s

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Kenyatta National Hospital – University of Nairobi Ethical Review Committee

Application Form

ETHICS RESEARCH COMMITTEE

Application Number

Submit one copy of this form with original inked signatures. Handwritten and /or
incomplete forms will not be accepted. All relevant appendices e.g. consent forms,
questionnaires, instruments, drug information summary, data collection forms, debriefing
statements, advertisements, etc.) must be included at the back of the proposal.

I. PRINCIPAL INVESTIGATOR: Provide the information requested below:

Last Name First Name Academic degrees
cinthia namoru Bachelor of Science in Community Health and
Development
Professional titles and/or work position within your home institution
Undergraduate student
Home institution(s) and/or department (s) approving this research project.
The Catholic University of Eastern Africa, Faculty of Science, Department of
Community Health and Development.

Mailing address, telephone and fax numbers, and email address

Telephone: +254793039923 Email: doyenamoru@gmail.com

All correspondence shall be addressed to the Principal Investigator. Research

Administrators may have delegated signatory authority only when listed as Co-
investigators.

II PROJECT TITLE
Factors associated with choice of place of delivery among post natal women in Tukana
county, Kenya

As the Principal Investigator in this research, I declare that:

Any change to this protocol and/or procedure shall be notified to and effected only after
approval by the Kenyatta National Hospital – University of Nairobi Ethical Review
Committee.
I shall notify the Kenyatta National Hospital – University of Nairobi Ethical Review
Committee of intended publication, or any other form of dissemination of results of this
study and provide the draft contents.
Other members of the research team are bound by 1) and 2) above.
_______________________________________ Date___________________
Principal Investigator’s Signature
III RESEARCH PERSONNEL. Please provide the information requested below for
research administrators, co-investigators and collaborators in this research project.

Last name First name Academic Degrees

Odhiambo Felix PhD in Epidemiology and Disease
Control
Professional titles and/or work position within your home institution
Tutorial Fellow, Community Health and Development
Home institution(s) and department (s) approving this research project
The Catholic University of Eastern Africa, Lang’ata Campus, P.O Box 62157-00200
Nairobi, Kenya, Tel: +254-20-2525811-15.

Mailing address, telephone and fax numbers, e-mail address

Telephone: +254723914385 Email: odhis.felix@gmail.com

Research Administrators’
Signature _____________________Date____________________

Co-Investigators’ Signature
Signature _____________________Date____________________

Collaborator’s Signatures
Signature _____________________Date____________________

IV REQUIRED ATTACHMENTS
Letters of Study Approval from the Principal Investigator’s Home Institution
(Department).
One copy of the Curriculum Vitae of each member in the research team describing their
research qualifications and experience.
Research Personnel Information (Roles and responsibilities in the research project).

V .FUNDING INFORMATION
Briefly describe current and pending grant and contract information
Not applicable
VI. DESCRIPTION OF RESEARCH PROJECT
Please provide an executive summary of this research project including, in non-technical
language, the following information:
Background and Purpose of Research
A clear justification for the study, its significance in meeting the needs of the country
and/or participant population.
Motherhood is commonly viewed as a rewarding and a positive journey, but numerous
women connect it with pain, health issues, and mortality (WHO, 2022). Assuming no
complications, pregnancy is expected to be a straightforward, natural progression leading
to childbirth, with minimal need for external interventions. Because of the unpredictable
birth outcome, its recommended one to use skilled attendance during delivery because of
easy access of health facility, in order to manage complications in case it occurs (WHO,
2022).
Kenya’s commitment to achieving the united nation sustainable development goals
includes a pledge to decrease the pregnancy-related death by 75% by 2015
(KEMRI/CDC, 2015). The Kenyan Government has implemented a policy to guarantee
that female can access trained birth attendants during childbirth. Kenya’s national
maternal mortality rate stood at 362/100,000 live births in 2015 (KEMRI/CDC, 2015)
however changes in pattern were noted as the maternal mortality rate nationwide
increased to 432 deaths per 100,000 live births in 2010, afterward it decreases to 353
deaths per 100,000 live births in 2015(USAID,2015; UNICEF, 2010). The worldwide
objective is to decrease the maternal mortality ratio to below 70 deaths 100,000 live
births by 2030 as part of the Sustainable Development Goals. For Kenya to achieve the
maternal mortality rate target of 140 per 100,000 by 2030 an annual rate reduction of at
least 8.6% is required.
Women in the northwestern region of Kenya exhibit unfavorable traits (KDHS, 2022):
limited educational attainment, precarious economic status, and high number of
childbirths (average children per woman 5), opt for home deliveries, and prefer
traditional birth attendants as their midwives

