Magister Public Health - MPH / Although the Kenyan government implemented safe motherhood programme two decades ago, available data indicate that prevalence of home delivery is still high among women in Garissa District. The aim of this thesis was to investigate the factors influencing the choice of place of childbirth. Methodology: A descriptive cross-sectional study was carried out among 224 women who delivered babies two years prior to December 2010. Using a statcalc program in Epi Info 3.3.2, with expected frequency of home delivery at 83% +5% and a 95% confidence level, the calculated sample size was 215. Furthermore, with a 95% response rate the adjusted minimum sample size was 226.There were two none-responses hence 224 women were interviewed. Stratified sampling was used. Data were collected using pre-tested structured questionnaires and analyzed using SPSS. Descriptive, bivariate and multivariate analysis was performed. A binary logistic regression analysis using the Enter method was performed to determine independent predictors for use or non-use of healthcare services for childbirth. The threshold for statistical significance was set at 0.05. Results: The result was presented in text and tables. The study found 67% (n=224) women delivered at home and 33% delivered in hospital. The study found low level of education, poverty, none-attendance of ANC, distance, cost of services, poor quality services, negative attitude towards midwives, experience of previous obstetric complications and decision-making to be significant predictors in home delivery at the bivariate level (p<0.05). The study did not find relationship between age, marital status, religion and place of childbirth (p>0.05). At multivariate level, the following variables were still found to be significant predictors of home delivery: no education OR=8.36 (95% CI; 4.12-17.17), no occupation OR=1.43(95% CI; 1.08–5.49) experience of obstetric complications OR=1.38 (95% CI; 1.15-2.12), none-attendance of antenatal clinic OR=1.11 (95% CI; 1.03–1.51), Rude midwives OR=5.60 (95% CI; 2.66-11.96). Conclusions: high prevalence of home delivery was noted due to lack of education, poverty and inaccessible maternity services hence the need to empower women in education and economy to enhance hospital delivery.

Background Globally, about 800 women die daily from complications arising during labor or within 42 days of childbirth. These deaths can be prevented by ensuring that women give birth in a safe environment in the presence of Skilled Birth Attendants (SBAs). SBAs are efficient to manage pregnancy, child birth and postnatal complications or refer in very complicated cases. Only about half of the women use SBAs in Kakamega County, Kenya. The study aim was to describe the determinants of utilization of SBA in Kakamega County. Method A cross sectional design was used. Data was obtained from Multiple Indicator Cluster Survey (MICS) conducted in the year 2014. A sample of 295 women were selected through two-stage cluster sampling. Standardized questionnaire was used to collect data from women who had given birth two years prior to the survey. Univariate and multivariate analysis was used to analyze the data. Results There was an association for use of SBAs with lower parity Odds Ratio (OR) 3.11(95% CI,1.82-5.52), early Antenatal Care (ANC) attendance OR 0.49(95% CI,0.27-0.88), secondary education OR 1.89(95% CI, 1.16-3.05) and high wealth index OR 2.87(95% CI,1.76-4.69). There was no association with ANC visits OR 1.3 (95% CI, 0.80-2.24) and place of residence OR 1.50 (95% CI,0.93-2.41). Conclusion Being in higher quartile, exposure to secondary education and low parity were key influencers of SBA use while place of residence did not show any association. There is an association between use of SBA and timely ANC attendance but not with number of ANC visits.

Magister Philosophiae - MPhil / Skilled birth attendance at childbirth is vital for decreasing maternal and child mortality in Zimbabwe. Infant mortality and maternal mortality in Zimbabwe are quite high due to low- use of skilled birth attendance. Based on different study sources, home delivery with complications are high, with many socio-economic and demographic associated factors including lack or no use of skilled birth attendance at childbirth in Zimbabwe. Therefore, the study looked at "preventive" which refers to an action taken to reduce or eliminate the probability of specific undesirable events or dangers from happening in the future and the present time in Zimbabwe. The objective of the study was to highlight the significance of the crucial function within the health systems of saving both the lives of a mother and the child. Furthermore to determine the frequent use of maternal health care services (skilled birth attendant) and identify factors affecting them. The data that was used was nationally represented large scale secondary data ZDHS of Zimbabwe with sample population n = 9,171. It was a secondary data that included all the provinces of Zimbabwe, simple random sampling was used that had questionnaires of both man, women and household questionnaires, these questionnaires helped in examining the socio-economic factors and determinants that leads to low-use of skilled birth attendants at childbirth. The prosed statistics analysis that were used were univariate, bivariate and multivariate techniques. The statistical analysis showed that demographic variables such age, place of delivery and socio-economic factors such as level of education of a mother and wealth index (occupation of a parent) and region has a significant effect on the use of skilled birth attendant during birth. Women with higher level of education were found to have high use rate of maternal health care services (Skilled birth attendants), while women with primary and secondary education were found to have high use rate of less ( traditional birth attendant) or no use of skilled birth attendant. Therefore, the female age at birth, place of delivery, level of education and wealth index played a major role in decision making about the importance of having a skilled birth attendant when giving birth. The access to skilled birth attendance was found to be a significant factor in reducing maternal and child mortality in Zimbabwe. Furthermore women need to be educated about the importance of maternal health care services use and postnatal care and the department of health in Zimbabwe can implement mobile clinics for those who are residing far from health facilities.