found that belonging to the highest wealth quintiles, currently not being married, and living near a health facility were positively associated with health facility delivery. On the other hand, high parity was negatively associated with health facility delivery. Barriers to health facility delivery included women not being the final decision-makers on the place of birth, lack of a birth plan, gender of health providers, unfamiliar birthing positions, disrespect and/or abuse, distance, attitude of health providers, and lack of essential drugs and supplies. Motivators included proximity to a health facility, the mother’s health condition, integration of TBAs into the health system, and health education/advice received.

Based on the findings, the study recommends addressing gender inequity and cultural practices such as lack of birth preparedness. It also suggests establishing transport mechanisms to avoid delays in reaching a health facility and ensuring that health systems are functional with adequate supplies and motivated staff.

The study was published in BMC Pregnancy and Childbirth in 2018 and was conducted in the Entasopia community, located in Magadi sub-county of Kajiado County, Kenya. The area is classified as an arid and semi-arid land (ASAL) and is home to nomadic and semi-nomadic communities such as the Maasai and Turkana, who have poor maternal, newborn, and child health (MNCH) indicators. The study focused on Entasopia community because it had a relatively better quality health facility with 24-hour obstetric care, allowing for a deeper understanding of the factors influencing health facility delivery beyond geographic access.

Overall, the study provides valuable insights into the factors influencing health facility delivery in a rural Maasai community and offers recommendations to improve access to maternal health services.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a potential methodology could involve the following steps:

1. Establish a baseline: Collect data on the current status of maternal health access in the target community, including the percentage of health facility deliveries, barriers faced by women, and availability of essential drugs and supplies.

2. Implement interventions: Based on the study’s recommendations, implement interventions to address the identified barriers and improve access to maternal health services. These interventions could include:

a. Gender equity and cultural practices: Conduct community awareness campaigns and workshops to promote gender equity and address cultural practices that hinder birth preparedness. Engage community leaders, traditional birth attendants, and influential individuals to support and advocate for these changes.

b. Transport mechanisms: Establish and improve transportation systems to ensure timely access to health facilities. This could involve providing ambulances or other means of transportation for pregnant women in need.

c. Strengthen health systems: Work with local health authorities to ensure that health facilities are adequately equipped with essential drugs and supplies. Provide training and support to health providers to improve their attitudes and quality of care.

3. Monitor and evaluate: Continuously monitor the implementation of interventions and collect data on key indicators related to maternal health access, such as the percentage of health facility deliveries, women’s decision-making power, and availability of essential drugs and supplies.

4. Analyze the impact: Analyze the collected data to assess the impact of the interventions on improving access to maternal health services. Compare the post-intervention data with the baseline data to identify any changes and trends.

5. Adjust and refine interventions: Based on the analysis of the impact, make adjustments and refinements to the interventions as needed. This could involve scaling up successful interventions, addressing any unforeseen challenges, and continuously improving the strategies to further enhance access to maternal health services.

6. Repeat the process: Continuously repeat steps 3 to 5 to monitor the ongoing impact of the interventions and make further improvements as necessary.

By following this methodology, it would be possible to simulate the impact of the study’s recommendations on improving access to maternal health services in the target community.

Statistics:
Citations: 19
Authors: 11
Identifiers:
DOI: 10.1186/s12884-017-1632-x
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Kenya
Study Design:
Case Study, Cross Sectional Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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