Socio-Demographic, Cultural, Economic, and Health System Determinants of Skilled Birth Attendance Utilisation among Women of Reproductive Age in Kajiado Central Sub-County, Kenya: A Cross-Sectional Study
Abstract
Kenya continues to face an unacceptably high maternal mortality ratio, which is a major public health challenge. In 2014, the maternal mortality ratio was 362 per 100,000 live births. Even though there has been a slight reduction to this rate as the current rate is 355 per 100,000 live births, the rate is still way too high than the Sustainable Development Goal (SDG) target 3.1 which aims to reduce the global maternal mortality rate to less than 70 per 100,000 live births by the year 2030 through ensuring that majority of the women of reproductive age deliver by a skilled health personnel. Increasing skilled birth attendance (SBA) use is a critical strategy for reducing these preventable deaths. This study examined factors influencing SBA utilisation among women in Kajiado Central Sub-County. A community-based descriptive cross-sectional study design was used. Data were collected from 324 women of reproductive age between June 2013 and July 2013. The study participants were selected through systematic sampling of households. Semi-structured questionnaires were used for the collection of quantitative data. Chi-square test was used for hypothesis testing (p-value <0.05 considered significant). This study revealed a low SBA utilisation rate of 42% among the respondents. Key determinants significantly associated with SBA utilisation included demographic factors such as area of residence (OR=0.038, p<0.001), parity (OR=0.219, p<0.001), and number of births in the past five years (OR=0.336, p<0.001). Socio-economic determinants were also critical, with higher odds of SBA utilisation associated with the respondent's education (OR=6.586, p<0.001), higher monthly income (OR=4.593, p<0.001), and the husband's education (OR=2.497, p<0.001). The cost of delivery and institutional factors were also identified as influential barriers. In Conclusion, SBA utilisation in Kajiado Central Sub-County remains suboptimal and is influenced by a complex interplay of socioeconomic, demographic, and access-related factors. To improve uptake, this study recommends: (1) promoting universal education for girls at least up to the secondary level; (2) implementing robust behavior change communication campaigns; (3) implementing initiatives to empower women economically; (4) increasing the coverage of health facilities and the number of employed SBAs; and (5) the Ministry of Health introducing mobile health clinics and home-based care visits for remote and hard-to-reach communities.
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