Abstract:
A measure of the proportion of deliveries assisted by skilled attendants is one of the
indicators of progress towards Millennium Development Goal (MDG) 5, which aims at
improving maternal health. In Kenya, the proportion of deliveries attended by skilled
attendants is estimated at 42% which is far below the MDG 5 targets which aims to assure
that 90% of deliveries are attended by skilled attendants by 2015. The main objective of
this study was to establish delivery practices and associated factors among mothers
attending Maternal Child Health (MCH) clinics at selected health facilities in Nyandarua
South district. A cross-sectional descriptive study whose study population comprised of
mothers attending MCH clinics at the district and sub-district hospitals was undertaken. A
total of 409 mothers systematically sampled on alternate visiting days were recruited into
the study and personal interviews carried out using a semi-structured questionnaire. In each
of the facilities, additional qualitative data was obtained using Focus Group Discussions
(FGDs) with a group of mothers and In-depth Interviews (IDIs) with selected key
informants. Univariate, bivariate and multivariate analysis of data was carried out. Of the
1170 deliveries reported, 48.2% were attended by skilled attendants. Utilization of safe
delivery practice was significantly influenced by the total number of deliveries a mother
had in a lifetime (parity), place of delivery and perception of mothers on birth attendants.
Increase in total number of deliveries in a lifetime was associated with increased
probability of practicing unsafe delivery (OR 1.5, 95% CI 1.2–2.0). Majority of the
deliveries, 38.6% (452) attended by unskilled attendants were by neighbors and/or
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relatives. TBAs attended 1.5% (17) of the deliveries. 11.7% (137) of the deliveries were
not attended in which case the mother delivered alone. There was a significant association
between first and last places of delivery (P<0.001). There was more than three times
chance that a mother will deliver in the same place they delivered during their first delivery
(OR 3.9). There was a significant association between delivery safety and place of delivery
(P<0.001). Majority of the home deliveries were unsafe (90.3%). However, 72.9% of the
mothers perceived medically trained birth attendants in health facility to be more skilled in
attending to deliveries than birth attendants at home (TBAs, relatives & friends). Based on
all variables, 77.9% (279) of the respondent mothers were dissatisfied with health facility
delivery services. Results from this study suggest that the overall rate of skilled attendance
among the mothers in this study was low. There is need to create awareness of risks
involved in home deliveries among mothers. In order to increase the number of mothers
utilizing maternity services, the government through the Ministry of Health should
increase women’s access to maternal health services especially in rural areas as well as
improve service delivery through improving staffing in the health facilities.
