RESEARCH PROJECT

ON

FACTORS HINDERING MOTHERS FROM RECEIVING SKILLED CARE

DURING BIRTH IN KAMAHUHA LOCATION

PRESENTED BY

DAVID KINYANJUI GITAU.

College no: D/NURS/08006/051

SUBMITTED TO THE DEPARTMENT OF NURSING IN PARTIAL

FULFILLMENT OF THE AWARD OF DIPLOMA IN COMMUNITY HEALTH

NURSING (K.R.C.H.N) YEAR 2010

Kenya Medical Training College

P.O. Box 30195

NAIROBI

DECLARATION

This research project is my original work and has not been

presented in any other institution/college for the award

of a diploma.

………………………………… ………………………………………..

SIGNATURE

DATE

DAVID KINYANJUI GITAU

Student,

KMTC, Murang’a Campus

The research project has been presented with my approval

as the research Supervisor.

…………………………………… ………………………………………..

SIGNATURE

DATE

Miss. Ndegwa

Lecturer,

KMTC, Murang’a Campus.

ii

TABLE OF CONTENTS

CONTENT PAGE

Title ………………………………………………………………… i

Declaration ………………………………………………………………….. ii

Table of contents

….........................................................

......................................... iii

List of tables ………………………………………………….…………………….. v

List of figures ……………………………………………………………………….vi

Acknowledgment ………………………………………………………………… ..vii

Operational definitions …………………………………………………………….. viii

List of abbreviations ………………………………………………………………. .i X

Abstract …………………………………………………………………………….. X

CHAPTER ONE: INTRODUCTION

1.1 Introduction to the

study………………………………................................... 1

1.2 Problem Statement……………………………………………………………

1.3 Study justification………………………………………………………...

1.4 Broad objectives of the study …………………………………………

1.5 Specific objectives for the study……………………………………………….

CHAPTER TWO: LITERATURE REVIEW

2.1 Socio-economic factors and demographic factors

hindering women from receiving skilled care at birth

CHAPTER THREE: RESEARCH METHODOLOGY

3.0 Introduction and Background of the study area.

iii

3.1 Study design

3.2 Study area

3.3 Définition of variables

3.4 Inclusion and exclusion criteria

3.5 Study population

3.6 Sampling procedure ……………………………………………………...

3.7 Sample size……………………………………………………………….

3.8 Data Collection instruments…………………………………………….

3.9 Data Collection procedure…………………………………………………..

3.10 Study limitations ……………………………………………………………

CHAPTER FOUR: STUDY FINDINGS

CHAPTER FIVE: DISCUSSION AND INTERPRETATION

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

REFERENCES AND BIBIOGRAPHY

APPENDICES

I Questionnaire cover letter

II Data collection instruments

III Budget

IV Workplan

V Map of Kamahuha Location

iv

LIST OF TABLES

Table 1 The ages of the respondents

Table 2 Marital status of the respondents

Table 3 Level of education of the respondents

Table 4 Parity of the respondents

Table 3 Persons assisting in unskilled care at birth

Table 6 Reasons for not receiving skilled care at birth

v

LIST OF FIGURES

Figure 1 Number of respondents per sublocation

Figure 2 Occupation of the respondents.

vi

ACKNOWLEDGEMENT

I have had generous help from many sources. My

sincere gratitude’s goes out to everyone who has

contributed to the success of my project.

I want to sincerely thank Miss Ndegwa who taught and

guided me during this project and also her fellow

tutors, who were also supportive in my work.

I would also like to thank all the staff of Kamahuha

Dispensary for their moral support and help in

collecting data. I would like to recognize the good

will of Mr. Kimani, data clerk at Maragua District

Hospital for his contribution.

Am also, highly indebted to my wife Lydia and my two

daughters for their support and understanding

throughout my project.

Lastly, I am grateful to my colleagues and classmates

for their support.

God bless you all.

vii

1.6 OPERATIONAL DEFINITIONS.

Here below are terms used by the researcher in relation to

the study.

a) A skilled birth attendant

This term exclusively refers to people with midwifery

skills like doctors, clinical officers, nurses or

midwives, who have been trained to proficiency in the

skills necessary to manage normal deliveries and diagnose

or refer obstetric complications.

b) A traditional birth attendant.

