Investigating Access to Maternal Health Services for Kenyan Women Based on Place of Residence: Nairobi and Eastern Kenya Público
Fleuristal, Jenny (Spring 2023)
Published
Abstract
Background: According to the World Health Organization, everyday approximately 800 women and girls die globally from preventable pregnancy-related complications and about 99% of all maternal deaths occur in developing nations. The large disparity concerning maternal health between developing and developed nations is indicated by the WHO’s calculated maternal mortality ratio (developing countries ratio: 240 per 100,000 births; developed countries: 16 per 100,000 births). In Kenya, the lack of accessible maternal health services for women is a critical problem. In addition, women’s regional positionality plays an important role in their ability to access basic health services. Kenyan women who live in remote/rural communities have less access to adequate maternal care; hence, they are less likely to receive the four recommended ANC visits while pregnant, more likely to be unassisted by a skilled professional during childbirth, and less likely to give birth in a health facility.
Objective: To investigate the influence of place of residence, particularly Nairobi and Eastern Kenya, on women’s access to maternal services such as antenatal care, assistance during childbirth, and place of delivery.
Methods: The conceptual framework for this analysis was based on Kroeger’s revised version of Anderson’s healthcare utilization model. Data were drawn from the 2014 Kenya Demographic and Health Survey (KDHS), representing 36,430 household participants consisting of 31,079 women between 15-49 years old who have had live births five years before the study. Simple regression models and chi-square tests were fitted to analyze factors associated with maternal health service access using three main indicators: antenatal care, assistance during childbirth, and place of delivery.
Results: The assessment reveals that there is a significant difference between women residing in Nairobi versus Eastern Kenya in access to certain maternal services. 42% of women in received less than the 4 minimum antenatal care visits required by the WHO. Additionally, about 33% of the respondents reported having given birth in a government hospital and ~34% reported to have given birth in their homes. Lastly, a large majority of women were assisted during childbirth by a nurse/midwife, doctor, or traditional birth person. All reported value was compared with (a = 0.05) to determine statistical significance.
Conclusion: The analysis provided evidence that women’s access to adequate and recommended maternal health services is dependent on regional positionality of women. It further supported Kroeger’s argument that health systems in addition to predisposing characteristics such as age, sex, birth order marital status, ethnic group, education, occupation, assets, and household size may impact health outcomes.
Table of Contents
Table of Contents
Chapter 1. Introduction
1.1 Background..........................................................................................................................1
1.2 Problem Statement...............................................................................................................2
1.3 Main Objectives...................................................................................................................3
1.3.1 Specific Aims....................................................................................................................3
1.4 Significance.........................................................................................................................3
1.5 Organization.......................................................................................................................4
1.6 List of Acronyms..................................................................................................................5
1.7 Definition of Terms..............................................................................................................6
Chapter 2. Literature Review
2.1 Introduction.........................................................................................................................7
2.2 How the Literature Search was Conducted...............................................................................8
2.3 Background of the country.....................................................................................................9
2.3.1 Geography..........................................................................................................................9
2.3.2 Population Size and Distribution/Composition.....................................................................10
2.3.3 Political Environment and Structure....................................................................................11
2.3.4 Socio-Economic Development.............................................................................................12
2.4 Health and Health Systems Development in Kenya..................................................................15
2.5 Maternal Health Service Accessibility in Kenya........................................................................17
2.6 Trends of Antenatal Care in Kenya..........................................................................................21
2.7 Trends of Delivery of Care in Kenya.........................................................................................23
2.8 Delivery by Skilled Professionals in Kenya...............................................................................26
2.9 Overview of Literature...........................................................................................................28
Chapter 3. Methodology
3.1 Purpose of Analysis...............................................................................................................29
3.2 General Objective..................................................................................................................29
3.3 Specific Objectives.................................................................................................................29
3.4 Study Population and Sample.................................................................................................31
3.5 Data Source...........................................................................................................................31
3.6 Study Design and Data Collection...........................................................................................32
3.7 Procedures and Instruments...................................................................................................32
3.8 Study Variables and Definitions...............................................................................................33
3.9 Strengths and Limitations of the Study.....................................................................................35
3.10 Ethical Considerations..........................................................................................................36
3.11 Data Analysis.......................................................................................................................37
Chapter 4. Results
4.1 Introduction...........................................................................................................................39
4.2 Characteristics of the Study Population.....................................................................................39
4.3 Research Questions and Hypotheses Analysis Plan A..................................................................40
4.3.1 Bivariate Associations Between Place of Residence and Antenatal Care Visits............................41
4.4 Adjusted vs. Unadjusted Bivariate Association: Place of Residence and Confounding Variables......................................................................................................................................41
4.5 Research Questions and Hypotheses Analysis Plan B..................................................................42
4.6 Research Questions and Hypotheses Analysis Plan C..................................................................44
Chapter 5. Discussion, Conclusion, Recommendations
5.1 Introduction............................................................................................................................45
5.2 Discussion of the Study Results.................................................................................................45
5.3 Conclusions.............................................................................................................................47
5.4 Recommendations....................................................................................................................48
Chapter 6. Public Health Implications
6.1 Introduction.............................................................................................................................49
6.2 Public Health Implications.........................................................................................................49
Tables and Figures..........................................................................................................................52 References.....................................................................................................................................59
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