PREVALENCE AND FACTORS ASSOCIATED WITH UPTAKE OF FACILITY-

BASED SKILLED BIRTH ATTENDANCE AMONG WOMEN OF REPRODUCTIVE

AGE IN SIGOR SUB-LOCATION, WEST POKOT COUNTY.

BY: LOMURIA P EMMANUEL

REG. NO.: H151-01-1571/2016

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR BACHELOR OF SCIENCE IN NURSING IN THE SCHOOL OF
NURSING AT DEDAN KIMATHI UNIVERSITY OF TECHNOLOGY.

2022
DECLARATION

Declaration by candidate

This research project is my original work and has not been presented for the award of any degree

in any other institution.

LOMURIA P EMMANUEL

H151-01-1571/2016

Signature……………………………………. Date……………………………….

Declaration by supervisor

This research project has been submitted for examination with my approval as the Supervisor

MR. MICHAEL OKUMU

School of Nursing

Dedan Kimathi University of Technology

Signature…………………………………………. Date…………………………………

i
 DEDICATION

I dedicate this work to almighty God, my loving father Joseph Piretwo and the entire loving

family for their financial support this far.

ii
 ACKNOWLEDGEMENT

I acknowledge God wholeheartedly for the guidance and support in developing this

uptake of facility-based birth attendance service. I would like to thank my supervisor Mr Michael

Okumu for his tireless effort in monitoring, correcting, and supporting me through the entire

research proposal. Thank you for your immense knowledge, motivation, and enthusiasm that

enabled me to reach this far.

iii
 Table of Contents

DECLARATION...............................................................................................................................................i
DEDICATION.................................................................................................................................................ii
ACKNOWLEDGEMENT.................................................................................................................................iii
Table of Contents........................................................................................................................................iv
LIST OF TABLES AND FIGURES....................................................................................................................vii
LIST OF ABBREVIATIONS AND ACRONYMS..................................................................................................ix
OPERATIONAL DEFINITIONS OF TERMS.......................................................................................................x
ABSTRACT...................................................................................................................................................xi
CHAPTER ONE: INTRODUCTION...................................................................................................................1
BACKGROUND INFORMATION.................................................................................................................1
1.1 PROBLEM STATEMENT................................................................................................................3
1.2 OBJECTIVES..................................................................................................................................5
1.2.1 BROAD OBJECTIVE...............................................................................................................5
1.2.2 SPECIFIC OBJECTIVES...........................................................................................................5
1.3 RESEARCH QUESTIONS................................................................................................................5
1.4 JUSTIFICATION.............................................................................................................................7
1.5 CONCEPTUAL FRAMEWORK........................................................................................................8
CHAPTER TWO: LITERATURE REVIEW........................................................................................................10
2.0 Introduction.....................................................................................................................................10
2.1 Proportion of hospital-based deliveries...........................................................................................10
2.2 Socio-demographic factors associated with uptake of facility-based skilled birth attendance
services..................................................................................................................................................10
2.3 Cultural Factors associated with uptake of facility-based skilled birth attendance services among
women of reproductive age..................................................................................................................16
2.4 Contextual factors associate with uptake of skilled birth attendance services among women of
reproductive age...................................................................................................................................17
CHAPTER THREE: RESEARCH METHODOLOGY...........................................................................................20
3.0 Introduction.....................................................................................................................................20
3.1 STUDY DESIGN.................................................................................................................................20
3.2 STUDY AREA.....................................................................................................................................20

iv
 3.3 STUDY POPULATION........................................................................................................................20
3.4 INCLUSION AND EXCLUSION CRITERIA............................................................................................21
3.4.1 INCLUSION CRITERIA.................................................................................................................21
3.4.2 EXCLUSION CRITERIA................................................................................................................21
3.5 STUDY VARIABLES............................................................................................................................21
3.5.1 DEPENDENT VARIABLE..............................................................................................................21
3.5.2 INDEPENDENT VARIABLES........................................................................................................21
3.6 SAMPLE SIZE DETERMINATION........................................................................................................21
3.7 SAMPLING PROCEDURE/TECHNIQUE..............................................................................................23
3.8 DATA COLLECTION INSTRUMENT....................................................................................................23
3.9 DATA COLLECTION PROCEDURES....................................................................................................24
3.10 DATA ANALYSIS AND PRESENTATION............................................................................................24
3.11 VALIDITY AND RELIABILITY.............................................................................................................25
3.11.1 Validity....................................................................................................................................25
3.11.2 Reliability................................................................................................................................26
3.12 PRE-TEST STUDY............................................................................................................................27
3.13 ETHICAL CONSIDERATIONS............................................................................................................27
CHAPTER FOUR: RESULTS..........................................................................................................................29
4.1 Response rate..................................................................................................................................29
4.2 Socio-demographic -demographic characteristics of the respondents............................................29
4.3 Uptake of skilled birth attendance...................................................................................................31
4.4 Cultural factors................................................................................................................................32
4.5 Contextual factor............................................................................................................................33
4.6 Association between social demographic characteristics of respondents and uptake of skilled birth
attendance.............................................................................................................................................34
4.7 Association between cultural factors with uptake of skilled birth attendance................................35
4.8 Association between contextual factors with uptake of skilled birth attendance...........................37
CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATION.........................................................38
5.1 Discussion........................................................................................................................................38
5.1.1 Proportion of facility-based deliveries......................................................................................38
5.1.2 Socio-demographic factors associated with uptake of skilled birth attendance.......................38
5.1.3 Cultural factors associated with uptake of skilled birth attendance.........................................39
5.1.4 Contextual factors associated with uptake of skilled birth attendance....................................40

v
 5.2 Conclusion.......................................................................................................................................41
5.3 Recommendations...........................................................................................................................41
APPENDICES..............................................................................................................................................47
Appendix 1: Study Instrument; Questionnaire......................................................................................47
Appendix 2: Informed Consent Form (ICF)...........................................................................................50
Appendix 3: Letter of Introduction........................................................................................................51
Appendix 4: Work Plan..........................................................................................................................52
Appendix 5: Study Budget.....................................................................................................................53
Appendix 6: Approval letter...................................................................................................................54
Appendix 7: Map of the study area.......................................................................................................55

vi
 LIST OF TABLES AND FIGURES

LIST OF TABLES

Table 1: Socio-demographic characteristics of the respondents....................................................30

Table 2: Cultural factors................................................................................................................32

Table 3: Contextual factors...........................................................................................................33

Table 4: The association between socio-demographic characteristics with uptake of skilled birth

attendance......................................................................................................................................35

Table 5: The association between cultural factors with uptake of skilled birth attendance..........36

Table 6: The association between contextual contextual factors with uptake of skilled birth

attendance......................................................................................................................................37

vii
LIST OF FIGURES

Figure 4.1: Uptake of facility-ased birth attendance service ....................................................................31

viii
 LIST OF ABBREVIATIONS AND ACRONYMS

KDHS: Kenya Demographic and Health Survey

MMR: maternal mortality ratio

MNH: maternal and neonatal health.

SBA: skilled birth attendant

SDG: Sustainable Developmental Goal

WHO: World Health Organization.

ix
 OPERATIONAL DEFINITIONS OF TERMS

Uptake of facility-based birth attendance: This variable is used in this study to measure and

indicate the value in the percentage of women who got ideal skilled services offered or those

who did not get services such as ANC profile, Early detection and treatment of complications,

prevention of complications, birth preparedness, health promotion, and skilled birth attendant.

Women of reproductive age: Refers to Women of childbearing ages between 15 to 49 years.

This study will be used to refer to the value of women capable of giving birth (15-49).

Skilled birth attendant: In this study it refers to the medically qualified provider with

midwifery skills (midwife, nurse, or doctor) who has been trained to broficient in the skills

necessary to manage normal deliveries and diagnose, manage, or refer obstetric complications.

