A Model to Promote Utilization of Skilled Birth Attendance among Women of Reproductive age in Kandara Sub-County, Murang’a County - Kenya

Abstract

Globally, over 90% of deliveries in developed countries are attended by skilled health personnel, this indicates a significant high disparity when compared to Sub-Saharan Africa, with only 57% of births occurring in health facilities under the care of a skilled health worker. In Kenya, the percentage of skilled deliveries stands at 89%, but there remains variability within the country. In Murang’a County, the rate of skilled deliveries is at 87% slightly below that of the national, while Kandara Sub-County reports a marked lower figure at 65%. These statistics underscore the ongoing challenges and regional differences in access to skilled maternity care posing significant risks of maternal and neonatal mortality and morbidity. This study aimed to develop a model of care to enhance skilled birth attendance in Kandara Sub-County, Murang’a County, Kenya, where skilled deliveries are at 65% and home deliveries at 35%. It investigated women's experiences, devised strategies, developed a model of care and tested the model's impact. The study comprised two phases: phase 1 was baseline data collection and model development, while phase two involved testing of the developed model. The study utilized community-based approach within structures of community strategy. Descriptive Cross-sectional study design was used where by collection of baseline data involved surveys, interviews, and focus group discussions with a sample size of 347 women,6 women FGDs with 8 participants per group, 6 community health volunteers (CHVs) FGDs with 8 participants per group , 10 KII Community Health Assistants(CHAs) and 7 KII local health administrators’ while phase two employed quasi-experimental design (non-equivalent) with 77 participants per wing a total of 154 participants. Quantitative data analysis utilized SPSS, while qualitative data was thematically analyzed using NVIVO. The study adopted the two tailed Z-Test - a statistical test used to determine the difference in utilization of skilled deliveries between the interventional group and the comparison group. The study adopted an alpha of 0.05. Surveys gathered experiences of women in Kandara Sub-County on skilled delivery services. Strategies, including community education and infrastructure improvements, were devised to enhance skilled delivery usage. A validated model of care, addressing demand and supply factors, was developed. After pilot implementation, skilled delivery utilization surged to 98.7%, indicating a 13% increase from the comparison group's 85.7%. Analysis resulted to a z score of 3.08 and a P value of 0.002 resulting in rejection of the null hypothesis. Recommendations: the national and county governments should enhance health facility conditions and staff attitudes through prioritized training by allocating resources for monitoring and engage proficient research teams. The two levels of governments should collaborate on supportive policies, enact legislation to adopt the model of care.