Date of Award

12-2025

Degree Type

Thesis

Degree Name

Master of Science in Advanced Practice Midwifery (MSc-APM)

First Advisor

Dr. Eunice Muthoni Mwangi

Second Advisor

Dr. Evah Maina

Department

School of Nursing and Midwifery, East Africa

Abstract

Background: Maternal care provided by a skilled birth attendant (SBA) during pregnancy, at delivery, childbirth, and the postpartum period is vital for reducing maternal and neonatal mortality. In sub-Saharan Africa, the overall prevalence of usage of SBA in a 2021 study was 63%. Tanzania recorded the lowest rate at 13.8%, while Kenya registered 89.3% in 2023. However, disparities exist within Kenyan counties, for instance, in Wajir County only 57% of births were assisted by skilled health providers, a disparity that could be due to socio-cultural differences.

Aim: This study aimed to determine the factors influencing the utilization of skilled birth attendants (SBA) among women aged 18–49 years in Habaswein ward Wajir south Sub-Couty.

Methods: The study targeting women of reproductive age, and 266 participants were recruited through a multi-stage sampling design approach. Employing a cross-sectional analytical design, data was collected using a structured researcher-administered questionnaire. Ethical approval was obtained from the relevant authorities, starting from the Aga Khan University, NACOSTI and Wajir county administration. Descriptive statistics such as frequencies (percentages) were generated for categorical data and mean (standard deviation) or median (interquartile range) as was appropriate for the continuous variables. Both bivariate and multivariable logistic regression analyses were performed to identify factors associated with the utilization of SBA. All analyses were conducted using Statistical Program for Social Sciences (SPSS) version 23, with statistical significance set at p-value < 0.05.

Results: Of the recruited participants, the median age was 34 years (IQR:28-39) with married accounting for 84.5% of the total sample. The proportion of women who have ever given birth in a health facility was 47.8%. Utilization of SBA was significantly associated with sociodemographic characteristics decision for place of delivery being made by a relative or a family member (aOR: 9.86;95%CI: 2.15-57.63; p=0.005) and attending antenatal care at least four times (aOR: 6.37; 95%CI: 1.74-28.01; p=0.008). Health systems factors that influenced utilization of SBA included availability of healthcare workers at the facility of delivery (aOR: 1.08; 95%CI: 1.02-1.18; p=0.008)]. Traditions, however, had a decreased effect on the utilization of SBA (aOR: 0.83; 95%CI: 0.75-0.91, p < 0.001).None of the environmental factors assessed were associated with the utilization of SBA. The odds of SBA use increased by 3% for an increase in safety and security scores (aOR: 1.03; 95%CI: 0.97-1.10; p=0.356). On the other hand, the odds of utilization decreased for an increase in the scores of weather (aOR: 0.99; 95%CI: 0.93-1.06; p=0.869).

Conclusion: Having a relative/family member as the main decision maker, attending antenatal care at least four times, and the availability of healthcare workers, were more likely to influence utilization of SBA services, while traditional practices posed a barrier to SBA utilization in this setting. Therefore, efforts focusing on strengthening community programs that promote antenatal care attendance, engaging family members in decision-making, and improving health care worker-client relationships should be encouraged. In addition, community leaders should develop culturally sensitive health promotion strategies to counter harmful traditional practices and beliefs that discourage the use of SBAs.

First Page

1

Last Page

89

Download

Share

COinS