Facility-based skilled attendance: It means skilled attendants operating within an enabling

environment or health system capable of providing care for normal deliveries as well as

appropriate emergency obstetric care for all women who develop complications during

childbirth.

Traditional birth attendant (TBA): it means a community-based provider of care during

pregnancy and childbirth. In this study, the term has been used to mean the number of

community-based providers who assist pregnant mothers to have a delivery. They lack

qualifications in midwifery skills.

x
 ABSTRACT

Facility-based skilled birth attendance is the process by which a pregnant woman and her infant
are provided with adequate care during labor, birth, and postpartum.

The study was aimed at assessing factors associated with uptake of facility-based skilled birth
attendance among women of reproductive age, in the Sigor sub-location, West Pokot County. A
community based cross-sectional study was employed among 129 respondents. Data was
collected via researcher administered questionnaire, cleaned, entered in STATA version 9.10 and
analyzed. The data were analyzed both descriptively and by inferential statistics using a Chi-
square at a confidence interval of 95% with a significance level of < 0.05. The findings from this
study revealed that; socio-demographic factors such as parity (p=0.000), income (p=0.000) and
level of education (p=0.000) were significantly associated with the uptake of skilled birth
attendance. Further, cultural factors and beliefs (p=0.028) were also significant factors associated
with the uptake of skilled birth attendance. Moreover, regarding contextual factors, distance to
health facility (p=0.000) and mode of transport (p=0.009) were the factors significantly
associated with the uptake of skilled birth attendance. the uptake of skilled birth attendance in the
area of study was low hence the researcher recommends the relevant authorities to put up
strategies to clarify on the various cultural practices that hinder utilization of skilled birth
attendance and have more delivery facilities closer to people to reduce commuting distance as
these were found to be significantly associated with the uptake of skilled birth attendance.

xi
 CHAPTER ONE: INTRODUCTION

BACKGROUND INFORMATION

Facility-based skilled birth attendance is the process by which a pregnant woman and her infant

are provided with adequate care during labor, birth, and postpartum (WHO,2022) As referenced

by sustainable developmental goal (SDG) indicator 3, skilled health personnel are competent

maternal and newborn health (MNH) professionals educated, trained, and regulated to national

and international standards. They are qualified to provide and promote evidence-based, human-

rights-based, quality, sociocultural sensitive, and dignified care to women and newborns; it

facilitates physiological processes during labor and delivery to ensure a clean and positive

childbirth experience. It also identifies and manages or refers to women and newborns with

complications (Mugellini et al., 2021)

The skilled birth attendant’s percentage rate has increased globally, from 59 per cent in 1990 to

71 per cent in 2015 and 80 per cent in 2017. (Damian et al., 2020). The skilled health personnel

provide professional services translating only 59 per cent of births in Sub-Saharan Africa,

compared to 90–95 per cent in South America and 99 per cent in high-income nations (WHO,

2022). This percentage falls short of the global target of 90 per cent SBA coverage for all

newborns. (Ahinkorah et al., 2021).

In Kenya, skilled birth attendance is significantly below the international target of 90%, and the

maternal mortality ratio is high at 362 (CI 254-471) per 100,000 live births. Skilled attendance at

birth plays a prophylactic role, making it a benchmark indicator for safe motherhood (Nyongesa

et al., 2018, KDHS, 2014). A skilled Birth Attendant is essential in decreasing preventable

1
maternal deaths. Maternal mortality in developing nations can be successfully reduced by

investing in enabling policies, enabling environments, expanding skilled birth attendance in rural

and underserved areas, and removing financial barriers. (Damian et al., 2020). The Kenyan

government launched a free maternity care policy in June 2013 to increase maternal health care

services across the country. Pregnant women can get free maternity services (including prenatal,

delivery, and postnatal care) in all public health institutions under the policy. The public health

facilities provide the services for free and request payment from the Ministry of Health. (Ikamari

et al., 2020).

In Kenya, skilled birth attendance is sorely left to doctors, nurses and midwives. Traditional birth

attendants are excluded as 80% of them lack formal training in pregnancy and labor and birth-

related matters (Wanjira et. al., 2011). The majority of skilled attendants are found in urban areas

because many health facilities are found there (KDHS, 2014). In West Pokot County there are

few urban settlements compared to rural dwellers which make many mothers to be attended by

TBAs. Most deliveries in West Pokot County are attended by traditional birth attendants, with 74

per cent of women giving birth at home. Only 10% of women who had home delivery receive

postpartum care within two days of giving birth. This is a squandered opportunity to recognize

and respond to danger signs, as this can only be done by skilled care attendance. (Ogolla et al.,

2015).

The correlations between births attended by trained personnel and lower MMRs indicate that

maternal deaths are substantially reduced when a high proportion of births are attended by

professionals, including primary health care workers trained in midwifery skills, with the health

maintenance of an aseptic environment, the identification of maternal and fetal complications,

2
and the opportunity when necessary to transfer parturient mothers to centres with higher-level

skills and facilities. (Bradley et al., 2015, Robinson et al., 2001).

There have been some studies done to check on factors associated with the uptake of facility-

based skilled birth attendance. In previous studies done in Kenya, many concluded the level of

education of the mother, distance to the health facility, attitude of health workers, and cultural

factors are among key factors influencing uptake in other regions (Onyango et al., 2016). Despite

many factors seen to play role in other regions, in Sigor sub-location, west Pokot there exists

little data on factors influencing uptake of facility-based skilled birth attendance thus

necessitating this study.

1.1 PROBLEM STATEMENT.

According to a WHO report in 2015, it showed that 99% of maternal deaths occur in developing

countries. The greatest burden by far is in sub-Saharan Africa which accounts for 66%. of global

pregnancy mortality (WHO, 2020). The Kenyan government, 2013 introduced free maternal

services in promoting skilled care during pregnancy and childbirth for both mothers and

3
newborns (Masaba et al., 2020). Since the introduction of free maternal services, in West Pokot

County, many women, particularly those in impoverished rural settlement, and entire Pokot

central constituency, are still underserved by these safe motherhood programs. As a result, MMR

of 565 deaths per 100,000 births is projected to occur annually, which is in direct contrast to the

national rate of 362 fatalities per 100,000 live births. This has resulted from the low uptake of

skilled care services in the available health facilities (Ogolla et al., 2015).

The low uptake of skilled care services at delivery is still a major challenge in West Pokot

county because cultural beliefs and traditional norms that guide their social practices (Kasmai et

al., 2018). The people in impoverished rural settlement in Pokot Central beliefs that the effects of

enhancing health and welfare using their traditional doctors. For example, medical practitioners

in Pokot society: `Chepsaketian’, an older woman skilled in diagnosing most diseases and using

herbal remedies, and `Kokeogh,’ the traditional birth attendants (midwife). This, coupled with

the average distance of 25Km to the nearest Health facility, makes access to quality health

services a challenge in the county (Ogolla et al., 2015).

The culture of the Sigor people being one most belief practices by its people, is guided by socio-

cultural norms and traditions is located in a semi-arid part of Pokot central; it was, therefore,

necessary to undertake this study in understanding the factors associated with the uptake of

facility-based birth attendance services at birth by women of reproductive age in Sigor Sub-

location to create awareness to the ministry of health on intensive investments in recruiting and

4
training more trained birth attendants on adequate delivery care, as well as the development of a

community-based skilled birth attendants' program, to prevent unnecessary maternal mortality.

1.2 OBJECTIVES.

1.2.1 BROAD OBJECTIVE

To assess factors associated with uptake of facility-based skilled birth attendance

among women of reproductive age, in the Sigor sub-location, West Pokot County.

1.2.2 SPECIFIC OBJECTIVES

1. To determine the prevalence of hospital/facility-based deliveries in Sigor sub-

location

2. To determine socio-demographic factors associated with uptake of skilled birth

attendance services in Sigor sub-location

3. To determine cultural factors associated with the uptake of skilled birth attendance
services in the Sigor sub-location.

