Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya

  • BMC Public Health, Volume 11, Year 2011

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Study Justification:
– The study aimed to assess the delivery practices and associated factors among mothers seeking child welfare services in Nyandarua South District, Kenya.
– This study is important because it provides information on the utilization of skilled delivery attendance services and the prevalence of unqualified lay persons attending deliveries.
– The findings of this study can help identify gaps in maternal health services and inform the development of interventions to improve the quality of care and reduce maternal mortality.
Highlights:
– Among the mothers interviewed, 51.8% of deliveries were attended by unskilled birth attendants.
– Of the deliveries attended by unskilled birth attendants, 38.6% were by neighbors and/or relatives, 1.5% were by Traditional Birth Attendants, and 11.7% were self-administered.
– Factors associated with unskilled delivery attendance included having less than 3 years of education, having more than three deliveries in a lifetime, perceiving similarity in delivery attendance between skilled and unskilled attendants, and having a lower knowledge score on safe delivery.
Recommendations:
– Implement cost-effective and sustainable measures to improve the quality of maternal health services.
– Promote safe delivery practices by increasing the utilization of skilled birth attendants.
– Provide education and awareness programs to improve knowledge on safe delivery practices.
– Strengthen the regulation and training of birth attendants to ensure their qualifications and competence.
Key Role Players:
– Ministry of Health: Responsible for policy development, coordination, and implementation of maternal health programs.
– Health Facilities: Provide the necessary infrastructure and resources for safe deliveries.
– Community Health Workers: Play a crucial role in educating and mobilizing communities on safe delivery practices.
– Non-Governmental Organizations: Support the implementation of maternal health programs and provide additional resources and support.
Cost Items for Planning Recommendations:
– Training and capacity building for birth attendants.
– Development and dissemination of educational materials on safe delivery practices.
– Strengthening of health facilities to ensure availability of necessary equipment and supplies.
– Community outreach programs and awareness campaigns.
– Monitoring and evaluation of interventions to assess their effectiveness and impact.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides specific data on delivery practices and associated factors among mothers seeking child welfare services in Nyandarua South District, Kenya. The study used a hospital-based cross-sectional survey and binary logistic regression to analyze the data. The sample size was calculated using the Fisher formula, and statistical analysis was performed using SPSS. The study identified factors that predicted mothers’ delivery practice and found that a high number of deliveries were attended by unqualified lay persons. The conclusion suggests the need to implement measures to improve the quality of maternal health services. To improve the strength of the evidence, future studies could consider using a larger sample size and conducting a longitudinal study to assess the impact of interventions on delivery practices.

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

1. Training and deploying skilled birth attendants: To address the high number of deliveries attended by unskilled birth attendants, there could be a focus on training and deploying more skilled birth attendants in the study area. This would ensure that mothers have access to qualified professionals during childbirth.

2. Community-based education programs: Implementing community-based education programs could help improve knowledge and awareness about safe delivery practices among mothers. These programs could provide information on the importance of skilled birth attendance and the risks associated with unskilled delivery attendance.

3. Mobile health (mHealth) interventions: Utilizing mobile technology, such as SMS messages or mobile apps, could be an effective way to reach and educate mothers about safe delivery practices. These interventions could provide information on the nearest health facilities, availability of skilled birth attendants, and reminders for antenatal care visits.

4. Strengthening referral systems: Improving the referral systems between health facilities and communities could ensure that mothers are able to access appropriate delivery care when needed. This could involve establishing clear protocols for referrals, providing transportation options, and strengthening communication channels between health facilities.

5. Community engagement and involvement: Engaging the community, including traditional birth attendants and community leaders, in promoting safe delivery practices could help change cultural norms and beliefs around childbirth. This could involve training traditional birth attendants on basic emergency obstetric care and encouraging them to refer mothers to skilled birth attendants.

These are just a few potential innovations that could be considered to improve access to maternal health based on the findings of the study. It is important to note that the implementation of these innovations would require careful planning, collaboration between stakeholders, and ongoing monitoring and evaluation to ensure their effectiveness.
AI Innovations Description
Based on the study titled “Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya,” the following recommendation can be developed into an innovation to improve access to maternal health:

Implementing community-based education programs: The study found that mothers with lower knowledge scores on safe delivery were more likely to have unskilled delivery attendance. To address this issue, an innovation could involve developing community-based education programs that provide comprehensive information on safe delivery practices. These programs can be conducted in collaboration with local health facilities, community leaders, and trained healthcare workers. The education programs can focus on topics such as the importance of skilled birth attendants, the risks of unskilled birth attendance, and the availability of maternal health services in the area. By increasing knowledge and awareness among mothers, this innovation can empower them to make informed decisions about their delivery care and seek appropriate maternal health services.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations for improving access to maternal health:

1. Increase access to skilled birth attendants: Implement strategies to ensure that more deliveries are attended by skilled birth attendants. This could involve training and deploying more skilled birth attendants to areas with low access, providing incentives for skilled attendants to work in underserved areas, and improving transportation infrastructure to facilitate access to skilled attendants.

2. Improve education and awareness: Enhance education and awareness programs to increase knowledge among mothers about the importance of skilled birth attendance and safe delivery practices. This could include community-based education campaigns, antenatal classes, and targeted messaging through various media channels.

3. Strengthen referral systems: Establish and strengthen referral systems to ensure that women with complications during pregnancy or delivery can access appropriate medical care in a timely manner. This could involve improving communication and coordination between different levels of healthcare facilities, training healthcare providers on referral protocols, and ensuring availability of emergency obstetric care services.

4. Address cultural and social barriers: Address cultural and social factors that contribute to the preference for unskilled birth attendants. This could involve engaging community leaders and traditional birth attendants in discussions about the importance of skilled birth attendance, promoting cultural practices that support safe delivery, and involving men and families in decision-making regarding maternal health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the proportion of deliveries attended by skilled birth attendants, maternal mortality rate, and satisfaction with maternal health services.

2. Collect baseline data: Gather baseline data on the selected indicators before implementing the recommendations. This could involve conducting surveys, reviewing existing data sources, and analyzing relevant statistics.

3. Implement interventions: Implement the recommended interventions in the target area or population. This could be done through a phased approach, piloting the interventions in a smaller scale before scaling up.

4. Monitor and evaluate: Continuously monitor and evaluate the impact of the interventions on the selected indicators. This could involve collecting data at regular intervals, conducting surveys or interviews with beneficiaries, and analyzing the data to assess changes over time.

5. Analyze and interpret results: Analyze the data collected to assess the impact of the interventions on improving access to maternal health. This could involve statistical analysis, comparing the baseline data with the post-intervention data, and identifying any trends or patterns.

6. Adjust and refine interventions: Based on the findings from the evaluation, make any necessary adjustments or refinements to the interventions. This could involve modifying strategies, reallocating resources, or targeting specific areas or populations that may require additional attention.

7. Repeat the process: Continuously repeat the monitoring, evaluation, and adjustment process to ensure ongoing improvement in access to maternal health. This could involve implementing new interventions, expanding successful interventions to other areas, and addressing any emerging challenges or barriers.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

Statistics:
Citations: 48
Authors: 5
Identifiers:
DOI: 10.1186/1471-2458-11-360
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Kenya
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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