This study aims to investigate how women perceive the ease of access, price, and quality
of the services they receive and to investigate the maternal age, education, socioeconomic
and socio-cultural factors that contribute to choices of location of childbirth amid
postnatal females in Turkana County. The results of this study will be utilized to
formulate guidance for interruptions aimed at enhancing women’s access to healthcare
utility during childbirth.
Broad objective
To identify the factors linked to postnatal women’s decisions regarding the location of
childbirth Turkana County, Kenya.
Specific objective
Assess the level of awareness concerning delivery practices in Turkana County

To determine the contribution of socioeconomic factors to choices of location of

childbirth

To identify cultural factors and maternity services utilization

Research questions

What is the relationship between sociocultural factors and maternity services utilization?

What is the impact of socioeconomic factors on the choices of place delivery in Turkana
County?

What extent are women in Turkana County aware of safe delivery Practices?

Research Ethics
Provide a definition of the ethical issues and considerations that you believe are implicit
to this research project, and when appropriate, explain how you will deal with them.
Participation of respondents in the study will be purely voluntary and have the right to
withdraw at any stage they wish to do so.

Respondents will participate after giving their consent verbally and in form of a written
document which will entail sufficient information and assurances about participation to
allow individuals to understand the implications of participation and to reach a fully
informed, considered and freely given a decision about participating, without the exercise
of any pressure or coercion.
Maintaining respondents’ privacy and anonymity will be of paramount importance.
Names of respondents will not be used in the study report.

Research Methodology and Procedures

Study design
A descriptive cross-sectional study that will be done in Turkana County. Sociocultural,
socioeconomic, sociodemographic, obstetric experience, and distance to health facilities
are the characteristics compared among women during this study. This comparison will
also be done on ANC among health facility user with those who delivered at home.

Research procedures (please use non-technical language).

This will be done using interviewer-administered questionnaires at Turkana County. This
interpretation will provide quantitative information about the factors influencing the
choice of place of delivery among postnatal women and qualitative information about its
determinants. This approach will allow the researcher to understand the factors associated
with the choices of place of delivery among postnatal women and also provide early
intervention mechanisms to help in safe delivery and hospital delivery.
Source, amount or dose of the products/materials.
Not applicable.

Provide information (about the type of specimen, amount, use and destination) if
shipment is required.
Not applicable.
Human participants in the project (number and type of participants, inclusion/ exclusion
criteria and the recruitment strategy).
Estimated number of participants will be 416 women of reproductive age residing in
Turkana County.

Exclusion criteria:
Mothers who had deliveries less than 2months from date of interview
Mothers who are not sure of their delivery time
Women outside the age range of 15-49
Mothers unwilling to provide informed consent

Inclusion Criteria:
Mothers who had deliveries in the last 3years
Mothers who consented to the interview
Mothers who are residents of Turkana County

Study location: Include a statement about the sites (s) where the study will take place.
Attach letters of cooperation.
The research will be carried out in Turkana county, .it has a total of 926,976 households,
Risks and benefits of the study
The study will help in identifying factors that leads to choices of place of delivery among
postnatal women in Turkana county. There will be no monetary benefits for those who
chose to participate.

Potential adverse events and proposed interventions

Please provide the information requested below in an attachment formatted as shown by
the requested information.

Nature and Degree of Risk: Describe any possible injury, stress, discomfort, invasion of
privacy and other side effects from all study procedures, drugs and devices (both standard
and experimental), interviews and questionnaires. Include psycho-social risks as well as
physiological risks. Include risks arising from the withholding of standard procedures
(Do not refer to the consent form).
Some of the questions asked may slightly be uncomfortable to the participant. They are
free to answer any question that they are comfortable with. They have the right to refuse
the interview or any questions asked during the interview.

