title: Determinants of health facility utilization for childbirth in rural western Kenya: cross-sectional study.
abstract: BACKGROUND
  Skilled attendance at delivery is recognized as one of the most important factors in preventing maternal death. However, more than 50% of births in Kenya still occur in non-institutional locations supported by family members and/or traditional birth attendants (TBAs). To improve this situation, a study of the determinants of facility delivery, including individual, family and community factors, was necessary to consider effective intervention in Kenya.
  
  
  METHODS
  This study was conducted to identify the factors which influence the place of delivery in rural western Kenya, and to recommend ways to improve women's access to skilled attendants at delivery. A community-based cross-sectional survey was carried out from August to September 2011 in all 64 sub-locations which were covered by community health workers (CHWs). An interviewer-administered questionnaire on seventeen comprehensive variables was administered to 2,560 women who had children aged 12-24 months.
  
  
  RESULTS
  The response rate was 79% (n = 2,026). Of the respondents, 48% of births occurred in a health facility and 52% in a non-institutional location. The significant determinants of facility delivery examined using multivariate analysis were: maternal education level, maternal health knowledge, ANC visits, birth interval, economic status of household, number of household members, household sanitation practices and traveling time to nearest health facility.
  
  
  CONCLUSIONS
  The results suggest that the involvement of TBAs to promote facility delivery is still one of the most important strategies. Strengthening CHWs' performance by focusing on a limited number of topics and clear management guidance might also be an effective intervention. Stressing the importance of regular attendance at ANC (at least four times) would be effective in enhancing motivation for a facility delivery. Based on our findings, those actions to improve the facility delivery rate should focus more on pregnant women who have a low education level, poor health knowledge and short pregnancy spacing. In addition, women with low economic status, a large number of family members and a long distance to travel to a health facility should also be targeted by further interventions.
authors.affiliation: JICA SEMAH project, Kisumu, Kenya. y.kawakatsu.0829@gmail.com.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Kawakatsu
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sugishita
authors.forename: Kennedy
authors.initials: K
authors.lastname: Oruenjo
authors.forename: Steve
authors.initials: S
authors.lastname: Wakhule
authors.forename: Kennedy
authors.initials: K
authors.lastname: Kibosia
authors.forename: Eric
authors.initials: E
authors.lastname: Were
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Honda
mesh_terms: D000328:Adult; D001721:Birth Intervals; D002648:Child; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D008423:Maternal Age; D009035:Mothers / Q000193:education; D036801:Parturition; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012499:Sanitation; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
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