Refers to persons, especially women who though not

professionally trained, conduct deliveries in the

communities.

c) Health facility

Refers to an institution which offers supervised care at

birth in an enabling environment with established referral

systems to provide emergency treatment for life

threatening

d) Community midwives

These are professionally trained midwives living in the

community who are either in private practice or retired.

e) Grandmultipara

This refers to a mother who has delivered 5 or more times

viii

LIST OF ABBREVIATIONS

A.N.C Antenatal Clinic

T.B.A Tradational Birth Attendant

S.B.A Skilled Birth Attendant

MCH/FP Maternal and Child Health /Family Planning

MOH Ministry of Health

DHMT District Health Management Team

FGD Focused Group Discussion

BCG Bacillus Camelltte Guerin

OPV Oral Polio Vaccine

WHO World Health Organization

KDHS Kenya Demographic Health Survey

MOPHS Ministry of Public Health and Sanitation

NGO Non Governmental Organization

IBP Individual Birth Plan

FANC Focused Antenatal care

UN United Nations

CBS Central Bureau of Statistics

iX

ABSTRACT

The problem of women not receiving skilled care at birth

is prevalent in third world countries and Kenya is one of

them. According to (Nginya, 1980) the problem is more in

the rural areas than in the urban areas. The research was

done in Kamahuha Location in Murang’a South District which

is in the rural area. The purpose of this study was to

evaluate the factors that hinder pregnant mothers from

receiving skilled care during birth in Kamahuha Location

in Murang’a South District. The specific objectives of the

study are; identifying hindering demographic factors

hindering women from receiving skilled care during

delivery and to identify socio-economic factors that

hinder women from receiving skilled care at birth.

The researcher identified the study population and then

developed a sample to study on. The researcher was able to

get qualitative and quantitative data using focused group

discussions and structured interview schedules. The

researcher used both case study design and survey designs.

The researcher then analyzed the data, interpreted it and

came up with conclusions and recommendations of how to

deal with the factors that hinder women from receiving

skilled care at birth.

It’s hoped that the study will be used by the relevant

health, education and political authorities to adopt

appropriate interventions to improve the communities’

maternal health.

X

CHAPTER ONE

1.1 Introduction

According to (Feuerstein, 1993), one of the objectives of

the safe motherhood initiative is to create circumstance

within which, a woman is enabled to have access to trained

birth attendant.

According to the (KDHS, 2003), 88% of pregnant women

attend ANC and only 41% of mothers are assisted by a

skilled birth attendant during delivery. The declining

number of deliveries conducted by skilled providers

against an increasing number of home deliveries has caused

maternal mortality to increase. Children born to women who

obtained both antenatal and delivery care from trained

service providers during pregnancy, have lower mortality

than children whose mothers receive no antenatal or

delivery care.

The target set by Kenya Sessional Paper No 1 is to

increase professionally (skilled birth attendants)

attended deliveries from 44% in 20003 to 90% by year

2010(NHRS 1997-2010)

The term skilled attendant refers exclusively to people

with midwifery skills who have been trained to proficiency

in the skills necessary to manage normal deliveries and

diagnose or refer obstetric complications. A traditional

birth attendant is not a skilled birth attendant. This

kind of delivery care is supervised and involves safe and

clean delivery. The environment under which this takes

place must be enabling, with established referral systems

to provide emergency treatment for life threatening

conditions.15% of all pregnant women develop life

threatening complications requiring obstetric care (Yuster

1995,Fortney 1995 Antenatal Care).

This phenomena of women not having skilled attendants at

birth has been a notable trend in Kamahuha Location and

that is what prompted the researcher to research and get

to know the mothers thoughts , feelings and perceptions on

the issue.

1.2 Problem Statement

Pregnant women in Kamahuha Location have varied and

different factors or reasons for delivering at home where

deliveries are conducted by unskilled birth attendants.

This is despite the fact that there are several health

facilities where they can get the services of a skilled

birth attendant. These facilities include Makuyu Health

Centre, Sabasaba Health Centre, Maragua District Hospital,

Murang’a District Hospital and two community midwives who

have been supported by the Ministry of Public Health and

Sanitation (MOPHS) and an NGO called TUZA to offer these

services. These women deliver at home despite having made

an Individual Birth Plan (IBP) with them at the Antenatal

Clinic (ANC) and educated them on the importance of having

a skilled care attendant at birth.

1.3 Study justification

This study is necessary because it will offer insight into

why a woman despite having attended the four antenatal

clinics recommended by the Focused Antenatal Care approach

(FANC) would not seek services of a skilled birth

attendant. This research to the academic field as the

information gathered will add to what is there on birth

preparedness and readiness. This study will help the

practionners, health development committees and health

care managers to know the hindering factors and strategize

on how to overcome them. The community health development

committees will give priority to projects or initiatives

that will be geared towards creating enabling environments

for conducting of safe and clean deliveries.

1.4. Broad Objective

To evaluate factors that hinder pregnant mothers from

receiving skilled care during birth in Kamahuha

Location in Murang’a South District.

1.5 Specific Objectives

a) To identify demographic factors that hinder women

from receiving of skilled care during delivery.

b) To identify socio-economic factors that hinder

women from receiving skilled care at birth.

CHAPTER 2: LITERATURE REVIEW

This literature review will mainly focus on the objectives

of the research which include identifying hindering

demographic factors and socio-economic factors hindering

women to the receiving of skilled care during delivery.