4. To determine the contextual factors associated with the uptake of skilled birth
attendance services in the Sigor sub-location.

1.3 RESEARCH QUESTIONS

1. What are the prevalence of women who deliver at the health facility in Sigor sub-

location?

2. What are the socio-demographic factors associated with the uptake of skilled birth

attendance service in the Sigor sub-location?

5
3. What are the cultural factors associated with the uptake of skilled birth attendance in the

Sigor sub-location?

4. What are the contextual factors associated with the uptake of skilled birth attendance

service in the Sigor sub-location?

6
1.4 JUSTIFICATION

Skilled care services at delivery are essential for every pregnant mother who wants a better

pregnancy outcome. Early diagnosis and management of pregnancy-related complications lead to

better pregnancy results and promote quality of life for both the mother and the fetus. The early

diagnosis and management depend on the level of adherence and sustenance in attending skilled

health care services in the facilities.

Among the many studies done on the factors associated with uptake of skilled care services

among women of reproductive age, a Study conducted by Ogola,2015 focused only on factors

related to home deliveries, which has not indicated the aspects related to uptake of skilled care

services at birth among the pastoralist’s women of reproductive age in the arid and semi-arid

areas as a distinct group in Kenya more so in endemic malarial regions specifically in Pokot

Central sub-county.

This study aimed at showing how; the socio-demographic, economic factors and cultural and

physical factors influence the uptake of skilled birth attendance services among women of

reproductive age.

The assessment of the factors associated with the uptake of facility-based birth attendance

services will provide information that the government can use in the ministry of health to

reinforce those that contribute to positive influence and amend policies and practices that would

discourage women from utilizing the available skilled care services.

7
1.5 CONCEPTUAL FRAMEWORK

Factors that influence the uptake of skilled care services are either person or facility related. This

study will focus only on the person-related factors, including the mother’s socio-demographic

characteristics, economic factors, cultural factors, and physical factors, and, and how it supports

the use of health care facilities before, during, and after childbirth. All the above points will,

directly and indirectly, affect the uptake of skilled birth attendance service by women of

reproductive age. When these factors hinder the uptake of capable birth, it will undoubtedly lead

to infant and maternal mortality.

8
Independent variable Dependent variable

Sociodemographic
factors
Age, Parity

-Level of education

-Occupation

-Marital status, Income

Cultural factors

-Decision-maker on place Skilled birth

of delivery attendance uptake

-Cultural beliefs

Contextual factors

-Transport Costs

-Distance to the health

facility

-Mode of transport

9
 CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter will review relevant literature on the factors associated with the uptake of skilled
birth attendance services among women of reproductive age from global, African, and Kenyan
perspectives.

Various studies have shown that skilled birth attendance services are dependent on various
factors such as sociodemographic factors, cultural factors, and physical factors.

2.1 Proportion of hospital-based deliveries

The skilled birth attendant’s percentage rate has increased globally, from 59 per cent in 1990 to
71 per cent in 2015 and 80 per cent in 2017. (Damian et al., 2020). The skilled health personnel
provide professional services translating only 59 per cent of births in Sub-Saharan Africa,
compared to 90–95 per cent in South America and 99 per cent in high-income nations (WHO,
2022). This percentage falls short of the global target of 90 per cent SBA coverage for all
newborns. (Ahinkorah et al., 2021).

In Kenya, skilled birth attendance is significantly below the international target of 90%, and the
maternal mortality ratio is high at 362 (CI 254-471) per 100,000 live births. Skilled attendance at
birth plays a prophylactic role, making it a benchmark indicator for safe motherhood (Nyongesa
et al., 2018, KDHS, 2014).

2.2 Socio-demographic factors associated with uptake of facility-based skilled birth

attendance services

Age

A study in Ghana on predictors of utilization of skilled birth attendance noted that maternal age
was a significant predicting factor. In Ghana, women aged 20 to 34 years (58%) were more

10
likely to use the health facility for delivery as compared to women who were aged 35-49 years
(Adjei M. et al., 2019).

According to a study done by Mwangi, he noted that maternal age was a determinant of health
facility delivery. Women aged >/=35 years were more likely to deliver at home than at a health
facility. This factor increases the risk of maternal mortality. Younger mothers aged <20 years
however due to the fear of complications prefer delivery at the hospital hence increased uptake
of skilled delivery(Mwangi et al., 2018). A study conducted to establish the level of skilled birth
attendance and associated factors showed that age was one of the determinant factors.

From the study, the proportion of women who delivered from the facility under skilled birth
attendance was high among women aged 25-29 years (80%) and lowest among women aged 40
to 44 years (50%). Women who had advanced in age chose home delivery because they may
have had a bad experience in their previous hospital delivery (Gitonga et al., 2017)

A study conducted to check the predictors of uptake of skilled delivery in Lurambi, Kenya
found no significant association between age and uptake of skilled birth delivery. The p-value
was >0.05 hence no association (Emali et al., 2019)
According to study conducted to show factors associated with uptake of skilled delivery
and its associated factors in Papua New Guinea found age as one of the determinant factors
(x2=49.9, p-value<0.001). The majority of the women in New Papua who received skilled
delivery were aged 25 to 29 years (Seiduet al., 2022)

Parity

A study on Skilled Birth Attendance among Women in Tharaka-Nithi County showed that an
increase in parity is likewise linked to an increase in age. Women in their forties and fifties have
less experience with previous hospital deliveries and choose home births. Women aged 15–19
years were 3times more likely than those old 40-45 years to deliver under skilled birth
attendance in Ghanaian research. (Gitonga et al.,2017). According to a study by Adjei, marital
status was one of the determinant factors of the utilization of skilled delivery. This was attributed

11
to the fact that married women have to depend on their husbands to make decisions in terms of
breadwinning and place of birth. It was noted that women who were married to educated
husbands were more likely to utilize skilled delivery (Adjeiet al., 2019).

Marital status
A study conducted on determinants of health facility delivery indicated marital status as one of
the determinant factors.
Single women were noted to have increased autonomy as compared to married women who had
to depend on their husbands to make a decision such as if they can utilize skilled birth
attendance. Therefore, single women utilized health facility delivery more. On the other hand,
widowed women reported the lowest percentage of women utilizing health facility delivery
(Mwangi et al., 2018). In a study done to determine predictors of uptake of skilled delivery in
Lurambi, marital status was noted as one of the determinant factors. There was a significant
association between marital status and uptake of skilled birth delivery (p<0.05). The majority of
women who received skilled delivery were married (66%) (Emali et al., 2019)
Education

According to various studies, it shows maternal education is a significant factor influencing the
utilization of skilled birth attendance. Women, who spent more years in school, had those who
had attained primary or secondary education or had any formal education; demonstrated
utilization of skilled birth delivery at a health facility (Adjei et al., 2019). Ikamari noted that
having an educational background made women twice more likely to attend four ANC visits and
facility delivery as compared to those not having an educational background (Ikamari et al.,
2020). Mwangi’s study on Uptake of health facility delivery showed that education had an
impact on the determination of the decision to deliver at a health facility. Girl education even the
basic form of education was seen to have a positive impact on the uptake of health facility
maternal services (Mwangi et al., 2018)
The findings of a study on the level of skilled birth attendance and its associated factors. From
the study, it was noted that with an increase in the level of study, the level of skilled birth
attendance increased. Since education influences decision-making and also enables one to assess

12
the risks of delivering at home, this made education a contributing factor to increased uptake of
health facility delivery (Gitonga et al., 2017).
In the study on predictors of uptake of skilled delivery in Lurambi, Kenya, education level was
not significantly associated with uptake of skilled delivery (p>0.05). However from the study
majority had attained secondary-level education (Emali et al., 2019). Seidu’s study on factors
associated with the utilization of skilled delivery services in Papua, New Guinea noted that the
level of education influenced the utilization of skilled delivery. Women who had completed
primary, secondary or higher had higher odds (AOR=1.712, 95% CI 1.343 to 2.181) of utilizing
the skilled delivery services as compared to women who had no education.(Seidu et al., 2022).
Also, women whose partners had formal education or had attained secondary education had
higher odds of utilizing skilled delivery services when compared to those whose partners had no
formal education (Seidu et al., 2022)
A study on Factors influencing the utilization of skilled birth attendants during childbirth in the
Southern Highlands, Tanzania, showed that women with secondary education or higher had a
considerably higher likelihood of using competent birth attendants during delivery than women
with no formal education. Women. These findings support a study conducted on predictors of
Utilization of Skilled Birth Attendants Among Women of Reproductive Age in Mandera East
Sub County, Mandera County, Kenya. found that women with secondary education or higher had
a considerably higher likelihood of using competent birth attendants during delivery than women
with no formal education. (Damian et al., 2020).

