Determinants and Outcomes of an Integrated Maternal Health Intervention on Uptake of Skilled Care During and Post Delivery in Migori County, Kenya

Abstract

Skilled care through antenatal, delivery and postpartum period, is essential for the mother-newborn health. Migori County in the Nyanza region had 53.4% births aided by a skilled health professional compared to an average nationally of 61.8%, while the region averaged 65% in the 2014 Demographic and Health Survey. To address the comparatively lower uptake of skilled care, a maternal-infant community-level health interventional project was instituted. This study assessed the effectiveness and determinants of the integrated maternal- infant health intervention on uptake of skilled professional services through birth and postnatal among reproductive age women in Migori County. A quasi-experimental, posttest only nonequivalent groups design was applied in this study. A sample of 590 reproductive age women, who gave birth after January 2014 in Rongo and Migori sub-county, were included in the study. Data were collected using interviewer administered questionnaire and key informant guides. Utilization of postpartum and delivery services in a health facility were the two main outcome measures of the study. Descriptive statistics reporting proportions, Chi square and Fisher’s exact test at bivariate and odds ratio at multivariate analysis level were computed. The findings show a twenty seven percent (27.2%) increase in utilization of facility delivery for the intervention group, compared to 16.6% increase for the control (χ2= 9.0, P= 0.003). Participants who received the intervention had increased odds - AOR= 1.56, p=0.048, of having a health facility delivery and higher odds - AOR= 3.31, p=0.016, to using postpartum care services. Being in married union decreased the odds - AOR= 0.33, p=0.006, of seeking health facility delivery. Choice of health facility delivery was positively influenced by a mother having had attended at least four antenatal visits and having a birth companion (p=0,000), with ones mother as a birth companion (AOR 4.97, p=0.000). There were a higher proportion of complications necessitating attention by a health professional reported at 13.3% in the control group, compared to intervention at 2.9%. Having been sensitized on maternal-infant health by traditional birth assistant, cut down probability of uptake of delivery at health facility by 18.2 times (AOR= 0.055, p=0.017). At multivariate analysis, participants who had community health Volunteer referral for post natal care to a health facility, had greater odds - AOR= 2.72, p=0.039, of taking up the services, the odds declined for those taking between 30 to 60 minutes to health facility (AOR 0.166, p=0.002). From the key informants, lack of male partner support and ‘feeling experienced’ were cited as barriers to seeking skilled care at health facility. In conclusion, the intervention improved uptake of facility delivery and postpartum care. Availing health education and having ones mother as birth companion are two critical aspects that can improve uptake of skilled birth attendance and postpartum care. Study recommends appliance, and scaling up similar ‘community-level’ approaches in raising utilization of health facility care in the other Migori County, sub-Counties and in other places in Kenya where reduced uptake of SBA prevails. Further, more emphasis is needed on health education for the pivotal role played in influencing uptake of postnatal care.