Action of the ICPD 1994 states that; “all countries must

expand the provision of maternal health services… All

births should be assisted by trained persons, preferably

nurses and midwives, but at least by trained birth

attendants” (UN, 1995, chapter 1, Resolution 1).

To achieve this,according to (MOH,2006) all antenatal

mothers should be able to identify a health facility where

they plan to deliver or go in case of an emergency and

also identify a skilled birth attendant . Complications

arising from maternal obstetric conditions occur mainly

because of socio-economic deprivations that are prevalent

in developing countries (MOH;DRH,DMC,JHPIEGO, (2002).

However, the socio-economic factors do not operate in

isolation, but in conjunction with access to health

services and ease of transportation (MOH, 1997; Obermeyer

and Potter, 1991). Therefore, mothers should know how to

get to the facility either by public means of transport or

by hiring a vehicle to ferry her to the health facility.

This also helps them to know when and where exactly where

to go because they are aware of the distance and logistics

needed. If the mother had not decided where to deliver and

she is making the decision when she is in labour there are

chances that she will end up delivering at home. Maternity

services often make the difference between life and death

(MOH, 1997). These services should be accessible and

affordable to women on a 24-hour basis since many

pregnancy complications occur without warning.

The mothers should be made aware of the fact that, a TBA

is not a skilled birth attendant because they do not

conduct the deliveries in professional manner increasing

the chances for life threatening complications and sepsis.

The rural women are more likely to deliver without

assistance such women are more at risk of deaths that can

be prevented with effective use of modern medical

facilities (NCPD & MI, 1994).Mothers are also made aware

that every pregnant woman should be prepared for a

possibility of complications because some mothers deliver

at home because they had previous home deliveries with no

complications. Majority of women who experienced

complications were considered low risk and 90% of women

considered high risk gave birth without experiencing a

complication.(MOH,1997). Unskilled birth attendants do not

have the capacity to handle these complications. Home

deliveries are more likely to occur without assistance

from medically trained personnel, whereas births delivered

at health facilities are more likely to be delivered by

professional health personnel (NCPD & MI, 1994).

Another hindering factor is issues to do with planning and

availability of transport. As it was noted, the socio-

economic factors do not operate in isolation, but in

conjunction with access to health services and ease of

transportation (MOH, 1997; Obermeyer and Potter, 1991).The

mother must know where she is going to deliver and its

location and distance so that she can make arrangements of

how she will get to the hospital. She needs to know which

mode of transport she will use, to get to the facility.

The mother also needs to know how much it will cost her to

arrange for transport and availability of the funds. If

the mother or family starts to think or organize for

transport when mother is already in labour, the mother

will either delivery at home or on the way to hospital.

The Kenya Demographic and Health Survey (KDHS) of 1993

revealed that 50% of the population was within 5

kilometers of a health facility offering antenatal care.

In rural areas, health facilities offering laboratory and

delivery services can be up to 20 to 25 kilometers away.

The single most important proximate determinant of

maternal health and survival is the extent to which women

have access to and utilize high quality maternal health

care services (UN, 1998).This is despite dwindling and

limited resources. This is a complex socio economic factor

because it can determine place of birth; solve

transportation issues, purchase of basic supplies for

birth and for the baby, paying of hospital bills and other

contingencies required during pregnancy, childbirth and

puerperium. The socio-economic conditions of women affect

their attitudes and values. Mothers, who are economically

engaged, have a positive and improved use of maternal

health care services (Owino , 2007).

In a study done in Nyanza, the cost of transportation and

registration for antenatal care and hospital delivery was

seen as an inconvenience. According to (Owino ,2007) both

female respondents and service providers said that the

costs incurred in seeking maternity services prohibited

women from going to maternity health facilities. In

another study conducted in the same district,the district

hospital, which offers the best services, is several

kilometers away for most women, meaning they have to spend

a considerable amount of money on transportation and

personal needs such as lunch. (CBS 1996).

The government is the main provider of MCH services in

Kenya, and these are provided through the Maternal and

Child Health/Family Planning (MCH/FP) facilities (MOH,

1996). In the public sector, antenatal care and

immunization are provided free of charge. In Kenya, nearly

all pregnant women access antenatal care (ANC), with just

over 50% starting clinic before 6 months of pregnancy.