A study on Skilled Birth Attendance among Women in Tharaka-Nithi County showed that
education impacts decision-making (Gitonga et al., 2017) this research identified education as a
favourable predictor of birth readiness, health-care delivery, and targeted antenatal care. Both
skilled birth attendance and birth readiness were influenced by schooling. Under the SBA,
women with a greater degree of education were found to be more likely to plan for birth and
place of delivery (Gitonga et al.,2017)

13
According to the study on Predictors of Utilization of Skilled Birth Attendants among Women of
Reproductive Age in Mandera East Sub County, Mandera County, Kenya showed that mothers
with no formal education had a 4.2 per cent higher chance of giving birth at a health facility than
those who had a TBA aided delivery. This points to a pattern in which lower levels of education
contribute to low rates of skilled delivery. (Elena et al. 2013) found that 66.3 per cent of moms
with a primary education gave birth in a health institution. (Ali Ibrahim, 2017)
Occupation

Mother’s occupation

According to Abdul, a socioeconomic status that is wealth and employment determined skilled
birth attendant usage. The higher the socio-economic status, the higher the chances of the
utilization of skilled birth attendants. Those women who had a higher wealth status and those
who were employed demonstrated a higher likelihood of SBA uptake. This was attributed to the
fact that they had financial empowerment to attend skilled attendance during delivery.
Furthermore, they were in a better position to pay for transport charges (Seidu et al., 2022).
Victor and Beatrice did another study in Lurambi, Kenya to determine what predicted uptake of
skilled birth services.

From the study, the majority of the women were entrepreneurs (25.5%), followed by farmers
(21%), housewives (21%), students (20%), teachers (15%) and medical personnel (3.5%). The
wealth status determined whether one could afford means of transport to the facility for delivery
(Emali et al., 2019)
A study conducted on the uptake of skilled birth deliveries in women of reproductive age in
Nyatike Sub-County showed that most mothers do not have stable jobs. They are frequently
unable to earn a living. Most of the women said they were housewives, with only about 20%
saying they worked outside the home. According to the focus group discussions, men are often
the economic caretakers of the household and hence make financial decisions in the family.
According to the survey, the husband provides a regular source of income in the participating
families. This tendency suggests that women do not have the authority to decide when and how
much money to spend. In this scenario, they rely on their spouses, who are hesitant to send
money on a mother's delivery. (Okomo et al., 2018)

14
Partner’s occupation

The partner’s income played a major role in determining whether a woman would utilize skilled
birth attendance (Adjeiet al., 2019). Although women may have their wealth such as land and
even their income, most of them don’t influence their partner’s income. This fact may put
women in vulnerable situations as they may not be in a position to make independent decisions
such as spending money on health care services and even taking insurance covers (Emali et al.,
2019).

A study on Predictors of Utilization of Skilled Birth Attendants Among Women of Reproductive

Age in Mandera East Sub County, Mandera County, Kenya showed that because the majority of
people employed earned between Ksh.10,000 and 20,000, the focus group discussions also
suggested that TBA fees may be paid on a more flexible basis, making them more accessible to
the majority of the poor. To add to this, the WHO says that in developing countries, women's
motivation to work is typically fueled by poverty and tailored to meet fundamental requirements.
This could explain why unemployed people use low-wage delivery services (Ali Ibrahim et al.,
2017).
Income/ household wealth

Many studies conducted showed that average family income and type of employment were
associated with the uptake of skilled birth attendance in a study he did in Tharaka Nithi County,
Kenya. The economic status was linked with the family’s income. Since birth is associated with
costs such as hospital charges, and transport charges for the baby’s supplies, one’s ability to meet
these costs influences their ability to receive skilled birth attendance. Women with increased
family income were more likely to experience skilled birth attendance (Gitonga et al., 2017)
A study in Ghana found that a household’s wealth was a major predictor of skilled birth
attendant utilization. From the study, health-seeking behavior was observed among women from
wealthier households. Women who had financial support were in a better position to afford
transport and health services costs (Adjeiet al., 2019).

15
Another study in Western Kenya to determine the uptake of maternal health services and its
associated factors. From the study, it was noted that there were differentials in the uptake of
maternal health services. Women from rich households were more likely to receive skilled
delivery care (Ikamari et al.,2020).
A study conducted on Skilled Birth Attendance among Women in Tharaka-Nithi County showed
skilled birth attendance is connected to one's socioeconomic position. There are expenses
associated with childbirth (hospital charges, transport fees, and supplies for the baby); the ability
to cover these expenditures impacts whether to hire a professional birth attendant (Gitonga et al.,
2017)

2.3 Cultural Factors associated with uptake of facility-based skilled birth attendance
services among women of reproductive age

A study conducted on Socio-Cultural Factors Influencing Uptake of Skilled Childbirth Services

among Women in Kaiti Division, Makueni District, Kenya shows that People's ability to regulate
their environment is heavily influenced by cultural elements. It indicated that Women were the
primary decision-makers, but there was also a chain of other key decision-makers within the
family and society. However, the decision to seek care outside of the home is a complicated one,
including a chain of family members in many circumstances. In the same study, it was also
shown that a vast percentage of the respondents were unaware of any cultural taboos or beliefs
prohibiting women from giving birth in a health facility. This is most likely because the majority
of the population had been converted to Christianity. Some cultural activities that are labelled as
morally reprehensible are discouraged by Christian beliefs. (Mathulu et al., 2017)
In a study carried out on prevalence and determinants of rural-urban utilization of skilled
delivery services in northern Ghana; issues of decision-making for obtaining expert delivery
were relatively favourable with the majority (44.1 per cent) taking a combined option by both
respondent and partner, with a few families taking a communal decision.
When asked who decided on delivery location, the majority of 138 (35%) stated it was a joint
decision by the responder and partner, with 111 (28.2%) citing the partner solely and 79 (20.1%)

16
citing a solo decision. A family decision was made by less than a quarter of a per cent (66.7%).
(Saaka et al., 2020)
A study in Lurambi, Kenya to determine the influence of cultural and religious factors on the
uptake of skilled birth attendance. In the study, culture was measured using four assessment
questions. The questions sought to identify whether women believed delivery must never be
assisted by a man; if home delivery must be done in a new homestead; or all deliveries should be
done in a health facility, or if all deliveries must be conducted at home. The study concluded that
culture was less likely to be associated with the utilization of skilled birth attendance as most
women (97.5%) believed that delivery must be done in a health facility (Emali et al., 2019).
Framework analysis on factors influencing uptake of institutional delivery by skilled birth
attendance. From the analysis, he found out that women from Ghana had a deeply rooted culture
that influenced the outcome of the pregnancy. Most of the cultural beliefs motivated women to
deliver at home. Women in Ghana believed that health facilities were unable to deliver herbs and
concoctions that would facilitate labor hence settled for home delivery by traditional birth
attendants. They also believed that health facility delivery as a result of labor complications was
due to the woman’s indulgence in infidelity and dishonesty to the spouse. To avoid such shame,
many women were compelled to deliver at home as it was believed to be a sign of faithfulness to
the husband. Protracted labor among Ghanaian women was perceived to be a curse by ancestors
and one had to publicly confess infidelity. Others believed that the delivery process was a secret
and hence sought to deliver at home to avoid being bewitched (Adjei et al., 2019).
Adjei also found that women from Uganda had similar cultural beliefs that motivated them to
deliver at home. They could only deliver in facilities where health care professionals handled
their placenta with dignity because of the belief that the placenta was their second child. They
believed that the survival of the child was determined by how the placenta was handled (Adjei et
al., 2019)

