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

listen audio

Study Justification:
– Maternal mortality in Kenya is a significant issue, with a high maternal mortality ratio of 488 per 100,000 live births.
– The presence of a skilled birth attendant at delivery is crucial in preventing maternal deaths.
– The proportion of births attended by skilled health professionals in Kenya has remained below 50% for over a decade, falling short of the national target of 65%.
– This study aims to examine the factors that influence the use of skilled birth attendants in Makueni County, Kenya.
Highlights:
– The study found that mothers with tertiary/university education were more likely to use a skilled birth attendant during delivery.
– Women whose partners had secondary education were also more likely to seek skilled delivery.
– Attending antenatal care (ANC) was significantly associated with the use of skilled birth attendants.
– Living within a distance of 1-5 kilometers from a health facility increased the likelihood of skilled birth attendance.
– These findings suggest that the woman’s level of education, her partner’s level of education, attending ANC, and proximity to a health facility are important factors in determining the use of skilled birth attendants.
Recommendations:
– Health education and behavior change communication strategies should be enhanced to increase demand for skilled delivery.
– Efforts should be made to improve access to reproductive health services, particularly ANC, in order to promote the use of skilled birth attendants.
– Policies and programs should focus on improving education levels, both for women and their partners, to increase the likelihood of seeking skilled delivery.
– Investments should be made to ensure that health facilities are easily accessible to pregnant women, particularly those living within a distance of 1-5 kilometers.
Key Role Players:
– Ministry of Health, Kenya
– County Health Department
– Non-governmental organizations working in maternal health
– Community health workers
– Health facility staff
– Women’s groups and community leaders
Cost Items:
– Health education and behavior change communication materials
– Training programs for health workers and community health workers
– Infrastructure development to improve access to health facilities
– Supplies and equipment for health facilities
– Monitoring and evaluation activities to assess the impact of interventions

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on a cross-sectional study with a large sample size. The study used statistical analysis to identify associations between various factors and the use of skilled birth attendants. The results show statistically significant relationships between the mother’s level of education, partner’s level of education, attending ANC, and living within a certain distance from a health facility with the use of skilled birth attendants. To improve the evidence, the study could have included a more diverse sample to ensure generalizability and used a longitudinal design to establish causality.

