Background: A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care. Methods. A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers’ delivery practice. Results: Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 – 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 – 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 – 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 – 309.3). Conclusion: Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality. © 2011 Wanjira et al; licensee BioMed Central Ltd.
The study was carried out in Nyandarua South district, Kenya. The district is amongst districts with unsafe motherhood as an issue of concern in Kenya [16]. The district has an area of 1,367.2 square kilometers and is divided into 3 administrative divisions. Based on the National Population Census, the district has a total population of 230,622 with an annual growth rate of 3.3% [16]. The crude birth rate (CBR) is 39.2% and a total fertility rate (TFR) of 6.6. Population of special health significance include: infant population (10,861), children under five years is (48,357) and 11,655 women in the reproductive age group (15-49 years) [16]. This was a descriptive cross-sectional study where the study population comprised of mothers aged 15 to 49 years attending Maternal Child Health (MCH) clinics at the district and sub-district hospitals, and who had a live birth in the two years preceding the survey while in the study area. Delivery practice in this study was defined as the type of care a mother utilized during delivery with regard to the place of delivery and type of attendant during delivery. Using the estimated proportion of deliveries attended by skilled attendants (42%) in Kenya as reported by the most recent demographic data available at the time of the study [17], the sample size was calculated using the Fisher formula [18]. Using a sampling frame estimated from using the average number of mothers visiting the clinic per day (established from the facility), multiplied by the number of days to be spent on the site, a random sample of 416 mothers were selected to participate out of which 409 gave successful interviews. To calculate the sampling interval, the total estimated sampling size was divided by the calculated sample size giving an interval of three thus every third mother was recruited systematically. This was done every day until the desired sample size was realized. A structured questionnaire designed in English but administered by the researcher and/or trained research assistants in Kikuyu (local language) was used to collect data. Respondent mothers were asked about their demographic characteristics (age, education level, marital status, number of deliveries), socio-economic data (type of household and number of sources of income), practices and perceptions (place of delivery, birth attendants, antenatal attendance, spouse involvement in reproductive health issues, experiences during their last delivery). Satisfaction, practice and knowledge scores were generated by the researcher using different elements from the questionnaire each with 100 scores. Data captured in questionnaires was entered into Access database and cleaned. Data analysis was performed using Statistical Package for Social Sciences (SPSS Vers. 12.0 inc., 444 N. Michigan Ave. Chicago Illinois). Analysis of safe and unsafe delivery practices among the 409 mothers was carried out using the most recent delivery report. Definition of safe or unsafe practice was based on the skills of the personnel that assisted in the delivery. Safe delivery was considered to be one that was attended by a skilled birth attendant. Analysis of first and last delivery reports excluded mothers who had delivered only once at the time of the study. Differences in proportions were compared using the Pearson's chi-square test for the categorical variables. A two-sided P-value < 0.05 was considered statistically significant. Binary logistic regression was used to eliminate confounding factors and assess the effect of various factors on place of delivery and type of attendant at delivery. The six predictive factors which significantly associated (independently) with type of delivery care in bivariate analysis were included in the model and their effects examined. These factors (independent variables) included: age of the mother, total number of deliveries in a life time, mothers level of education, perception on home versus hospital attendants, satisfaction and knowledge scores. The dependent variable was delivery practice which was dichotomized as delivery by skilled birth attendant coded as zero and delivery by unskilled birth attendant was coded as one. Variables with P < 0.05 in the logistic regression were considered to predict delivery practice. Approval to carry out the study was obtained from Kenya Medical Research Institute (KEMRI) Scientific/Steering and National Ethical Review Committees. Only those mothers, who met the study requirements, verbally consented and voluntarily signed the consent forms were enrolled into the study. Participants who could not who could not write indicated their consent by a fingerprint, which was witnessed by the interviewer.
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