Factors Affecting Utilization of Hospital Delivery Services at Garissa County Referral Hospital, Kenya

Abstract

Reducing maternal mortality remains one of the targets of the Sustainable Development Goals that has not been achieved in sub-Saharan Africa. While there is evidence that institutional delivery and skilled attendance are essential in decreasing maternal and neonatal mortality, majority of women in low income countries continue to deliver at home. The 2014 Kenya Demographic and Health Survey indicated that 92% and 65.9% of women in Kenya and the former North Eastern Province, respectively, received Antenatal Care from a medical professional yet, only 17.3% of births are delivered in a health facility compared to 82.7% home deliveries in NEP. The main objective of this study was to determine factors affecting hospital delivery utilization among women attending Garissa level 5 hospital. This cross-sectional study enrolled 410 women who had given birth in the previous one year. Data was collected using questionnaire which was administered to the study population and three focus group discussions consisting of 12 participants were conducted using a guide. Data from questionnaire was entered and analyzed using SPSS version 18 while qualitative data in form of notes were analyzed manually based on themes generated from responses in line with the study objectives. Chi square was used to determine associations with variables. Its results are presented in form of tables, percentage and graphs. Findings from FGD are presented in verbatim form. Proposal for this study got ethical approval from KEMRI ethical committee. Participants were requested to give informed consent prior to their acceptance to participate in the study. The mean age of these 338 women who responded was 27.03 (SD± 4.66) years ranging from 17 to 48 years. The majority of the women (71.6%) were aged between 21 to 30 years, 32.8% had tertiary level education, 86.1% were married, 62.4% attended the GCRH for antenatal care services, and 56.2% were currently pregnant. About three quarters (76.3%) had previously delivered at the GCRH. In multivariate analysis, women who were nulliparous (OR 0.2, 95% CI 0.09 to 0.6), had delivered in the hospital in the previous 2 years (OR 12.8, 95% CI 5.1 to 32.4) or 3 years (OR 13.1, 95% CI 4.9 to 34.4) or those who liked the cleanliness of the hospital (OR 1.9, 95% CI 1.1 to 3.7) and appreciated hospital due to availability of medical supplies (OR 1.8, 95% CI 1.1 to 3.3) were independently associated with hospital delivery. From FGDs, previous hospital experience, parity and socio-cultural norms had a significant influence on Utilization of hospital delivery. In conclusion, a high proportion of women from Garissa County; an arid, marginalized and hard to reach region in the North Eastern Kenya, are increasingly delivering at the hospital. If issues that improve women’s rating of the hospital such as ANC, hospital cleanliness, equipment and medical supply availability and improved privacy are tackled, this region is poised to record one of the highest up take of hospital delivery in Kenya.