| dc.description.abstract | Utilization of skilled maternal healthcare services during pregnancy, delivery and post delivery can reduce maternal deaths. The high maternal mortality ratio in Siaya County (691/100,000 live births) which surpasses that of the Country - Kenya (395/100,000 live births) can be attributed to the lack of utilization of skilled maternal healthcare services. The aim of this study was to develop, pilot and evaluate an evidence based quality framework for increasing utilization of skilled maternal healthcare services in Siaya County. The study adopted longitudinal study design where a three (3) phased approach involving baseline, intervention and end line was followed. Study participants comprised service users and service providers, community leaders and community health volunteers. In total, 517 sampled pregnant mothers and 123 community health volunteers, Eighty four (84) women (previous users), Fourteen (14) skilled health providers and 9 managers participated. Data was collected using semi-structured questionnaires, KIIG and FGDS. Quantitative data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0 while qualitative data were analyzed thematically using interpretative inductive approaches. All tests of significance were computed at p=0.05. At baseline, findings showed low utilization; 4th antenatal care was at 53.2%, skilled delivery at 55.7% and post-natal care within 48 hours at 23.6%. Further analysis showed that those with is secondary (aOR=2.62, 95% CI: 4.33-4.58) and tertiary (aOR=l .43, 95% CI: 2.87- 4.63) education were more likely to utilize maternal healthcare services relative to those with no education and those with primary education. Similarly, the respondents' whose husbands had no education (aOR=0.89, 95% CI: 2.07-1.60) or had primary education (aOR=0.89, 95% CI: 2.07-1.60) were less likely to utilize maternal healthcare services relative to those whose husbands had secondary or tertiary level of education. Barriers identified include; women's characteristics such as low education level, those whose husbands have low education, lack of awareness and knowledge on maternal health, uncertainty about pregnancy, lack of 24 hours skilled delivery services, negative providers attitude and lack of evidence of maternal healthcare continuum. Perceived strategies to overcome the above barriers informed the development of the framework which was then piloted for-one year and evaluated. At end line, 4th Antenatal visits increased from 53.2% to 63.9%, skilled deliveries from 55.7% to 64.6% and postnatal care services from 23.6% to 47.4%. Chi-square test showed p < 0.05 meaning that the differences were statistically significant. The framework proved effective in increasing utilization of skilled maternal healthcare services in Siaya County. The above results indicate that the evidence based quality framework developed proved effective in increasing utilization of skilled maternal healthcare services and should inform programming for maternal healthcare in Siaya County. Siaya County Government to develop strategies to empower women with knowledge on maternal health, scale up the provision of 24 hours skilled delivery services, sensitize health providers on respectful maternity care, empower community health volunteers with knowledge on maternal health and promote use of household health visitors log book in order to enhance evidence based maternal healthcare continuum. | en_US |