Utilization of hospital services during delivery among post-natal mothers in Thika urban and Kangundo rural Counties, Kenya

Background: Maternal mortality rate due to pregnancy-related complications in Kenya remains high at 362 per 100,000 live births. Hospital deliveries are low despite government strategies on improving health system and human resources. Home delivery practice is common in many parts of Kenya, especially in the rural areas. Generally, midwifery in home delivery lacks the necessary expertise to identify, resolve or prevent maternal complication, a situation which could raise maternal delivery related morbidity and mortality rates. Objectives: The study aimed to determine the rates of hospital deliveries both in urban and the rural hospital settings and establish the factors that determined the choice for hospital services. Methods: The study population was composed of post-natal mothers attending Maternal Child Health Clinics in an urban hospital setting and a rural hospital setting. The mothers were those who had delivered less than one year earlier. Thika Level 5 Hospital in Kiambu County represented the urban setting while Kangundo Level 4 Hospital represented the rural setting. A total of 400 post-natal mothers in each of the two hospitals were interviewed using a structured questionnaire to collect the relevant data in each hospital. Focus Group Discussions and Key informants interviews were also conducted in each hospital. Results: Client specific factors that were associated with hospital delivery included a steady source of income and occupation (p = 0.028, p = 0.007), ability to pay for hospital expenses and remedies (p = 0.000, p = 0.00), accessibility and short distance from the health facility (p= 0.001, p = 0.029), and client having a positive experience from a previous delivery and hope for a better services in the hospital (p = 0.000, p = 0.000) respectively. Health facility factors were lack of privacy (p = 0.000) manner in which the mother was handled by the health care worker (p = 0.0901) and the expected care (p =0.017). Conclusion: The study concludes that mothers fail to utilize the health facility for delivery due to service related factors such as long distance from the hospital, negative attitude of health workers, lack of privacy and poor quality of care, an improvement of which will make them deliver in hospitals and not at home.