Factors influencing uptake of maternal health services initiatives among mothers: a case study of Nakuru-Kenya.
Wairia, Samuel Kingori
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Strengthening health Service delivery is very important in improving maternal mortality which remains an urgent problem to be addressed in developing countries around the world. Kenya has a very high maternal mortality rate which stood at 471 per 100,000 live births compared to other developing countries of 230 per 100,000 live birth and 16 per 100,000 in developed countries while Nakuru County had a maternal mortality rate of 374 per 100,000 live births despite being one of the counties with the best infrastructure, high number of health workers and better health care financing. This revelation is an indication of an ineffective health systems leading to poor uptake of MHS. The broad objective of this study was to assess factors influencing uptake of maternal health services initiatives among mothers in Nakuru County. The specific objectives were: to determine if the clients characteristics influenced uptake of maternal health initiatives, to assess levels of awareness of maternal health initiatives and to establish if the organization of health services influenced uptake of maternal health services in Nakuru County. The study was undertaken in Nakuru County between January and April 2015. The study was a cross-sectional in design where both qualitative and quantitative approaches were used. A total of fifteen level 4 hospitals (9 private and 6 public) were purposively selected for the study. The sample size was obtained by use of Cochran 1963 formula where 233 mothers were included in the study as respondents and sampled using systematic sampling and purposive sampling was used 8 health workers who were in-charge of MCH services in their respective facilities, these were included to be part of a focus group discussion (FGD). The data was collected using semi structured questionnaires for mothers and FGD guide. Quantitative data was analyzed using SPSS version 20 and presented in tables, percentages and pie charts while Qualitative data was analyzed using excel sheet software. To understand the relationship between variables, inferential statistics was done using Chi-square Test and P-values obtained. The response rate was 233(100%). The finding of the study indicated that a client's characteristics like age, education, religion, marital status and employments have significant influence on the uptake of MHS and the level of education was the best predictor of uptake of MHS initiatives, mothers had low levels of awareness of MHS initiatives with the least being in emergency obstetric care (EmOC) and free maternity services (FMS) which had a median of 1 (that is slightly aware). The least P-value was in free maternity services (P-value=.037). The poor organization of services affected the uptake of maternal health services especially due to acute shortage of staffs (that is hospitals operating below 50%), intermittent supplies of drugs, poor healthcare financing and services setup. In conclusion, client's characteristics influence uptake of MHS, mothers had low levels of awareness on MHS initiatives and poor organization of health services affect uptake of MHS. Therefore, the researcher recommended that :Community opinion leaders should be involved in decision making process to increase uptake/utilization of maternal health services among the low education class, door to door awareness campaigns especially of free maternity and emergency obstetric services be carried out within community through community own resource persons (CORPs) and Health facility management forums should be created to improve organizational approaches that will make services more user friendly to the community. Further Studies can be done on the impact of devolution of health services on access to maternal health services among mothers.