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Open Access Highly Accessed Research article

“Not too far to walk”: the influence of distance on place of delivery in a western Kenya health demographic surveillance system

Emily Mwaliko1*, Raymond Downing2, Wendy O’Meara3, Dinah Chelagat4, Andrew Obala5, Timothy Downing6, Chrispinus Simiyu7, David Odhiambo8, Paul Ayuo7, Diana Menya9 and Barasa Khwa-Otsyula10

Author Affiliations

1 College of Health Sciences, School of Medicine, Department of Reproductive Health, Moi University, P. O. Box 4606, Eldoret, Kenya

2 College of Health Sciences, School of Medicine, Department of Family Medicine, Moi University, P.O. Box 4606, Eldoret, Kenya

3 Duke University School of Medicine and Duke Global Health, Institute, Durham, NC, USA

4 College of Health Sciences, School of Nursing, Moi University, P.O. Box 4606, Eldoret, Kenya

5 College of Health Sciences, School of Medicine, Department of Microbiology, Moi University, P.O. Box 4606, Eldoret, Kenya

6 USDA Forest Service, Santa Fe National Forest, 11 Forest Lane, Santa Fe, NM 87508, USA

7 College of Health Sciences, School of Medicine, Department of Medicine, Moi University, P.O. Box 4606, Eldoret, Kenya

8 College of Health Sciences, School of Medicine, Moi University HDSS Program Manager, P.O BOX 4606, Eldoret, Kenya

9 College of Health Sciences, School of Public Health, Moi University, P.O. Box 4606, Eldoret, Kenya

10 College of Health Sciences, School of Medicine, Department of Surgery, Moi University, P.O. Box 4606, Eldoret, Kenya

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BMC Health Services Research 2014, 14:212  doi:10.1186/1472-6963-14-212

Published: 10 May 2014

Abstract

Background

Maternal health service coverage in Kenya remains low, especially in rural areas where 63% of women deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the present study were to (1) determine the association between the place of delivery and the distance of a household from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a demographic surveillance system (DSS).

Methods

Census sampling was conducted for 13,333 households in the Webuye health and demographic surveillance system area in 2008–2009. Information was collected on deliveries that had occurred during the previous 12 months. Digital coordinates of households and sentinel locations such as health facilities were collected. Data were analyzed using STATA version 11. The Euclidean distance from households to health facilities was calculated using WinGRASS version 6.4. Hotspot analysis was conducted in ArcGIS to detect clustering of delivery facilities. Unadjusted and adjusted odds ratios were estimated using logistic regression models. P-values less than 0.05 were considered significant.

Results

Of the 13,333 households in the study area, 3255 (24%) reported a birth, with 77% of deliveries being at home. The percentage of home deliveries increased from 30% to 80% of women living within 2km from a health facility. Beyond 2km, distance had no effect on place of delivery (OR 1.29, CI 1.06–1.57, p = 0.011). Heads of households where women delivered at home were less likely to be employed (OR 0.598, CI 0.43–0.82, p = 0.002), and were less likely to have secondary education (OR 0.50, CI 0.41–0.61, p < 0.0001). Hotspot analysis showed households having facility deliveries were clustered around facilities offering comprehensive emergency obstetric care services.

Conclusion

Households where the nearest facility was offering emergency obstetric care were more likely to have a facility delivery, but only if the facility was within 2km of the home. Beyond the 2-km threshold, households were equally as likely to have home and facility deliveries. There is need for further research on other factors that affect the choice of place of delivery, and their relationships with maternal mortality.

Keywords:
Global positioning system; Demographic and surveillance system; Maternal health services; Emergency obstetric care; Hotspot analysis; Home/facility births