Factors Associated With Uptake of Free Maternity Services at Baringo County Referral Hospital

Abstract

High maternal mortality is a global issue. According to world health organization developing countries especially in sub-Saharan Africa bore the greatest brunt. Kenya was among the ten countries with very high maternal mortality ratio, at 510 per 100,000 live births. Free maternity services program was launched in June 2013 in government facilities to improve skilled attendance at birth, hence reduce maternal mortality. Inadequate preparation evident by a lack of a strategic plan and existing deficiencies in public maternity facilities made the program’s success uncertain. The objective of the study was to determine factors associated with uptake of free maternity services amongst women attending maternal child health services at Baringo county referral hospital. It was a facility based cross sectional design, a sample of 379 was obtained using Cochran’s formula and systematic sampling applied. Data was collected through semi structured questionnaire, a focus group discussions and key informants interviews. Ethical clearance was obtained from Kenyatta National Hospital / University of Nairobi ethical review committee. Quantitative data was analyzed using Statistical Package for Social Sciences while qualitative data was manually done based on themes. Of the 379 participants interviewed, above 70% were; 21 to 30 years, married and with secondary education. Three quarter chose place of delivery due the good reputation of the facility and 95.8% of the deliveries were in government facilities. Significant association to uptake of free maternity services were; reason of availability of modern equipment /technology (P=0.007, OR=43.357) and having a referral /expected complications (P=0.018, OR=42.732). Satisfaction of maternity services was significantly associated with reason of modern equipment /technology and courteous staff (p-value=<0.01, OR=0.041) and (p-value=< 0.01, OR =0.062) respectively. In conclusion availability of modern equipment /technology and referrals enhanced utilization of free maternity services. Therefore maternity facilities should be well furnished with modern equipment /technology and should have clearly outlined and functional referral systems to enhance skilled attendance at birth.