title: Quality of health care and its effects in the utilisation of maternal and child health services in Kenya.
abstract: OBJECTIVE
  To assess the quality of care provided by the Kisumu Municipal health facilities, with special reference to Maternal and Child health services (MCH).
  
  
  METHODS
  A descriptive cross-sectional survey.
  
  
  METHODS
  Kisumu Municipal Health facilities.
  
  
  METHODS
  Four hundred and eighty two mothers were interviewed in a household survey.
  
  
  RESULTS
  A total of 482 mothers were interviewed in the household survey. Out of these, only 40.4%, 53.7% and 45.7% had respectively used Municipal facilities for antenatal services (ANC), immunisation and treatment of their children the last time they required such a service. This translates to by-pass rates for Municipal health facilities of 59.5%, 46.3% and 54.3% respectively for the three services. By-pass was higher for the more central urban catchment areas than the more peripheral ones, a finding that was associated with the socio-economic status of the respondents and the relative location of the municipal facilities vis-a-vis competing facilities, mainly the District and Provincial hospitals. The main reasons cited for by-pass were poor care (21%), lack of drugs and supplies (17%) and lack of/poor laboratory services (12%). From the facility audit, most of the clinics had a reasonable capacity to offer basic health care with only three scoring less than 50% in the scale used. The worst areas were in availability of drugs, equipment and management issues. There was a strong relationship between the perceived quality of care and utilisation of MCH services as well as by-pass. The capacity of the facilities to offer care was however not associated with utilisation of MCH services or by-pass.
  
  
  CONCLUSIONS
  There is under-utilisation of Municipal health facilities for MCH services. This is related to the perceived poor quality of care in the facilities. Perception of quality is influenced by a person's socio-economic status especially education.
authors.affiliation: Department of Community Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
authors.forename: M O
authors.initials: MO
authors.lastname: Audo
authors.forename: A
authors.initials: A
authors.lastname: Ferguson
authors.forename: P K
authors.initials: PK
authors.lastname: Njoroge
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012959:Socioeconomic Factors