Prevalence of Home Deliveries and Associated Factors Among Women of Reproductive Age in Rural Areas Of Marsabit County, Kenya

Abstract

This study examined the prevalence and factors influencing the preference for home deliveries in rural Marsabit County, focusing on cultural practices, healthcare facility-related factors, socioeconomic conditions, and awareness of government health initiatives. A descriptive cross-sectional mixed-methods design was employed, with 402 women participating in quantitative surveys and additional qualitative data gathered from 10 interviews and two focus group discussions. After data cleaning, 396 valid responses were analyzed. The analysis revealed that the point prevalence of home deliveries among women of reproductive age was 64.65% (n = 256). Furthermore, 291 (94.17%) of these home deliveries were attended by traditional birth attendants (TBAs), highlighting their significant role. Cultural beliefs and family influence substantially shaped delivery choices, with family cultural influence reducing the likelihood of a facility delivery (OR = 0.47, p = 0.009). Health-facility-related factors were also significant determinants. Long waiting times (OR = 1.58, p = 0.002) and respectful treatment by staff (OR = 1.86, p = 0.011) significantly influenced healthcare utilization. Socio-economic conditions, including higher education levels (OR = 1.854, p < 0.001) and stable employment (OR = 2.776, p = 0.007), were strongly associated with an increased likelihood of facility-based deliveries. Awareness of government initiatives, such as the Linda Mama program, was low, with 210 (53.03%) of respondents unaware of these programs, which contributed to the preference for home deliveries. Qualitative insights supported these findings, emphasizing deeply rooted cultural norms, mistrust in government healthcare services, and financial constraints as key barriers. Significant variables in the multivariate analysis included religion, number of home deliveries, family's cultural beliefs, cultural practices discouraging facility delivery, traditional ceremonies, unavailability of essential medications, sufficient health workers, long waiting times, and access to information. The study concluded that an integrated approach addressing cultural, socioeconomic, and healthcare access barriers is crucial for promoting safer delivery practices. Recommendations include improving healthcare infrastructure, integrating TBAs into the formal healthcare system, providing targeted financial support, and enhancing communication strategies to build trust in government health programs.