Determinants of Mode of Delivery Among Postnatal Mothers Admitted in Wajir County Referral Hospital, Kenya

Maalim H, Omuga B, Ongeso A, Okube T. "Determinants of Mode of Delivery Among Postnatal Mothers Admitted in Wajir County Referral Hospital, Kenya." EC Gynaecology. 2017;6(4):128-138.


Background: Globally, giving birth through the natural process, ‘Vaginally’ has been widely accepted as unquestioned mode of birth. On the other hand, use of caesarean Section (CS), which involves a surgical incision, has also been utilized as a mode of delivery especially among women with medical or obstetric indications. Delivery through CS is a life saving measure which plays a crucial role in reducing maternal morbidity and mortality from direct causes such as hemorrhage, infection, hypertensive disorders of pregnancy and obstructed labor [1]. In Kenya, the National maternal mortality rate was 362/100,000. However, in the study area, Wajir county, it was 1683/100,000 [2]. Advances in technology and its adoption in reproductive health have resulted in an increase in the number of Caesarean delivery in the recent years. This has increased options for preferred mode of delivery for mothers and plays a significant role in reduction of maternal and neonatal mortality and morbidity rates. However, in most African countries, mainly in rural and marginalized areas, use of caesarian section remains low even when there is clear indication. Despite this, limited studies to establish determinants of modes of delivery have been done especially in remote rural areas such as Wajir County.
Objective: The main objective of this study was to establish determinants of mode of delivery among postnatal mothers admitted in Wajir County referral Hospital.
Materials and Methods: A hospital based descriptive cross-sectional study design was used. Mixed method of quantitative and qualitative data was employed among 178 postnatal mothers who were systematically sampled from Wajir county Referral hospital.
Quantitative data was collected using pre-tested semi-structured questionnaire and qualitative data was collected using Focus group discussion from the postnatal mothers. Descriptive analysis using means, frequency and proportions was computed. Chi-square test
(p < 0.05) with corresponding 95% confidence interval was used to determine the association between the various variables.
Results: The prevalence of Caesarian Section delivery among the respondents was 32%. Analyses with Chi-Square test of independence revealed that maternal age (p = 0.001), marital status (p = 0.016), level of education (p = 0.007), parity (p = 0.03), FGM practice
(p = 0.001) and belonging to the social health groups (p = 0.001) were the variables significantly associated with mode of delivery. A substantial number of women did not have sufficient knowledge on delivery options, benefits and risks to inform their decisions on delivery modes.
Conclusion: Vaginal Delivery is the most preferred mode of delivery even when CS is medically indicated. Caesarian section acceptance remains low due to lack of correct knowledge, poor attitude towards CS and lack of proper women counseling during ANC visits. Therefore, there is need for educational and economic empowerment of women and girls complemented with effective community sensitization and awareness campaigns on delivery-related complications, risks and alternative delivery options for emergency cases.
Keywords: Mode of Delivery; Postnatal Mothers; Wajir County Referral Hospital; Vaginal Delivery

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