Factors influencing utilisation of maternal health care services in Nyanza province, Kenya

Abstract

The study is based on data drawn from the 1993 Kenya Demographic and Health Survey (KDHS). An analytical model was adapted from Kroeger (1983) to act as a guideline to the study. Cross tabulations were used to establish differentials in use of maternal health care services. Logistic regression analysis was used to analyse the effects of the independent variables on use of different maternal health care services. The results obtained show that for the births in the study, there is a general low level of utilisation of maternal health care services in Nyanza province. In addition, there are significant differentials in the use of maternal health care services by the study population. Factors that had significant influence on the uptake of tetanus toxoid vaccinations were paternal education and ever use of family planning. The uptake of tetanus vaccination was positively and significantly ,associated with paternal education. Women who had ever used modem methods were also most likely to get the vaccine. Timing of the first antenatal check was associated with whether a woman earned cash for work or not. There was a significant association between choice of prenatal care provider and the each of the following: maternal education, paternal education, household economic status and the number of children ever born. The type of place of delivery and assistance during delivery were significantly associated with maternal and paternal education, household economic status, earning cash, maternal age and total children ever born. Other factors that were associated with the type of place and assistance during delivery were number of antenatal visits, scale of antenatal care, timing of antenatal visits and type of place of residence. Household economic status and paternal education was each significantly associated with the choice of a prenatal care provider. Higher status households and having at least secondary education led to greater likelihood of seeking professional antenatal care. Timing of the first antenatal visit was determined by earning cash for work, whereby mothers who earned had greater chances of seeking early prenatal care. The other factor was maternal education, so that the higher the level of education, the greater the chances of early onset of antenatal care. The choice of place of delivery and assistance received during delivery were each determined by household economic status, type of place of residence, ever use of family planning, paternal education, the timing of antenatal visits and the number of clinic visits made. Overall, the study found that differences in utilisation of maternal health care services in Nyanza province were mainly as a result of socio-economic factors rather than demographic factors. Arising from the results of the study, several recommendations have been made. The study found that majority of births, their mothers got adequate antenatal care. However over 60 per cent of the births were delivered at home. The study therefore strongly recommends that coverage of health facilities offering delivery services should be increased. Studies should also be conducted to establish the reasons for the discrepancy. Secondly, community education on the importance of using maternity health care services is necessary. Moreover, barriers to access in rural areas should be eliminated. Lastly, the study recommends that qualitative research should be done to explain some of the patterns of utilisation observed, since the study was only able to give a quantitative approach. Specifically, it would be useful to know why women in Nyanza begin antenatal clinics late, go for only a few clinic checks and why they prefer to deliver at home.