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

The study was an analysis of secondary data for cross-sectional baseline survey conducted in August 2012 for an Amref Health Africa intervention project entitled Mama na Mtoto wa Afrika (Mother and Child of Africa). The outcomes of the Mama na Mtoto wa Afrika project focus on increasing the access and utilisation of maternal health services, and increasing the capacity of local health systems to provide quality services. The study was supervised by Amref Health Africa project team, and it aimed at establishing benchmarks for Maternal, Newborn and Child Health Services in Makueni County, Kenya. The sampling frame consisted of the Population and Census Enumeration Areas (EAs) used in the 2009 Population and Housing Census in Kenya conducted by the Kenya National Bureau of Statistics. The primary sampling unit (PSU) referred to as a cluster in this survey was a village. A two-stage sampling design was used. In the first stage, a random sample of villages was selected for each of the 5 district based on probability proportional to their population (PPP). The number of villages selected from each district was determined based on population weights from the 2009 Kenya Population and Housing Census which detailed the number of women and men per household in each locality. In the second stage, a minimum of 20 households were systematically selected from each village, (every 5th household) in order to create a sample size of 1,181 households. Out of the targeted 1,181 women, a total of 1,205 women participated in the survey. The quantitative data collection was done through face to face interviews to eligible female respondents (15-49 years), who had children less than five years ago (0-59 months). If a household had two women who qualified for the study, then one was randomly selected. The household survey was conducted in Makueni County, which is located in the southern end of the Eastern Province in Kenya. The total population of Makueni is 884,527 with 11.8% living in urban areas. [12]. Makueni has a surface area of 8,009 km2 and a density of 110 people per kilometres-km2 [12]. Table 2 outlines the five districts, the total population and the number of households that were sampled. District sampling Data collection took place between August 13th and 23rd, 2012. The survey questionnaire was adopted from the 2008/09 KDHS and was designed to permit the calculation of specific MNCH indicators. The survey tool was pre-tested before data collection began. Trained enumerators were responsible for collecting the data. The survey was in English; however, the enumerators were capable of translating questions into Kamba, the local language, when necessary. The data was first entered into Census and Survey Processing System version 4.0 and then exported to Statistical Package for Social Sciences (SPSS) for further cleaning and analysis. Statistical analysis was based on the specific objectives of: identifying association between the mother’s characteristics and the use of skilled birth attendants during delivery and identifying associations between access to reproductive health services and the use of skilled birth attendants during delivery. The primary outcome of interest is the use of a ‘skilled attendant’ at delivery, which “refers exclusively to people with midwifery skills (for example, doctors, midwives, and nurses) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage, or refer obstetric complications” [13]. Within the context of the household survey, traditional birth attendants “are excluded from the category of skilled attendant at delivery” [14]. This is aligned with Kenyan national policies, the World Health Organization and the United Nations Population Fund. The survey asked respondents ‘who assisted with the delivery of (name)?’ Within the analysis, doctors and nurse/midwives were considered as skilled attendants at delivery and traditional birth attendants, relatives, friends or any other individual was classified as unskilled. The mother’s and partner’s levels of education were classified as; no formal education, primary, secondary or higher education. Mother’s religion was categorised as catholic, protestant or other. The employment status was classified as; unemployed (women with no employment), employed and self-employed. The number of births was grouped into 1, 2 and 3 or more. Use of ANC was divided into two; attending ANC sessions and not attending ANC sessions. The number of ANC visits was categorised into one-three visits and four or more ANC visits. The distance to a health facility was divided as 1-5 kilometres and above 6 kilometres. Data analysis was conducted using SPSS version 17.0. Complex Sample Analysis procedure was considered so as to adjust for sample weight, and multi stage sampling. An analysis plan was prepared using strata, cluster and sample weights. Univariate statistics was explored to determine the descriptive statistics. For bivariate analysis, we used chi-square tests to measure the significance of relationships between the outcome variable and the predictor variables. The independent variables were mother’s level of education, partner’s level of education, employment status, number of births in the past five years prior to the study, ANC attendance, as well as distance to a health facility. Multicollinearity of the independent variables was assessed. Results that were statistically significant with p-values, p < 0.25 were included into the multivariable logistic regression model. Adjusted odds ratio (AOR) and their 95% confidence intervals were calculated. A p value less than 0.05 were considered significant. Ethical approval for the secondary data analysis of the cross sectional cluster survey was provided by Amref Health Africa Ethics & Scientific Review Committee (ESRC). The ESRC has been appointed by the Kenya National Council of Science and Technology (NCST) as one of the Institutional Review Boards (IRBs) responsible for the ethical review process in Kenya.

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote areas, bringing skilled birth attendants and necessary medical equipment to women who may not have easy access to healthcare facilities.

2. Telemedicine: Utilizing telemedicine technology to provide remote consultations and support to pregnant women, allowing them to receive guidance and advice from healthcare professionals without having to travel long distances.

3. Community health workers: Training and deploying community health workers who can provide education, support, and basic healthcare services to pregnant women in their own communities, helping to increase awareness and access to skilled birth attendants.

4. Maternal health vouchers: Introducing a voucher system that provides pregnant women with financial assistance to cover the costs of skilled birth attendance, making it more affordable and accessible for those who may not be able to afford it otherwise.

5. Improving transportation infrastructure: Investing in better transportation infrastructure, such as roads and transportation services, to ensure that pregnant women can easily access healthcare facilities and skilled birth attendants.

6. Public awareness campaigns: Launching public awareness campaigns to educate communities about the importance of skilled birth attendance and the available resources and services in their area.

7. Strengthening health systems: Investing in the training and capacity building of healthcare professionals, improving the availability and quality of maternal health services, and ensuring that healthcare facilities are adequately equipped to handle childbirth complications.

These are just a few potential innovations that could be considered to improve access to maternal health based on the information provided. It is important to conduct further research and analysis to determine the feasibility and effectiveness of these innovations in the specific context of Makueni County, Kenya.
AI Innovations Description
Based on the study titled “Determinants of use of skilled birth attendant at delivery in Makueni, Kenya: A cross-sectional study,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Enhance health education and behavior change communication strategies: The study found that the woman’s level of education, her partner’s level of education, attending antenatal care (ANC), and living within 5 kilometers from a health facility are associated with being assisted by skilled birth attendants. To improve access to maternal health, innovative health education and behavior change communication strategies can be developed and implemented. These strategies should focus on increasing awareness about the importance of skilled birth attendance, ANC utilization, and the benefits of living near a health facility.