One-third begin at 7 to 8 months (NCPD & MI, 1994). More

than two-thirds of the women have more than four antenatal

visits and about one quarter have 2 to 3 visits. Only 4%

of pregnant women do not attend antenatal clinic (NCPD &

MI, 1994). It is reported in the KDHS of 1993 , that large

proportions of pregnant women in Kenya seek antenatal care

from health facilities. For 95% of births occurring during

the five years preceding the 1993 KDHS survey, the

expectant mother sought some antenatal care). In Kenya,

maternal health care services are available but their use

is low (NCPD & MI, 1994).Continuous research needs to be

done as it is not known why most women do not utilize

maternal health care services. Even in urban areas where

physical accessibility is less of a constraint, about one-

fourth of all deliveries still occur away from health

facilities (MOH, 1997). This finding is disturbing as it

indicates that a significant proportion of women fail to

seek delivery by trained health workers. The risk of

complications and deaths are highly increased under such

situations (MOH, 1997).A study done in Nyanza, the mothers

had received prenatal care from medical personnel, only

39% were delivered at a health facility. The remaining 61%

were delivered at home (CBS 1996).Women who have not

attended ANC and the fact that they don’t know when they

are having a baby makes them ill prepared for childbirth.

The labour pains just start and the mother had not

prepared in any way and so ends up delivering at home or

being assisted by unskilled birth attendants.

The level of education of a mother determines other

factors like economic, attitudes and values. Educated

people are more likely to use maternity care. Rural women

are usually less educated and therefore less exposed to

knowledge and importance of maternity care. Living in the

rural areas restricts the social networks of a woman,

since a woman operates within a predetermined circle of

friends and relatives. Therefore, information acquired

through social learning and formal education usually

influences very few women.

According to (Owino,2007) majority of the children were

born to women of low education level. The researcher also

found that about66% of them were born to mothers with

primary education, while only 18% had mothers with at

least secondary education. There is often a significant

association between level of education and use of

services. The low level of education among the sampled

women is a predictor of low utilization of maternity care

services (Owino, 2007)

Most births to mothers with primary or no education were

the most likely to be delivered at home, while mothers

with secondary education had greater chances of delivering

their babies in a health institution. (Owino, 2007)

The socio-economic conditions of women affect their

attitudes and values. For the poor especially in the rural

areas, poverty results in a lack of education, which in

turn leads to ignorance of health services. Those in the

lower socio-economic classes tend to be ignorant or

apathetic to seeking services of a skilled birth

attendant, even if these are free. Moreover, social

interventions across socio-economic groups are less in the

rural environment. Such interactions enable exchange of

information on reproductive health matters. The

information acquired influences attitudes and perceptions,

which together with access factors, determine one’s use of

maternity care services. However, in the rural areas like

Kamahuha Location, women tend to remain unaffected by

social interventions and health awareness campaigns.

According to (Owino, 2007),mothers who were economically

engaged were been found to influence the use of maternal

health care services

Mothers who earned cash have greater likelihood of

delivering at a health institution, whereas those who do

not earn cash were more likely to deliver at home. The

most plausible explanation for this is that the former

were better able to pay for delivery in a health

institution. Household economic status is the most

significant factor in predicting place of delivery while

births to women in low status households were least likely

to be delivered in a health facility (CBS, 1996).

According to a study done in Nyanza Province, 18% of

mothers delivered their babies unattended. Although this

is quite high, there are even greater proportions of

unattended delivery in other parts of the country. For

example, the proportion of children delivered in this

manner account for 52% in Turkana district, 39% in Kwale,

and 23% in Western Kenya. The attitude of mothers on child

birth is that, its natural and needs no medical attention

and this explains the high incidence of home deliveries.

(CBS, 1996).

In a study done in Kajiado District, relatives, friends or

the mother herself—without any assistance—attended about

44% of the deliveries. Such occurrences pose great risks

for both the mother and baby, as there is a high level of

unskilled handling of the delivery process ( Kuria,1989).

Younger women tend to deliver at a health facility for

fear of complications during childbirth whereas older

women deliver at home confidently due to their experience

with previous births (Bulut, 1995)

Women of higher parity have greater the chances of a

mother delivering at home. 71% of births to mothers of

parity seven and above were born at home, compared to 54%

for parity 1–3. (Owino , 2007).

Health facility deliveries are greatest among births to

lower parity women. The chances of delivering at home are

greatest among older mothers aged 35 years and above. The

youngest age group, of mothers aged from 15 to 24, have

the most chances of delivering at a health institution. A

greater percentage of mothers who deliver at health

institutions are lower parity women with 1 to 3 children.

According to (Owino , 2007),over 70% of mothers of parity

7 and above deliver at home, compared to about 54% of

those of parity 1–3. There is a relationship of age and

parity in which younger women tend to deliver at a health

facility for fear of complications during childbirth.

Older women, however deliver at home confidently due to

their experience with previous births (Bulut, 1995;

Dissevelt, 1978; Nginya, 1980; Obemeyer & Potter, 1991;

Winikoff, 1987; Sargent & Rawlings, 1991).

With regard to marital status, 48% of married women were

most likely to be attended by a relative, friend or self,

unlike children of single mothers (28%) and others, (46%).

