Determinants of Home Delivery Among Women Aged 11-50 Years in Kacheliba Sub-County, West Pokot County, Kenya.

Abstract

The vast majority of women who deliver outside the health facilities give birth at home, where risk of mortality is high. It has been estimated that decreasing the proportion of home deliveries reduces perinatal and maternal deaths by nearly half. The study area was determined through purposive sampling. This study sought to identify determinants of home delivery among the women aged 11- SO years in Kacheliba Sub-County, West Pokot County. The specific objectives were set to determine socio-demographic factors of home delivery, to determine knowledge on risks of home delivery, to establish the cultural beliefs and practices and perceived quality of maternity services. This was a cross-sectional study using quantitative and qualitative data collection tools. It targeted women who delivered in the last 2 years. Multistage sampling technique was used to select respondents. Purposive sampling was used to sample participants for key informant interview. Two wards in Kacheliba Sub-County were sampled as a result of security concerns in other wards. Sample size of390 was used. Data was collected using structured questionnaire and key informant interviews among health workers. Findings suggest that socio-demographic variables that were statistically significant were age (X2=9.S7, df6, p=0.021), religion (X2=8.39, df3, p=0.039) and occupation (X2=8.08, df 3, p=0.044). Findings on knowledge on risks of home delivery indicated that antenatal clinic attendance was significant with (OR=2.43, 9S%CI=1.69-2.72, p=O.037). Women who did not attend antenatal clinic were likely to have home delivery (OR=20.28, 9S%CI=2.42-29.34, P=O.OOS).Respondents who were knowledgeable on risks of home delivery were two times likely to have home delivery (OR=2.47, 9S%CI=1.49-3.41, p=O.039), while those who were not knowledgeable were four times likely to have home delivery (OR=4.84, 95% 9S%CI=2.95-S.11, p=O.0014). Findings on cultural beliefs indicate that the nomadic community had negative cultural practices such as burying the placenta and use of herbs after delivery to cleanse. Decision making on home delivery was mostly made by the mother-in-law (X2=14.86, df 2 p=0.001). Perception of quality maternity services was significant (X2=4.46/ df 2, p=0.023). Majority of the participants reported negative attitude among health workers as a major challenge. In conclusion, knowledge on risks of home delivery and cultural practices were major determinants of home delivery. The current study has added knowledge that will be utilized in the improvement of both maternal and child health, and hence reduction in mortality. This study recommends strategies and interventions such as sensitization of the community on safe delivery to ensure reduction in episodes of home delivery thereby, increasing community demand for maternal health care services.