Individual and Contextual Determinants of Adequate Maternal Health Care Services in Kenya

Abstract

This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008-09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care.

Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub‐Saharan Africa: a multicountry analysis of Demographic and Health Survey data

“…Several factors affect ANC coverage/attendance: age, premarital status, maternal education, husband's education, availability of health service, cost of health services, household income, employment status, media exposure and having a history of obstetric complications. But the direction and magnitude of effect is inconsistent across time and space .…”

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years

“…A few other studies have also shown the significant effect of husband's educational level on health care service utilization . It can be suggested that husbands with higher educational level might have encouraged their wives to seek more maternal and child health care services for their newborns …”

“…Utilization of prenatal care services and health care facilities for childbirth was found to be significantly higher among women covered under health insurance, and this significant effect was found in all analyses performed for different TDHS data over the past 20 years. A study in Kenya concluded that prenatal care utilization was 2.15 times higher among women who had health insurance . Another study performed in Turkey showed that women covered under health insurance used prenatal care services significantly more than women not covered under health insurance .…”

“…13,19,[27][28][29] It can be suggested that husbands with higher educational level might have encouraged their wives to seek more maternal and child health care services for their newborns. 27,30 Increasing birth order significantly decreased the likelihood of prenatal care utilization and giving birth at health care facilities. Women in their first pregnancy had a higher probability of using more prenatal care services and giving birth at health care facilities compared to women in their fourth or more pregnancy.…”

“…A study in Kenya concluded that prenatal care utilization was 2.15 times higher among women who had health insurance. 30 Another study performed in Turkey showed that women covered under health insurance used prenatal care services significantly more than women not covered under health insurance. 40 Wang and Hong 36 also concluded that the rate of giving birth at health care facilities at Cambodia was significantly and 1.2 times higher among women with health insurance compared with those not having health insurance.…”