Among births to single mothers, there is a greater chance

of seeking professional care during delivery than among

married women and other categories. (Owino , 2007)

According to (Owino , 2007) some women find hospitals to

be unfriendly and hostile. Some fear they would be forced

into surgical procedures such as sterilization and

episiotomy. Some women point that provider-client

relations were not good; they are rude, unfriendly and

often cold. The researcher attributed this to the fact

that few facilities offer maternity care and so , there is

a high incidence of client overload which leads to

impersonal attention and often hurried interaction between

clients and providers.

According to a study by (Kuria,1989) among the Maasai

community observed that whereas a relative, friend or

self-delivered accounted for 56% of births to women of

parity 7+, only 36% of those with parity 3 and less did

the same.

Socio-economic factors and demographic factors play a more

crucial role in influencing the use of services of a

skilled birth attendant. Most of the hindering factors are

concerned with inequalities in access to, and the quality

of skilled care services.

My research seeks to show that, from a mother’s point of

view of the factors that hinder mothers from receiving

skilled care at birth in Kamahuha Location.

CHAPTER THREE: RESEACH METHODOLOGY

3.0 Introduction and Background of study area

The study has used a combination of different research

approaches, research designs and different tools and

instruments in order to get comprehensive data necessary

to come up and rank the factors that hinder mothers from

receiving skilled care at birth in Kamahuha Location in

Murang’a South District in Central Province. The whole

area is rural and more so the socio-cultural factors are

important in delivery of healthcare services. The

procedure followed has been outlined under the following

sub-headings: study design,study area,definition of

variables,inclusion and exclusion criteria, study

population, sampling procedure,sample and size, data

collection instruments ,data collection procedure, and

study limitations.

3.1 Study design

Two research designs have been used. They are survey and

case study.

3.1.1 Survey

This type of design involves systematic gathering of

information from a sample population with a purpose

of identifying general trends or patterns in the

collected data. This design yields quantative data.

This design was used because its flexible and broad

in scope considering the variables am investigating.

The data collected was concerned with the mother’s

level of education, mother’s age, and distance from

health facility, marital status, occupation/economic

status and parity.

The data was collected by use of scheduled face to

face structured interview with the mothers.

3.1.2 Case study

This design is usually an in depth study of one

individual, group of individuals or an institution.

In the research, the researcher discussed with a

group of mothers at Kamahuha Dispensary and gave him

a description of their thoughts, feeling and

perceptions about reasons for delivering at home.

This design was effective since mothers provided

information in a free manner during the focused group

discussions because they all had an experience of

delivering at home.

The researcher used this method because it was cost

effective for him.

3.2 Study area

The study was done at Kamahuha Dispensary in Kamahuha

Location in Makuyu Division Murang’a South district. Its

based in the rural area. The dispensary is located in

Kamahuha Township and serves the residents of the three

sub locations in the location and has a catchment

population of 8500 people.(A map of the Location showing

the three sub locations is in the appendix). It’s is the

north eastern side of Murang’a South district.

The researcher chose this area because it is familiar to

him. This is because the researcher lives and works in the

area of study.

3.4 Inclusion and exclusion criteria

The study population included post natal mothers who

brought the neonates for B.C.G or O.P.V 0 and had not

gotten skilled care at birth.These mothers were involved

in responding to the interview schedules.

Those that were used in the case study were mothers who

had unskilled birth attendance and had brought their

children for O.P.V 1/O.P.V 2/O.P.V3 or Pentavalent

1/Pentavalent2/ Pentavalent3 and had a home delivery.

3.5 Study Population

The target population focussed on post natal mothers in

Kamahuha Location who come from the three sub locations of

Kamahuha, Iganjo and Kaharati.

The researcher used mothers who had brought their babies

at Kamahuha Dispensary for the immunization of the B.C.G.

vaccine or/and O.P.V 0 after home delivery and

administered the interview schedules on them. Focused

group discussions were made up of post natal mothers

bringing their children for O.P.V 1/O.P.V 2/O.P.V3 or

Pentavalent 1/Pentavalent2/ Pentavalent3 and have had a

home delivery.

3.6 Sampling Procedures.

The sampling procedure that was convenient, resource and

time friendly to the researcher for the study was

systematic random sampling which is a probability method

of sampling. The researcher used every 2nd post natal

mothers, bringing a baby for B.C.G and/or O.P.V 0 after a

home delivery. Purposive sampling which is a non

probability sampling method was used to select mothers for

the FGDs.These are mothers who brought their children for

O.P.V 1/O.P.V 2/O.P.V 3 or Pentavalent 1/ Pentavalent 2/

Pentavalent 3 after home delivery. The researcher used

cases that have required information with respect to the

objectives of the study.It was in the researcher’s opinion

that the sample was representative.

3.7 Sample size

The following sample size was chosen:

A sample size of 20 respondents was studied in the case of

Post natal mothers bringing babies for B.C.G and/or O.P.V

0 after receiving unskilled care at birth.

