Influence of Physical Access to Health Facilities on the Use of Skilled Providers During Delivery in Kenya

The burden of maternal mortality in Kenya is dependent on the extent to which women deliver in settings where skilled providers could ensure hygienic practices and provide emergency obstetric care in the event of complications. The objective of this study was to determine the spatial variation in the use of skilled providers during deliveries across Kenya and to examine the relationship between physical access to health facilities and the use of skilled birth attendants.

We linked data on skilled attendance at deliveries and maternal background characteristics from the 2008-2009 Kenya Demographic and Health Survey with geographical information on the location of health facilities from the Kenya Master Facility list. Multivariate logistic regression was used to examine the influence of distance to the nearest health facility and health facility density, in addition to other covariates, on the use of skilled birth attendants.

Overall, the percentage of deliveries conducted by skilled birth attendants was 44% nationally, with significant variations across the counties. The significant determinants of use of a skilled birth attendant were age of the mother, maternal educational attainment, household wealth, marital status, county facility density, and distance to the nearest health facility. Women who resided 5 km or less from the nearest health facility were more likely to deliver with the assistance of a skilled provider than women resident at greater distances (adjusted odds ratio 1.48, P value=0.01). Similarly, use of skilled birth attendants was significantly associated with the density of health facilities in the county (adjusted odds ratio 1.94, P value=0.000).

Physical proximity to health facilities is an important determinant of the use of a skilled provider during deliveries in Kenya. Innovative interventions, such as outreach maternity services, are urgently required in hard-to-reach areas to reduce the prevalence of deliveries in the absence of skilled providers.