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Factors influencing place of delivery for women in Kenya an analysis of the Kenya demographic and health survey, 20082009.doc

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Factors influencing place of delivery for women in Kenya an analysis of the Kenya demographic and health survey, 20082009

Kituietal.BMCPregnancyandChildbirth2013,13:40 /1471-2393/13/40 RESEARCH ARTICLE OpenAccess Factorsinfluencingplaceofdeliveryforwomen inKenya:ananalysisoftheKenyademographic andhealthsurvey,2008/2009 JohnKitui1*,SarahLewis2andGailDavey3 Abstract Background:MaternalmortalityinKenyaincreasedfrom380/100000livebirthsto530/100000livebirthsbetween 1990and2008.Skilledassistanceduringchildbirthiscentraltoreducingmaternalmortalityyettheproportionof deliveriestakingplaceinhealthfacilitieswheresuchassistancecanreliablybeprovidedhasremainedbelow50% sincetheearly1990s.Weusethe2008/2009KenyaDemographicandHealthSurveydatatodescribethefactors thatdeterminewherewomendeliverinKenyaandtoexplorereasonsgivenforhomedelivery. Methods:Dataonplaceofdelivery,reasonsforhomedelivery,andarangeofpotentialexplanatoryfactorswere collectedbyinterviewer-ledquestionnaireon3977womenandaugmentedwithdistancefromthenearesthealth facilityestimatedusinghealthfacilityGlobalPositioningSystem(GPS)co-ordinates.Predictorsofwhetherthe woman’smostrecentdeliverywasinahealthfacilitywereexploredinanexploratoryriskfactoranalysisusing multiplelogisticregression.Themainreasonsgivenbythewomanforhomedeliverywerealsoexamined. Results:Livinginurbanareas,beingwealthy,moreeducated,usingantenatalcareservicesoptimallyandlower paritystronglypredictedwherewomendelivered,andsodidregion,ethnicity,andtypeoffacilitiesused.Wealth andrural/urbanresidencewereindependentlyrelated.Theeffectofdistancefromahealthfacilitywasnot significantaftercontrollingforothervariables.Womenmostcommonlyciteddistanceand/orlackoftransportas reasonsfornotdeliveringinahealthfacilitybutover60%gaveotherreasonsincluding20.5%whoconsidered healthfacilitydeliveryunnecessary,18%whocitedabruptdeliveryasthemainreasonand11%whocitedhigh cost. Conclusion:Physicalaccesstohealthfacilitiesthroughdistanceand/orlackoftransport,andeconomic considerationsareimportantbarriersforwomentodeliveringinahealthfacilityinKenya.Somewomendonot perceiveaneedtodeliverinahealthfacilityand