A sample size of 10 respondents ( in 2 groups consisting

of 5 mothers each) was studied in the case of Post

natal mothers bringing babies for O.P.V 1/O.P.V 2/O.P.V

3 or Pentavalent 1/ Pentavalent 2/ Pentavalent 3 after

receiving unskilled care at birth.

3.8 Data Collection Procedure

The researcher sought permission from the District

Commisioner ,Murang’a South District which was granted.The

researcher the informed the Chief of Kamahuha

Location .The researcher then went ahead and collected

data using face to face structured interview schedules and

focused group discussions. After data was collected, it

was examined for completeness, accuracy,

comprehensibility, consistency and reliability.

Data collection was done at Kamahuha Dispensary at the

MCH/FP clinic in the month of November 2009.

Data collection instruments

3.8.1 Structured interview schedules.

The face to face structured interview schedules

consisted of structured questions. The interviews

were conducted by the researcher himself.

3.8.2Focused group discussions

These are interviews with groups of 5-15 people whose

opinions and experiences are solicited simultaneously

and whose composition is limited to those with

similar characteristics so that members feel free in

contributing to the issues on hand (Mugenda and

Mugenda, 1999). The researcher held two sessions with

5 post natal mothers in each session. The researcher

had a discussion with them to get their experiences,

views and perceptions on the factors hindering

mothers from receiving skilled care during delivery.

3.10 Limitations of the study

The researcher was unable to pick a bigger sample size due

to limitations of time and resources.

3.5 Ethical considerations

The considerations taken include right to privacy and the

researcher assured the respondents that the information

collected would be held in confidence and that the data

collected will not be in any way be linked to the

respondent. This was done before the face to face

interviews and in the focused group discussions.

CHAPTER FOUR: STUDY FINDINGS

3.10 Data Presentation, Analysis, and Interpretation

Qualitative data presentation and analysis

The researcher held focused group discussions and data

collection and analysis went on hand in hand. The data was

collected from two groups of five respondents each at

MCH/FP clinic. It should be noted that the women involved,

had gotten unskilled care at birth in at least the last

three months.

The mothers noted that lack of access to a health facility

offering maternity services was said to be a major

contributor to home deliveries. The mothers expressed

optimism that when the maternity will be complete, there

will be a reduction in home deliveries.

The mothers said that the community midwives who have

maternity nursing homes in Kamahuha Town are utilized by

some women but these are costly for women, most of whom

have a low income. They also said that, the midwives are

not ready to go to their homes to assist them in delivery.

The mothers said that women who delivered at home mostly

preferred to be assisted by TBAs in home deliveries

because they were available and not expensive to pay

compared to a skilled birth attendant.

The women also noted that the costs incurred in seeking

maternity services from local health facilities prohibited

women from going to maternity health facilities. This is

because they also have to spend a considerable amount of

money on transportation and personal needs. The means of

transportation was also noted to be unavailable, expensive

and irregular a situation that leads to women delivering

at home.

Some women said that they feared going to government

maternities because of the attitude of the midwives

working there saying that they were unfriendly and harsh.

Quantitative data presentation and analysis

Figure 1

a) Number of respondents per sub location

Total Number of respondents 20

13

4

3

Number of respondents per sub location

Kamahuha Sublocation 65%Iganjo Sub location 20 %Kaharati Sublocation 15 %

This indicates that 65 % of respondents came from

Kamahuha Sub Location which is not near a health facility

offering delivery services.Iganjo sub location had 20 % of

the respondents and this is attributed to nearness to

Maragua Ridge Health Centre and Maragua District Hospital.

The reason for 15% respondents, in Kaharati sub location

can be attributed to the fact that mothers of this sub

location get their services from Sabasaba Health Centre

which is nearer to them and the fact that its near the

Thika – Murang’a highway and they don’t have a lot of

transportation problems.

Table 1

b) Ages of the respondent

Total Number of respondents 20

AGE(YRS) No OF

RESPONDENTS

PERCENTAGE

Below 18 4 20%18 – 24 4 20%25 – 29 4 20%30 – 34 3 15%35 – 39 4 20%Above 40 1 5%

This indicates that 40 % of the respondents are below

24 years and are not receiving skilled care at birth.

These are young mothers and is an indicator of high

rates of teenage pregnancies.

Table 2

c) Marital status of the respondents

Total Number of respondents 20

STATUS No OF

RESPONDENTS

PERCENTAGE

Married 10 50%Separate

d

1 5%

Divorced 0 0%Single 8 40%Widowed 1 5%

This indicates that 40% of the respondents are single

mothers. This can be attributed to the fact that

these respondents are teenagers, young mothers or

primary school drop outs.

