A Model of Focused Antenatal Care Determinants that Influence Delivery by Skilled Birth Attendants among Women Attending Antenatal Clinics in Mbooni Sub-County, Makueni, Kenya

Abstract

Delivery by skilled birth attendants (SBA) improves the outcome of pregnancy during delivery and the postpartum period. Focused Antenatal Care (FANC) aims at providing individualized care to a woman attending ANC and preparing her for delivery. Main objective of this study was to determine the factors associated with choice of place of delivery among women attending ANC in Mbooni Sub-County. Three hundred and twenty four pregnant women were recruited to the study in Mbooni Sub-County at Tawa, Kisau and Kikima health facilities, which were randomly selected. The research determined how ante natal care, individual birth plan and birth preparedness affect delivery by skilled attendants and also identified the knowledge, attitudes and practices (KAP) of antenatal mothers that are associated with delivery by skilled birth attendants. The participants were followed during ante-natal period up to six weeks after delivery. The health promotion provided during different antenatal visits was recorded while knowledge, attitudes and practices regarding delivery by skilled birth attendants was elicited during six weeks postpartum visit. A questionnaire was used to collect data. Results of the study indicated that the following variables were significantly associated with choice of delivery by skilled birth attendants; age of respondents 20 - 24 years [OR = 1.4, CI: 0.53 - 3.86, P =0.03], 25 - 29years[OR = 2.4, CI: 0.87 – 6.65, P = 0.03]; high school level of education [OR = 1.6, CI: 1.02 – 2.58, P = 0.01]; College level of education [OR = 6.9, CI:1.84 – 26.46, P = 0.00]; being peasant farmer [OR = 0.07,0.015 – 0.38P< 0.01]; having a partner of college level education [OR = 6.1, CI: 1.91 – 19.93, P = 0.01]; using a vehicle as mode of transport [OR = 8.1, CI: 3.41 - 19.26, P = 0.00] and amount of money spent during delivery KShs 5370 (CI: 4918.14 - 5822.76) for health facility delivery versus KShs 2334 (CI: 2098.90 - 2570.69). It is recommended that these potentially modifiable determinants be addressed to increase delivery by skilled attendants through raising the economic and education status of women, male involvement during delivery; counseling mothers on need of skilled care during delivery especially the higher parity ones and making delivery by skilled birth attendants affordable. Health workers should improve services offered during delivery to reduce negative assessment by women who have utilized services of delivery in a health facility.