Two Worlds Apart: A Comparative Study Of Access And Utilization Of Maternal - Infant Health Services Between Two Counties In Kenya

Abstract

Maternal and infant mortalities in Kenya are still high compared to global targets. This study targeted women of reproductive age (15 - 49) with the aim of assessing disparities in the access and utilization of maternal - infant health services in Migori and Nyeri Counties. A crossectional study design was employed. Interviewer – administered questionnaires, Key Informant Interviews (KII) and Focused Group Discussions (FGD) were used. Quantitative data was analyzed using STATA 9, reporting proportions while qualitative data was recorded and transcribed, with responses being grouped according to emerging themes. The findings especially in Migori County indicated that there was limited access and utilization of maternal and infant health services. In Migori, the peak fertility was 20-24 as compared to Nyeri which was 25-29 with the average number of children per woman being four in Migori compared to two in Nyeri. In Migori, 417(93.9%) attended ANC, 32.2% making atleast 4 ANC visits during their last pregnancy while in Nyeri 97% did attend with 38.2% making 4 visits. Health facility delivery occurred in 53.3% of women in Migori, 93.1% in Nyeri. In Migori, 73.9% of the respondents had attended postnatal clinic compared to 93.1% for Nyeri County while 41.2% and 76.5% sought use of Family Planning methods after delivery in Migori Nyeri respectively.Some of the factors contributing to inaccessibility included economic, inadequate staffing, negative staff attitude and health facility factors as well as lack of equipment and some services. Training needs on current obstetric care practices by the health care workers were mainly identified in Migori. Male participation is merely passive in the two counties. There exists a wide gap in access and utilization of maternal and infant health services between the two counties. Access and utilization is hampered by a range of factors of which some are unique for each region. These include sociodemographic and economic factors, lack of knowledge of the health services, poor infrastructure including poor road network and negative staff attitude. Lack of capacity of the health facility to provide the services due to inadequate staffing and lack of equipment is also a contributory factor. Male involvement in maternal and infant health is low. These findings could guide design of interventions aimed at improving maternal and infant health at the tier two health facilities in line with Kenya Essential Package for Health (KEPH).