title: Determinants of use of skilled birth attendant at delivery in Makueni, Kenya: a cross sectional study.
abstract: BACKGROUND
  Kenya has a maternal mortality ratio of 488 per 100,000 live births. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at delivery. Kenyan national statistics estimate that the proportion of births attended by a skilled health professional have remained below 50% for over a decade; currently at 44%, according to Kenya's demographic health survey 2008/09 against the national target of 65%. This study examines the association of mother's characteristics, access to reproductive health services, and the use of skilled birth attendants in Makueni County, Kenya.
  
  
  METHODS
  We carried out secondary data analysis of a cross sectional cluster survey that was conducted in August 2012. Interviews were conducted with 1,205 eligible female respondents (15-49 years), who had children less than five years (0-59 months) at the time of the study. Data was analysed using SPSS version 17. Multicollinearity of the independent variables was assessed. Chi-square tests were used and results that were statistically significant with p-values, p < 0.25 were further included into the multivariable logistic regression model. Adjusted odds ratio (AOR) and their 95% confidence intervals were (95%) calculated. P value less than 0.05 were considered significant.
  
  
  RESULTS
  Among the mothers who were interviewed, 40.3% (489) were delivered by a skilled birth attendant while 59.7% (723) were delivered by unskilled birth attendants. Mothers with tertiary/university education were more likely to use a skilled birth attendant during delivery, adjusted OR 8.657, 95% CI, (1.445- 51.853) compared to those with no education. A woman whose partner had secondary education was 2.9 times more likely to seek skilled delivery, adjusted odds ratio 2.913, 95% CI, (1.337- 6.348). Attending ANC was equally significant, adjusted OR 11.938, 95% CI, (4.086- 34.88). Living within a distance of 1- 5 kilometers from a facility increased the likelihood of skilled birth attendance, adjusted OR 95% CI, 1.594 (1.071- 2.371).
  
  
  CONCLUSIONS
  The woman's level of education, her partner's level of education, attending ANC and living within 5kms from a health facility are associated with being assisted by skilled birth attendants. Health education and behaviour change communication strategies can be enhanced to increase demand for skilled delivery.
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Anne.Gitimu@amref.org.
authors: Anne
authors: A
authors: Gitimu
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. herr@ualberta.ca.
authors: Christine
authors: C
authors: Herr
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Happiness.Oruko@amref.org.
authors: Happiness
authors: H
authors: Oruko
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Evalin.Karijo@amref.org.
authors: Evalin
authors: E
authors: Karijo
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Richard.Gichuki@amref.org.
authors: Richard
authors: R
authors: Gichuki
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Peter.Ofware@amref.org.
authors: Peter
authors: P
authors: Ofware
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Alice.Lakati@amref.org.
authors: Alice
authors: A
authors: Lakati
authors: Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. Josephat.Nyagero@amref.org.
authors: Josephat
authors: J
authors: Nyagero
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000592:standards*; D004522:Educational Status; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D016015:Logistic Models; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009773:Obstetric Nursing / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D018454:Spouses / Q000706:statistics & numerical data; D055815:Young Adult
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