2.4 Contextual factors associate with uptake of skilled birth attendance services among
women of reproductive age

Cost of the service

17
Health insurance was considered an effective payment mechanism that contributed significantly
to the uptake of facility-based delivery. Those who were from rich or wealthy households were
more likely to receive skilled delivery ((Adjei et al., 2019).
A study conducted in Ghana showed that health insurance was an effective payment mechanism
that had a positive impact on skilled birth attendant delivery. Since Ghana is one of the sub-
Saharan countries that had implemented free maternal and child health care, it demonstrated
increased uptake of health facility delivery. However, despite the introduction of this policy,
some mothers still delivered at home because child delivery came with other costs such as
buying baby’s clothing, napkin, antiseptic agents, and bed sheets among others (Adjei et al.,
2019).

Another study in Lurambi, Kenya to determine what predicted uptake of skilled birth services.
Most women had increased uptake of skilled delivery, and this was attributed to the fact that
most women had Linda Mama NHIF cover which covered all service costs. The majority of
mothers that is 60.5% were covered by NHIF (Emali et al., 2019)

Distance to the health facility

According to a study in Papua New Guinea to assess the prevalence and factors associated with
the utilization of skilled birth attendance. The distance was found to influence the likelihood of
SBA uptake. Those women who did not consider distance to the health facility as a problem
reported h8 increased uptake of skilled birth attendance. Rural dwellers had lesser odds than
urban dwellers. This could be attributed to the fact that lack of availability of advanced health
care facilities in rural areas. Furthermore, the employment status and income level in rural areas
are low (Seidu et al., 2022)
According to a study by Victor and Beatrice, distance was not a major factor hindering the
uptake of skilled birth attendance. This was because the majority of women from that study
resided near health facilities. The majority (94.5%) resided at a distance of 1 to 5 kilometres
while the rest travelled a distance of more than 6kilometer (Emali et al., 2019).
There was a significant association between distance to the health facility and skilled birth
attendance (p<0.001). The distance was seen to imply the cost and time spent to reach the health

18
facility. Due to long distances, some women would deliver before reaching the health facility and
hence would not receive skilled birth attendance during delivery (Gitonga et al., 2017).

According to a study in Ghana, to determine factors influencing institutional delivery by skilled

birth attendants. From the study, distance to the health facility was one of the factors influencing
institutional delivery. Women from urban areas were more likely to use institutional delivery
services when compared to women from rural areas (Adjei et al., 2019)

19
 CHAPTER THREE: RESEARCH METHODOLOGY

3.0 Introduction

This section describes all methods used by the researcher while studying this research problem.

Involve research design, study area, study population, sampling method, sample frame, sample

size, data collection procedures/technique, reliability and validity, data analysis and presentation,

pilot test, and ethical consideration.

3.1 STUDY DESIGN

A community-based cross-sectional study design was used.

It also provides time to answer the questions, and there is a fairly quick turnaround (Trochin et

al., 2006). Also, the information obtained can be generalized to the general population (Wang &

Cheng et al., 2020)

3.2 STUDY AREA

The study was conducted at the Sigor sub-location. Sigor sub- location in Wei-Wei Ward. Wei-

Wei ward in Sigor constituency in West Pokot County. Wei-Wei ward has a population of

approximately 27,631 people.

3.3 STUDY POPULATION

The study population was women of reproductive age with children below 18 months living in

the Sigor sub-location.

20
 3.4 INCLUSION AND EXCLUSION CRITERIA

3.4.1 INCLUSION CRITERIA

The study included the women of reproductive age (18-49 years) who delivered in the last 18

months and were available during data collection and who have resided in the sub-location for

the last 6 months

3.4.2 EXCLUSION CRITERIA

The participants who meet inclusion criteria, but have less than 6 months stay period in the
community.

3.5 STUDY VARIABLES

3.5.1 DEPENDENT VARIABLE

Uptake of skilled birth attendance service

3.5.2 INDEPENDENT VARIABLES

The independent variables in the study were socio-demographic, cultural, and cotual factors

influencing the uptake of facility ased birth attendance services.

3.6 SAMPLE SIZE DETERMINATION

Fischer’s formula was adopted since the target population is less than 10,000. It was taken at a

95% confidence interval, and a sampling error of 5% was used to calculate the sample size.

(Fisher et al.1998)

The sample size was calculated by using the modified formulary Fisher et al. 1998.
2
z p ( q)
n=
d2
21
z = is the Z value for the corresponding confidence level (i.e., 1.96 for 95% confidence).

d = is the margin of error (i.e., 0.05 = ± 5%) and

p = is the estimated value for the proportion of a sample that had a state of interest and, in this

case, a proportion of 50% (prevalence of uptake of skilled care services in West Pokot County)

N=1.962p(1-p)

d2

n=1.96x1.96xp(1-p) = 384

0.05x0.05

For a population less than 10,000, the following formula by Fisher et al. (1998) is used.

nf = __n__

1+ (n/N)

Where nf represents the desired sample of the population, < 10,000

n is the sample when the total population is more than 10,000

N is the estimated population of women of reproductive age, 15-49 years in Sigor location, who

have given birth are 196 (Ogolla et al., 2015).

Therefore,

nf = __n__

1+ (n/N)

384/1+(384/196) =129

22
 3.7 SAMPLING PROCEDURE/TECHNIQUE

The sampling was done via stratification methods. Stratification of the sub-location into basic

administrative units which is villages[strata]. The Sub-location had 9 villages hence forming 9

strata. 14 participants from each stratum were selected through consecutive convenience

sampling starting from a household close to the sub-chief camp. Women of reproductive age

who had delivered within the last 18 months in each household were selected skipping the

households without women who met the inclusion criteria. The sampling continued until 129

clients were obtained.

3.8 DATA COLLECTION INSTRUMENT

The researcher-administered questionnaire was used in this study because it was easier

compared to other tools of data collection since the utilization of a questionnaire as a research

tool provides the respondents with enough time to give well-thought responses to the

questionnaire items and allow extensive samples to be covered within a limited time (Kombo et

al. 2009).

A questionnaire had questions arranged in series and sections that elicit critical information from

informants (Mugenda & Mugenda 2003).

For this study, the questionnaire was designed in four sections

Section I- Socio-demographic characteristics of informants.

Section II. The proportion of women who delivered in the health facility

Section III- Cultural characteristics of the informants

Section IV- contextual –related information

23
 3.9 DATA COLLECTION PROCEDURES

After the approval of the research proposal, the participants were explained to and given written

informed consent to sign before participating in the study. The research adopted a researcher-

administered questionnaire and the time allocated to respond was 10 to 20min to respond to

questions. A research assistant, a community health volunteer was recruited and trained on

diverse aspects of the research and data collection technique to understand research objectives,

master research tools, ethical considerations in research, and plan on approaches to data

collection. Data collected through the interviewer-administered questionnaire was checked,

cleaned, and coded.

3.10 DATA ANALYSIS AND PRESENTATION

Data collected through the researcher-administered questionnaires was entered into and

analyzed through STATA, a software version 9.10. Descriptive statistics for the variables

included socio-demographic data of the women of reproductive age such as age, marital status,

education level, and occupation. Economic factors data have mothers’ employment, household

wealth, and partners’ work-related cultural factors such as decision-making and cultural

beliefs/taboos. Contextual factor include distance to the health facility, waiting time, return date

issuance, and mode of transport.