Table 3

d) Level of education of the respondents

Total Number of respondents 20

LEVEL OF

EDUCATION

No OF

RESPONDENTS

PERCENTAGE

Incomplete

primary

12 60%

Complete

primary

6 30%

Complete

secondary

1 5%

Incomplete 1 5%

secondarycollege 0 0%University 0 0%Illiterate 0 0%

This indicates that 60 % of mothers not receiving

skilled care at birth have incomplete primary

school. These finding shows that , low educational

status greatly affects delivery care seeking

behavior of mothers in Kamahuha Location.

Figure 2

e) Occupation of the respondents

Total Number of respondents 20

14

2

3

1

Occupation of respondents

Housewifes 70%Housewifes and Casual Labourer 10%Staying with Parents 15%Business/self employed 5%

This shows that 70 % of women in Kamahuha Location

who do not receive skilled care at birth are

housewives with no financial independence. This goes

on to show that this socio economic factor is a major

contributor to home deliveries.

Table 4

f) Number of children/Parity

Total Number of respondents 20

Parit

y

No of

responde

nts

Percent

age

Para

0

1 5%

Para

1

4 20%

Para

2

4 20%

Para

3

5 25%

Para

4

3 15%

Para

5

2 10%

Para 0 0%

6Para

7

0 0%

Para

8

0 0%

Para

9

1 5%

This table shows that 25% of women delivering at

home in Kamahuha Location are Para 3 mothers. It

also shows that 5% of the mothers are primiparas

and that 15% of the mothers are grandmultiparas and

this requires more research to determine this

scenario.

Table 5

g) Persons assisting women in unskilled care at birth.

Total Number of respondents 20

0

1

2

3

4

5

6

The above chart shows that 25% of the deliveries are

assisted by mother in laws who are mainly the decision

makers on issues of birth in many extended families.

Table 6

h) Reasons for not receiving skilled care at birth

Total Number of respondents 20

Experienced intense labour pains

Patient used to delivering at home

Relatives ignored clients wish

Didn’t have money for hospital

Was in the process of referal

Mother was sick throught pregnancy

There were transport problems

0 1 2 3 4 5 6

The above chart shows the reasons that the respondents

gave for not receiving skilled care at birth. From the

above it’s evident that a 25% of mothers experience

transport problems that makes them deliver at home. The

other major hindrance is that mothers experience intense

labour pains and end up delivering at home because of not

knowing when exactly to go to hospital for delivery which

account for 25% .20% of the respondents are used to

delivering at home and this is because in the other

pregnancies they didn’t get a complication.20% of the

respondents were ignored by their decision makers during

birth despite them themselves willing to have a hospital

based delivery.

CHAPTER SIX

CONCLUSIONS

The study has revealed the demographic factors, socio

economic factors hindering women from receiving skilled

care at birth in Kamahuha Location though at varied

extents.

The demographic factors were level of education, mother’s

age, and number of children and marital status

The socio economic factors were, mothers

occupation/economic status , lack of transport, and lack

of affordable local health facility offering maternity

services

Poor provider client relationship was also cited as a

hindrance. Mother in laws have a significant say on

matters of childbirth especially when they reside with the

mother in the same homestead and they should be involved

in preparation of the individual birth plan for antenatal

mothers.

RECOMMENDATIONS

The main socio economic factor is problem with

transportation and the researcher recommends the

establishment of a revolving fund from which

families can borrow money to pay for transport

to a referral facility and the family pays back

debt after delivery. The local leaders should

plan to make available an ambulance to help

ferry women to maternity units and for referral.

The local health facilities should budget and

set aside some money to meet emergency transport

costs.

Training and deploying an adequate number of

skilled birth attendants/ workers to provide the

majority of ANC, intrapartum and postnatal care.

This can also help in improving the attitudes of

care providers as they will have less ‘burn out’

at work which is mostly manifested in adoption

of harsh attitude.

Community midwives should make a deliberate

effort of assisting women to deliver in the

place of their choice in the community instead

of waiting for them to come to the clinic.

Health centers and dispensaries should be

equipped to provide affordable delivery services

to expectant mothers.

Involving and collaborating with local leaders

in planning and budgeting for structures and

infrastructure that provide enabling environment

for clean and safe deliveries. Funds should be

made available by the local authorities or

central government for the completion of the

Maternity Block at Kamahuha Dispensary.

Health care providers should collaborate with

the TBAs can assist in educating mothers on the

need for skilled care at birth.

During the ANC visits, the need for an IBP

should be emphasized so that mothers have birth

and complications readiness.

The antenatal mothers should involve their

mother in laws who are a significant decision

makers in the making of their Individual Birth

Plan.

A deliberate effort should be made to improve

the economic status of women and one important

effort would be empowering women to be educated

and learned so as to gain some form of economic

independence and change of attitude towards

health.

