BackgroundMaternal mortality has declined by 43 % globally between 1990 and 2013, a reduction that was insufficient to achieve the 75 % reduction target by millennium development goal (MDG) five. Kenya recorded a decline of 18 % from 490 deaths in 1990 to 400 deaths per 100,000 live births in 2013. Delivering at home, is associated with higher risk of maternal deaths, therefore reducing number of home deliveries is important to improve maternal health. In this study, we aimed at establishing the proportion of home deliveries and evaluating factors associated with home deliveries in Kilifi County.MethodsThe study was conducted among mothers seeking immunization services in selected health facilities within Kilifi County using Semi-structured questionnaires administered through face to face oral interviews to collect both quantitative and qualitative data. Six Focus Group Discussion (FGD) and ten in-depth interviews (IDIs) were used to collect qualitative data. A random sample of 379 mothers was sufficient to answer the study question. Log-binomial regression model was used to identify factors associated with childbirth at home.ResultsA total of 103 (26 %) mothers delivered at home. From the univariate analysis, both mother and the partners old age, being in a polygamy marriage, being a mother of at least two children and staying ≥5 Kms radius from the nearest health facility were associated with higher risk of delivering at home (crude P < 0.05). Both mother and partner’s higher education level were associated with a protective effect on the risk of delivering at home (RR < 1.0 and P < 0.05). In multivariate regression model, only long distance (≥10Kms) from the nearest health facility was associated with higher risk of delivering at home (adjusted RR 3.86, 95 % CI 2.13 to 7.02).ConclusionFrom this population, the major reason why mothers still deliver at home is the long distance from nearest health facility. To reduce maternal mortality, access to health facility by pregnant mothers need to be improved.
Vaccination is one of the most effective public health interventions today. However, there is a growing number of people who perceive vaccines as unsafe and unnecessary. Waning vaccine confidence threatens global immunization programmes, contributing to decreased immunization rates and outbreaks of vaccine-preventable diseases. We used a mixed-method approach surveying men and women of reproductive age and Focus Group Discussions with expectant mothers to understand maternal vaccine hesitancy within a rural setting of Kilifi County, Kenya. Of the 104 people surveyed, 70% of the participants were aware of the vaccine that expectant women receive and 26% stating that they know people in their community who have refused or were hesitant to take maternal vaccination. Reasons given for refusals include religion and rumors that have spread in the community that the tetanus toxoid vaccine was a family planning method. Stockout of the vaccine was identified as one of the healthcare factors affecting vaccine uptake. The majority of the respondents (84%) reported that they mainly trust a healthcare worker for vaccination information. Approximately 53% and 23% reported that they strongly agree or agreed, respectively, that vaccines for expectant women should be made compulsory. The availability of safe and effective maternal vaccines will only be beneficial if mothers choose to use them. Dissemination of accurate information and continuous engagement with the community members can build trust and confidence in vaccines.
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