A Chi-square test was used to analyze the inferential statistics to explore any association between

the independent variables and the dependent variables, which was the Uptake of facility-based

birth attendance services. Any value with a p-value of less than 0.05 was regarded as statistically

significant. Study findings were presented using percentages, tables, and pie charts.

24
 3.11 VALIDITY AND RELIABILITY

3.11.1 Validity

Validity is the degree of a research tool to measure the exactness of what it is supposed to

measure (Mugenda & Mugenda, 2003). It indicates the extent to which study findings can be

accurately deduced and generalized on the target population (Burns & Grove 2009). Study

validity measures the accuracy and truth of an argument (Burns & Grove 2009) To ensure the

validity of the research instruments, the questionnaire was given to a research expert (lecturer) at

Dedan Kimathi University who evaluated the elements of the questionnaire in relation to the

objectives of the study and ensured that the questionnaire was able to answer the research

questions. The items in the questionnaires were verified to ensure that they were written in

English language that is simple enough for easy understanding. Her advice was used to make the

necessary corrections. The research assistant was trained on data collection and sent complete

questionnaires immediately after collecting data and the principal researcher rechecked them to

ensure completeness of data.

25
 3.11.2 Reliability

Reliability refers to the degree to which study findings are considered consistent and replicable

(Amin, 2018). Reliability was used to measure consistency, exactness, accuracy, strength,

comparability, and homogeneity of the study.

Steps that were taken into account to ensure that the reliability of the study was maintained

included.

 The purpose of the study was explained to all participants and their informed consent and

cooperation to participate in the research was obtained.

 A pre-test study was conducted to ensure that the research instrument were accurate in

terms of collecting relevant data and information that was required in the study

 The research assistant was available during information collection sessions and explained

any unclear questions and aspects to the respondents to reduce any ambiguity.

 Medical terminologies were avoided to enhance participant’s comprehension abilities

hence ease inappropriate responses.

 There was constant communication between the principal researcher and research

assistant which ensured instant clarification whenever an issue occurred.

26
 3.12 PRE-TEST STUDY

Before main data collection, a pretest study was conducted among 13 respondents (10% of the

sample size) in Kokwositot village having the same characteristics as Sigor sub-location with the

same elements subjects a week before the main data is collected. Its purpose is to obtain clarity,

find out its appropriateness and obtain directly the main study and the time length needed to

complete the questions. The pretest therefore helped to address the reliability and validity of the

instrument.

3.13 ETHICAL CONSIDERATIONS.

Before conducting the study, request permission from the administration of the Sigor sub-

location by presenting a letter of introduction from the nursing department, Kimathi University

was done. The purpose of such regulation is to ensure that the benefits of this research outweigh

the disadvantages. Particularly the rights of the participants were prioritized over the interests of

this research. The respondents were explained how to go about the study and its purpose.

Participation in the study was voluntary. The respondents freely sought clarification concerning

the study and they were allowed to withdraw from the study at any time during the interview.

The participants were only those who gave their consent and voluntarily wanted to participate in

the study. Confidentiality was maintained by keeping the records of the participants secure

through the use of password-protected files and encryptions. Additionally, privacy and

confidentiality were assured to all the respondents throughout the study by not entering the name

of the respondent in the questionnaire instead code numbers were used.

27
Justice was ensured by making sure that all the participants were equally treated and approached

regardless of social class. Furthermore, the study saw all but not only some of the participants

benefit from the findings of this research. All the participants were respected regardless of their

age, and they were addressed in formal language. Morals and dignity were obeyed. Beneficence

was also observed since the data provided by the participants was used to improve their health

and to come up with more effective preventative strategies.

28
 CHAPTER FOUR: RESULTS

4.1 Response rate

The study had a target sample size of 129 respondents out of whom all respondents had their
questionnaires completely answered and submitted on time and analyzed hence the response rate
was 100%.

4.2 Socio-demographic -demographic characteristics of the respondents

The study established that, a majority of the respondents, 41.09% (n=53), in the study were aged
between 21-31 years. Majority of the respondents, 37.98% (n=49) had informal level education.
Further, majority of the respondents, 67.44% (n=87) were married. Majority of the respondents,
51.94% (n=67) were unemployed and majority, 43.41% (n=56) earned a monthly salary income
of less than Ksh,10,000. Majority of the respondents, 51.94% (n=67) had a parity of between 1 to
3 as shown in table1 below.

Table 1: Socio-demographic characteristics of the respondents

CHARACTERISTIC CATEGORY FREQUENCY (N) PERCENTAGE (%)

Age in years 15-20 41 31.78
21-31 53 41.09
32-42 21 16.28
43-49 14 10.85

Marital status Married 87 67.44

Single 17 13.18
Separated /divorced 12 9.3
Widowed 13 10.08

Level of education Informal/o education 49 37.98

Primary 46 35.66

29
 Secondary 21 16.28
Tertiary 10 10.08

Occupation Unemployed 67 51.94

Self-employed 38 29.46
Formally employed 24 18.6

Monthly income Less 10,000 56 43.41

10,000-30,000 38 29.46
Above 30,000 35 27.13

Parity Para 1-3 67 51.94

Para 4-5 40 31.01
Para >6 22 17.05

30
 4.3 Uptake of skilled birth attendance

The finding revealed that, 34.11% (n=44) of the respondents had delivered in a health facility by
the help of a skilled birth attendant during their previous delivery as shown in figure 4.1 below.

Uptake of skilled birth attendance

Yes; 34.11%

No; 65.89%

Figure 4.1: Uptake of skilled birth attendance

31
 4.4 Cultural factors

Regarding the cultural factors, the findings revealed that majority of the respondents, 31.78%
(n=41) reported their husbands making decisions for them in the household. Majority of the
respondents, 37.98% (n=49) attributed economic factors to be a barrier to choise of place of
delivery while 39.53% (n=51) reported having a culture that the mother/baby has to be bathed
after delivery and hence they attributed this to hinder skilled birth attendance utilization as
illustrated in table 2 below.

Table 2: Cultural factors

CHARACTERISTIC CATEGORY FREQUENCY (N) PERCENTAGE (%)

Decision maker Husband 41 31.78
Mother 16 12.4
Mother in-law 20 15.5
Extended family 16 12.4
None 36 27.91

Barriers to choice of facility of delivery Economic factors 49 37.98

Cultural factors 29 22.48
Distance to facility 18 13.95
Family wishes 33 25.58

Cultural barriers to skilled birth

attendance Placenta is buried 35 27.13
Mother/baby has to be
bathed 51 39.53
Mother in-law's presence 19 14.73
Men do not assist in
childbirth 24 18.6

32
 4.5 Contextual factor

Regarding contextual factors, the study revealed that, almost half of the respondents, 44.96%
(n=58) travelled less than 5 kilometers to reach the health facility while majority of the
respondents, 51.94% (n=67) used walking as a mode of transport to their health facilities as
shown in table 3 below

Table 3: Physical factors

Characteristic Category Frequency(N) Percentage (%)

Distance to health facility Less than 5km 58 44.96

5-15 km 49 37.98

Above 15 km 22 17.05

Mode of transport Walking 67 51.94

Motorcycle 19 14.73

Vehicle 43 33.33

Further, inferential statics using Chi-square was done to test the relationship between the
independent variables and the primary dependent variable which in this case was uptake of
skilled birth attendance and the results were as follows:

33
 4.6 Association between social demographic characteristics of respondents and
uptake of skilled birth attendance

The findings established that respondents parity, p=0.000; income, p=0.000; and level of
education, p=0.000; were statistically significant with uptake of skilled birth attendance while on
the other hand, age of respondents, p=0.338; marital status, p=0.737; and respondents occupation
, p=0.218 were not statistically significant with uptake of skilled birth attendance as shown in
table 4

Table 4: The association between socio-demographic characteristics with uptake of skilled birth
attendance