2. Strengthen ANC services: The study highlighted the significance of attending ANC in increasing the likelihood of skilled birth attendance. To improve access to maternal health, ANC services should be strengthened. This can be achieved by ensuring the availability of ANC services in all health facilities, training healthcare providers to provide comprehensive ANC, and promoting early and regular ANC visits through community outreach programs and awareness campaigns.

3. Improve infrastructure and transportation: Living within a distance of 1-5 kilometers from a health facility increased the likelihood of skilled birth attendance. To address the issue of distance, innovative solutions can be developed to improve infrastructure and transportation. This can include establishing more health facilities in remote areas, providing mobile health clinics or ambulances to transport pregnant women to health facilities, and utilizing telemedicine or telehealth technologies to provide remote access to maternal health services.

4. Empower women and involve partners: The study found that women with tertiary/university education and women whose partners had secondary education were more likely to seek skilled delivery. To improve access to maternal health, efforts should be made to empower women through education and involve partners in decision-making regarding maternal health. This can be achieved through community-based education programs, promoting gender equality, and engaging men in maternal health initiatives.

5. Collaborate with local communities and stakeholders: To ensure the success of any innovation aimed at improving access to maternal health, collaboration with local communities and stakeholders is crucial. Engaging community leaders, traditional birth attendants, and local healthcare providers can help in identifying barriers to access and developing context-specific solutions. Additionally, partnerships with government agencies, non-governmental organizations, and international agencies can provide resources and support for implementing innovative interventions.

By implementing these recommendations, it is possible to develop innovative solutions that can improve access to maternal health in Makueni County, Kenya, and potentially be scaled up to other regions facing similar challenges.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase access to reproductive health services: This could involve expanding the availability and reach of antenatal care (ANC) services, ensuring that pregnant women have access to regular check-ups and necessary interventions to ensure a safe delivery.

2. Improve education and awareness: Implement health education and behavior change communication strategies to increase awareness about the importance of skilled birth attendants and the benefits of seeking skilled delivery. This could involve community outreach programs, workshops, and campaigns to educate women and their families about the risks associated with unskilled birth attendants and the advantages of skilled care.

3. Enhance transportation infrastructure: Improve transportation infrastructure, particularly in rural areas, to ensure that pregnant women can easily access health facilities for delivery. This could involve building or improving roads, providing transportation subsidies, or implementing mobile health clinics to reach remote areas.

4. Strengthen health systems: Invest in training and capacity building for healthcare providers, particularly in areas with low skilled birth attendance rates. This could involve providing additional training for midwives, nurses, and doctors to ensure they have the necessary skills and knowledge to provide quality maternal healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed using a combination of quantitative and qualitative data. Here is a brief outline of a possible methodology:

1. Baseline data collection: Collect data on the current status of access to maternal health services, including the proportion of births attended by skilled birth attendants, the distance to health facilities, and the level of education and awareness among pregnant women.

2. Intervention implementation: Implement the recommended interventions, such as expanding reproductive health services, conducting health education campaigns, improving transportation infrastructure, and strengthening health systems.

3. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on key indicators, such as the number of births attended by skilled birth attendants, changes in awareness levels, and improvements in transportation infrastructure.

4. Data analysis: Analyze the collected data using statistical methods to assess the impact of the interventions on improving access to maternal health. This could involve comparing pre- and post-intervention data, conducting regression analyses to identify factors associated with improved access, and calculating adjusted odds ratios to measure the effect of different variables.

5. Qualitative assessment: Conduct qualitative assessments, such as interviews or focus group discussions, to gather insights and feedback from pregnant women, healthcare providers, and other stakeholders on the effectiveness of the interventions and any barriers or challenges encountered.

6. Recommendations and scaling up: Based on the findings from the data analysis and qualitative assessments, make recommendations for further improvements and scaling up of successful interventions. This could involve advocating for policy changes, securing additional funding, and collaborating with relevant stakeholders to ensure the sustainability and long-term impact of the interventions.

It is important to note that this is a simplified outline of a methodology and the actual implementation may require more detailed planning and considerations based on the specific context and resources available.

Yabelana ngalokhu:
Facebook
Twitter
LinkedIn
WhatsApp
Email