Local leaders and education management

authorities should look into ways of reducing

teenage pregnancies which leads to school drop

outs and predisposition to unskilled care during

delivery.

REFERENCES AND BIBIOGRAPHY

Bulut, A. (1995). Post partum family planning and

health needs of low income in Istanbul. Studies in

Family Planning 26 (6).

Central Bureau of Statistics (Kenya) 1996. Welfare

Monitoring Report , 1996.

Dissevelt, A.G. (1978). Integrated maternal and child

health services: a study at

a rural health centre in Kenya. Nairobi : Royal

Tropical Institute.

Kuria, E.W. (1989). Factors that influence maternal

and child health among the

Maasai: a case study of Olosho-Oiborr sub-location in

Kajiado District.

Ministry of Health (MOH), Kenya, (1997). A question

of survival? Review of

Safe motherhood. Nairobi: Ministry of Health -

Division of Primary Health

Care.

Kenya Demographic and Health Survey (KDHS ,2003)

Nginya, M.L. (1980). Rural health development in

Kenya: an analysis of health

services availability and utilization within the

framework of class formation

in rural areas. PhD thesis. Bradford University.

Obermeyer, C.M. & Potter, J.E. (1991). Maternal

health care utilisation patterns

in Jordan: a study of patterns and determinants.

Studies in Family Planning,

22 (3): 177–187.

Ministry of Health:National Health Sector Strategic

Plan 1999-2004

Mugenda and Mugenda, 1999 Research methods

Ministry of Health Kenya (1996) The National

Reproductive Health Strategy 1997-2010

Ministry of Health Kenya :DRH,DMC, JHPIEGO, (2002)

Focused Antenatal Care and Malaria in Pregnancy

Orientation Package.

APPENDIX I

The

Questionnaire Cover Letter

From

Mr. David Kinyanjui

Gitau,

Supervisor: Ms. Ndegwa,

Nursing Department,

K.M.T.C, Murang’a

Campus,

P. O. Box 1353

Thika-01000

Email

kinan1977us@yahoo.com

The Postnatal mothers,

Kamahuha Dispensary.

Dear Respondent,

Subject: The Interview schedule

I am a distance learning student undertaking a Diploma in

Community Health Nursing in K.M.T.C Murang’a Campus.

I am carrying out a research on factors that hinder

mothers from receiving skilled care at birth in Kamahuha

Location, as a partial fulfillment of the requirements for

this diploma course. This is for academic purposes and for

action.

I would be very grateful if you could spare sometime to

provide the information in the attached questionnaire.

Your responses will be treated with strict and at-most

confidentiality and good faith, and in no instance will

your name be mentioned anywhere inside or outside this

report.

Your cooperation shall be highly appreciated. Thank in

advance and God bless you.

Yours faithfully,

David Kinyanjui Gitau

APPENDIX II

DATA COLLECTION INSTRUMENTS

A) INTERVEIW SCHEDULE

An interview schedule for factors/reasons that hinder

pregnant mothers from receiving skilled care during

delivery a case study for Kamahuha Location.

Please answer the following questions

Instructions

a) In case of a box tick where applicable and circle where

applicable

b) Any information given shall be treated with highest

degree of confidentiality

Date of interview …………………………………Respondent No ……..

1. Age of baby (in weeks) ……………………

2. Specific home area (village) of mother ……………………………………

3. Age of mother

4. Marital Status: Married Separated

Divorced

Single Windowed School drop

out

5. Highest Educational level: University

College Secondary

Complete Primary Incomplete Primary

None/Illiterate

6. Occupation :Housewife Self

employed/Business Casual

Permanent Employment Student

School drop out

7. Number of children before this delivery… Parity….No

of children dead……

8. Who aided or assisted you during delivery? ………………

9. What reasons hindered you from getting skilled care

during delivery? …………………………………………………………………………...

b) FOCUSESD GROUP DISCUSSIONS

The researcher will have in depth discussions with two

groups of five mothers each.

The discussions will focus on reasons that hinder women in

Kamahuha Location from receiving skilled care at birth.

The researcher will introduce the research topic, guide

the discussion and make short notes as the discussion

progresses.

No

APPENDIX III

BUDGET

DETAILS QUANTITY

COST

PER ITEM

(in

Ksh)

TOTAL

AMOUNT

(in Ksh)

Stationery - - 200

Photocopying 90 3 270

Transport - - 500

Typesetting and

Printing 20 30 600

Binding5 100 500

Internet services - - 500

Total - - 2570

APPENDIX IV

WORK PLAN

ACTIVITYSEP

09

OCT

09

NOV

09

DEC

09Identifying research topic.

Formulating research

objectivesJustification of study.

Literature review

Research methodology

Methods of data collection

Conducting a pretestData collection and

presentation

Data analysis and

interpretation

Report compiling and typing

APPENDIX V

MAP OF MAKUYU DIVISION SHOWING