Uptake of
skilled
CHARACTERISTI FREQUENCY PERCENTAGE birth
C CATEGORY (N) (%) attendance
Chi-
Yes No square(χ2)
Age in years 15-20 41 31.78 17 24 χ2 =3.3687
21-31 53 41.09 19 34 df = 3
32-42 14 10.85 4 10 p = 0.338
43-49 21 16.28 4 17

Marital status Married 87 67.44 30 57 χ2 =1.2666

Single 17 13.18 4 13 df = 3
Separated
/divorced 12 9.3 5 7 p = 0.737
Widowed 13 10.08 5 8

34
Level of χ2 =
education Informal 49 37.98 8 41 73.7568
Primary 46 35.66 15 31 df = 3
Secondary 21 16.28 9 12 p = 0.000*
Tertiary 13 10.08 10 3

Occupation Unemployed 67 51.94 13 54 χ2 =2.1673

Self-employed 38 29.46 25 13 df = 2
Formally
employed 24 18.6 6 18 p = 0.218

χ2 =
Monthly income Less 10,000 56 43.41 14 42 18.8917
10,000-30,000 38 29.46 20 18 df = 2
Above 30,000 35 27.13 10 25 p = 0.000*

χ2 =
Parity Para 1-3 67 51.94 7 60 35.1243
Para 4-5 40 31.01 25 15 df = 2
Para >6 22 17.05 12 10 p = 0.000*

4.7 Association between cultural factors with uptake of skilled birth attendance

The findings revealed that cultural barriers to skilled birth attendance, p=0.028 was statistically
significant with uptake of skilled birth attendance while decision maker, p=0.585 and barriers to
choosing facility of delivery, p=0.283 were not statistically significant with uptake of skilled
birth attendance as shown in table 5 below.

Table 5: The association between cultural factors with uptake of skilled birth attendance

35
 Uptake of
skilled
FREQUENC PERCENTAGE birth
CHARACTERISTIC CATEGORY Y (N) (%) attendance
N Chi-
Yes o square(χ2)
χ2 =
Decision maker Husband 41 31.78 10 31 2.8397
Mother 16 12.4 6 10 df = 4
Mother in-law 20 15.5 7 13 p = 0.585
Extended family 16 12.4 7 9
None 36 27.91 14 22

Barriers to choice of χ2 =
facility of delivery Economic factors 49 37.98 13 36 3.8067
Cultural factors 29 22.48 9 20 df = 3
Distance to
facility 18 13.95 9 9 p = 0.283
Family wishes 33 25.58 13 20

Cultural barriers to χ2 =
skilled birth attendance Placenta is buried 35 27.13 17 18 9.0696
Mother/baby has
to be bathed 51 39.53 15 36 df = 3
Mother in-law's
presence 19 14.73 2 17 p = 0.028*
Men do not assist
in child birth 24 18.6 10 14

36
 4.8 Association between contextual factors with uptake of skilled birth attendance

The findings established that Distance to health facility, p=0.000; and mode of transport,
p=009, were statistically significant with the uptake of skilled birth attendance as shown in table
6 below.

Table 6: The association between physical factors with uptake of skilled birth attendance

Uptake of
skilled
Percentag birth
Characteristic Category Frequency(N) e (%) attendance
Chi-
Yes No square(χ2)
Distance to health Less than χ2 =
facility 5km 58 44.96 39 19 52.0904

5-15 km 49 37.98 2 47 df = 2
Above 15
km 22 17.05 3 19 p = 0.000*

Mode of transport Walking 67 51.94 31 36 χ2 = 9.4987

Motorcycle 19 14.73 3 16 df = 2

Vehicle 43 33.33 44 85 p = 0.009*

37
 CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATION

5.1 Discussion

5.1.1 Proportion of facility-based deliveries

The study established a slightly low uptake of facility-based deliveries. This was lower than the
international target of 90% facility-based deliveries for every Country. This is therefore an
indication that a lot of efforts ought to be out in place to achieve this target which will ultimately
go a long way to reduce maternal and infant mortalities which have been associated with
deliveries that are not done in health facilities. This study is contradictory to findings from global
studies which have found out that the skilled birth attendant’s percentage rate has increased
globally, from 59 per cent in 1990 to 71 per cent in 2015 and 80 per cent in 2017 (Damian et al.,
2020).

5.1.2 Socio-demographic factors associated with uptake of skilled birth attendance

The respondents’ level of education was also found to be a key factor associated with the uptake
of facility based skilled birth attendance. Majority of the respondents with higher levels of
education were the most utilizers of skilled birth attendance. This could be attributed to the fact
that literacy could enable mothers to be aware of the need, benefits of delivery by the help of a
skilled birth attendant and the risks of home deliveries without a SBA. These findings concur
with finding from a study on factors associated with the utilization of skilled delivery services in
Papua, New Guinea which noted that the level of education influenced the utilization of skilled
delivery. The study established that women who had completed primary, secondary or higher
had higher odds (AOR=1.712, 95% CI 1.343 to 2.181) of utilizing the skilled delivery services as
compared to women who had no education (Seidu et al., 2022).

The respondents’ household income was found to be a significant factor associated with the
uptake of skilled birth attendance as majority of the women from high income households were
the most utilizers of skilled birrth attendance. This can be attributed to the fact that higher
income enables the mothers able to access services of skilled birth attendants when cost factors
are factored in for instance the hospital charges, transport fees among others. These findings is

38
supported by the findings from another study conducted on Skilled Birth Attendance among
Women in Tharaka-Nithi County which showed that skilled birth attendance was associated with
one's socioeconomic position.

The respondents’ parity was also found to be significantly associated with the uptake of skilled
birth attendance. Majority of women who had a lower parity utilized facility based skilled birth
attendance and this could be attributed to the fact that women with higher parities could consider
themselves having used to giving birth hence might not see the need to utilize the services of a
professional. These findings are consistent with findings from a study conducted in Kenya to
determine predictors of uptake of skilled delivery in Lurambi, where parity was noted as one of
the determinant factors. The study established that there was a significant association between
parity and uptake of skilled birth delivery (p<0.05). The majority of women who received skilled
delivery were those with lower parities, (66%) (Emali et al., 2019).

5.1.3 Cultural factors associated with uptake of skilled birth attendance

The respondents having cultural practices and beliefs for childbirth was established to be a
significant factor associated with the uptake of skilled birth attendance. This can be attributed to
the fact having various cultural practices in the society could either encourage or discourage a
certain practice. For instance, there are cultures which believe that a woman who delivers at
home on her won is brave and strong. Such cultures therefore discourage facility deliveries. This
was in support of findings in a study conducted among Ghanaian women which established that
the society believed that the delivery process was a secret and hence sought to deliver at home to
avoid being bewitched (Adjei et al., 2019). This study is however contrary to the findings from a
study in Lurambi, Kenya to determine the influence of cultural and religious factors on the
uptake of skilled birth attendance. In the study, culture was measured using four assessment
questions. The questions sought to identify whether women believed delivery must never be
assisted by a man; if home delivery must be done in a new homestead; or all deliveries should be
done in a health facility, or if all deliveries must be conducted at home. The study concluded that
culture was less likely to be associated with the utilization of skilled birth attendance as most
women (97.5%) believed that delivery must be done in a health facility (Emali et al., 2019).

39
 5.1.4 Contextual factors associated with uptake of skilled birth attendance

Distance to the health facility was also found to be significantly associated with the uptake of skilled
birth attendance. Women from households that were near health facilities were more likely utilize
facility based skilled birth attendance than those who were many kilometers away. This could be
attributed to the fact that being located far away from the health facilities could discourage women
who have to walk/travel a long distance to access these services and might be forced to incur high
transport costs to travel. These findings are in consistent with findings from a study in Ghana, to
determine factors influencing institutional delivery by skilled birth attendants. From the study,
distance to the health facility was one of the factors influencing institutional delivery. Women
from urban areas were more likely to use institutional delivery services when compared to
women from rural areas (Adjei et al., 2019). These findings however disagree with those from
another study in Ghana which established that distance was not a major factor hindering the
uptake of skilled birth attendance (Emali et al., 2019) .

40
 5.2 Conclusion

The findings established that; the uptake and utilization of facility based skilled birth attendance
in the area of study is slightly low. Further, some of the social -demographic factors associated
with the uptake of skilled birth attendance include respondents parity, income, and the level of
education. Cultural beliefs and practices were also established to be associated with the uptake of
skilled birth attendance. Moreover, with regards to physical factors, the study established that
Distance to the health facility and the mode of transport were significant factors associated with
the uptake of facility based skilled birth attendance.

5.3 Recommendations

The researcher recommends that:

1. The relevant stakeholders in the area of study should clarify various cultural practices
that hinder the utilization of skilled birth attendance and educational levels.

2. The administrators in the area of study should put up strategies to have more
health facilities for delivery closer to the locality to reduce the commuting distance as this
was established in this study to have a significant association with the uptake skilled birth
attendance.

3. The researcher recommends further investigation on the same topic in other areas of the
country especially the rural and marginalized areas.

41
42
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Afulani, P. A., & Moyer, C. (2016). Explaining disparities in use of skilled birth attendants in

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Ahinkorah, B. O., Seidu, A. A., Agbaglo, E., Adu, C., Budu, E., Hagan, J. E., ... & Yaya, S.

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 APPENDICES

Appendix 1: Study Instrument; Questionnaire

FACTORS ASSOCIATED WITH UPTAKE OF FACILITY-BASED SKILLED BIRTH

ATTENDANCE AMONG WOMEN OF REPRODUCTIVE AGE IN SIGOR SUB-
LOCATION, WEST POKOT COUNTY.

You are requested to participate in the above-mentioned study. If you agree to participate you
will be asked questions about yourself, and questions about people around you. The interview
will take approximately 20 minutes to complete. The interviewer will explain to you all the
question, and everything discussed with you will remain confidential and will help the leadership
of the area in improvement of skilled care delivery services uptake.

Participant serial number -------- Date of interview -------- Name of interviewer--------

Section
Socio-Demographic factors
A

Serial
Question Options
No.

Please indicate your Age

bracket 1. 15-20
2. 21-31
1
How old are you (in years)? 3. 32-42
4. 43-49

Marital Status: What is your 1. Married

marital status? 2. Single
2
3. Separated/Divorced
4. Widowed

3 What is your level of 1. Informal

47
 2. Primary
education?
3. Secondary
4. Tertiary

How many times have you 1. 1-3

4 2. 4-5
become pregnant? (parity)
3. >6

5 What is your occupational 1. Unemployed

Status? 2. Self-employed
3. Formally employed

In which of the following 1. Less than 10,000

categories would you place 2. 10,000-30,000
6
your monthly household 3. Above 30,000
income from all sources?

Cultural factors

Will anyone other than 1. Husband

yourself be participating in 2. My mother
decisions affecting you? 3. Mother-in-Law
1
4. Extended family
If yes, who? 5. None

Are there any barriers

related to you choosing the 1. Economic factor
2. Cultural considerations
2 hospital of your choice
3. Distance to health facilities
during delivery or for
4. Family wishes
treatment? Please tick one.

Do any of the following 1. Placenta is buried

cultural practices hinder 2. Mother and/or baby have to be bathed
3 you from accessing skilled 3. The mother-in-law always presents during
birth attendance at a health delivery
facility 4. Men do not assist in childbirth

Contextual factors

1 Approximate distance to the 1. Less than 5km

48
 health facility 2. 5-15 kilometers
3. 15Km and above
Means of transport to the 1. Walking
2 health facility 2. Motorcycle
3. Vehicle

Uptake of skilled delivery

Where did you deliver your 1. Home

1 last-born baby? 2. Roadside
3. Health facility
4. TBAs house
Who assisted you during 1. Trained health care worker
2 the delivery of your last 2. Mother-in-law
baby? 3. Traditional birth attendant
4. Others (specify)………………….
Do you have mothers and 1. yes
3. 2. no
child (MCH) handbook

Appendix 2: Informed Consent Form (ICF)

This informed consent is for respondents who will participate in a research study on
ASSESSMENT OF THE FACTORS ASSOCIATED WITH UPTAKE OF FACILITY-BASED
SKILLED BIRTH ATTENDANCE AMONG WOMEN OF REPRODUCTIVE AGE, IN THE
SIGOR SUB-LOCATION, WEST POKOT COUNTY.

49
INTRODUCTION
I am LOMURIA P EMMANUEL, a student at Dedan Kimathi University conducting research on
the above-named study. I am going to give you information and invite you to be part of this
research. Before you decide you can talk to anyone you feel comfortable with about the research.
PURPOSE OF THE RESEARCH
The study is carried out for academic purposes.
VOLUNTARY PARTICIPATION
Your participation in this study is entirely voluntary. It is your right to participate or not. You
may decide to terminate your participation at any stage of the research process.
DESCRIPTION OF THE PROCESS
You will be given a questionnaire which you’ll be required to fill the questions honestly and
complete all the sections in it under the guidance of the researcher or research assistant. Then the
data collected will be aggregated and analyzed.
RISKS
There are no expected risks in this study as it will not involve any manipulation of the sample
population in term of behavior or functioning.
BENEFITS
There will be no benefits directly for you right now, but your responses will help us answer the
research questions which will help the improvement to increase skilled care delivery services
uptake.
CONFIDENTIALITY
The questionnaire to be used in data collection will be coded and the respondent will not be
required to indicate his name or other identification credentials. The information collected will
only be subjected to the relevant research team.
I have read the foregoing information and had the opportunity to ask questions about it and any
questions that I have asked to have been answered to my satisfaction. I consent voluntarily to
participate as a participant in this research.
Signature of the participant…………………………….
Date…………………………………………………….

Appendix 3: Letter of Introduction

LOMURIA P EMMANUEL

50
DEDAN KIMATHI UNIVERSITY OF TECHNOLOGY
P.O BOX 657-10100
NYERI-KENYA
SIGOR SUB-LOCATION, WESTPOKOT.

PO BOX 378

WEI-WEI-KENYA

Dear Sir/Madam,

RE: AUTHORIZATION TO CARRY OUT RESEARCH IN YOUR AREA

I am LOMURURIA P EMMANUEL, a Bachelor of Science in Nursing student at the DEDAN

KIMATHI UNIVERSITY OF TECHNOLOGY requesting permission to conduct research
on; ASSESSMENT OF FACTORS ASSOCIATED WITH UPTAKE OF FACILITY-
BASED BIRTH ATTENDANCE AMONG WOMEN OF REPRODUCTIVE AGE IN
SIGOR SUB-LOCATION, WEST POKOT COUNTY. THE STUDY IS PURELY FOR
ACADEMIC PURPOSES.

A copy of the findings will be shared with your office upon completion of the study.

I look forward to your positive consideration.

Thank you in advance.

Yours faithfully,

EMMANUEL P LOMURIA,

PHONE: 0710734126

Appendix 4: Work Plan

Activity Month/ Marc April May June July August Sept Oct

51
 week/ h

year

Proposal X
development and
approval
Preparation for X
data collection
Data collection X

Data entry and X

statistical
analysis
Report writing X
and
submission/defen
d

52
 Appendix 5: Study Budget

Total
cost
Item Quantity Unit cost (Kshs) (Kshs)
Personnel (research
assistants) 1500 1500
Typing and photocopying of
research instruments 600 600
Questionnaires 500 500
Transport 300 300
Airtime 250 250
Stationery & equipment 300 300
Data processing, analysis
and report writing 500 500
Miscellaneous 550 550
TOTAL 4500 4500

53
Appendix 6: Approval letter

54
Appendix 7: Map of the study area

55