Minimization of Risk: Specify what steps you will take to protect the participant’s rights
and welfare. Please describe specific measures applicable to minors, foetuses-in-utero,
prisoners, and pregnant women, decisional impaired or economically or educationally
disadvantaged subjects.
Participants will not be coerced into participating and their personal details such as names
and will remain anonymous.
The data collection tool, in these cases a questionnaire and also there will be a
professional health worker from the study site who will help in explaining what the
questions from the data tool mean. Participants’ names will not be used in the study.
Before participation, study respondents
Will familiarize themselves with a written consent form so that they can decide whether
to participate or not

Unknown Conditions: Explain how you will handle the unanticipated discovery of a
participant’s unknown condition (disease, suicidal intention, genetic predisposition, etc.)
as a result of study procedures.
I will inform the Administrative Officer in charge of Health for necessary action.

Benefits: Describe concisely and realistically the benefits of the proposed study for
participant and for society (if none, please state accordingly).
You may benefit by getting free opportunity to share your experiences on place of
delivery, potentially getting empowered and raising awareness about safe delivery.
Adverse Events Treatment: Explain how you will handle adverse events that might result
both immediately, and in the future, from study procedures. Please specify under what
conditions an adverse event will be referred for treatment by someone outside the
research team.
Not applicable.

Adverse Events Facilities: Please state whether or not you have access to adequate
facilities and equipment to handle possible adverse events. If not, please outline what
measures you will take to handle the occurrence of an adverse event.
Not applicable.

Financial Responsibilities: Please explain who will be responsible for the treatment of
physical injuries resulting from participation in study procedures.
Not applicable.

Confidentiality of research data (how to deal with direct identifiers, data storage, access
and use).
The principle and co-investigator will be the only one who will be able to access the data.
Names of study respondents will not be used in the study report.

Ethical consideration: Summarize the ethical issues arising from the study and how they
will be dealt with.
Informed consent for all study participants will be obtained to ensure that study
participants participate freely, while privacy and confidentiality will be observed and
assured to the participants. Names of the participants will neither appear in the
questionnaires nor during presentation for anonymity and to maintain confidentiality
throughout the study.

Additional information (where applicable e.g., radiation exposure, access and use of
private records, audio- visual recordings, etc.)
Not applicable.
Consent /assent forms and waiver (Justify what applies):
Written
Oral
Waiver
Consent will be given orally and in form of a written signed document before
participating in the study.
FACTORS ASSOCIATED WITH CHOICE OF PLACE OF DELIVERY AMONG
POST NATAL WOMEN IN TURKANA COUNTY, KENYA

DOYE NAMORU CINTHIA

REGISTRATION NO. 1051705

A RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENT FOR THE AWARD OF BACHELOR'S DEGREE IN
COMMUNITY HEALTH AND DEVELOPMENT IN THE FACULTY OF
SCIENCE, CATHOLIC UNIVERSITY OF EASTERN AFRICA

APRIL, 2024
 DECLARATION

Declaration by the Candidate

I Doye Namoru Cinthia, hereby declare that the project proposal entitled “Factors
associated with the choice of place of delivery among women in Turkana County,
Kenya” submitted towards partial fulfillment of requirement for award of Bachelor’s
Degree in Community health and development is my original work.

Signature.................................................. Date..............................................................
Doye Namoru Cinthia
REG: 1051705

Declaration by the Supervisor

This Research proposal has been submitted with my approval as the supervisor.

Signature.................................................. Date..............................................................
Dr. Felix Blair Odhiambo
 Table of Contents
DECLARATION............................................................................................................i
ABSTRACT...................................................................................................................3
DEFINATION OF TERMS...........................................................................................5
LIST OF ABBREVIATIONS AND ACRONYMS.......................................................6
CHAPTER ONE: INTRODUCTION............................................................................1
1.0 Background to the study.......................................................................................1
1.1 Problem statement....................................................................................................1
1.2 Justification..............................................................................................................2
1.3 Objectives.................................................................................................................2
1.3.1 Broad objective.....................................................................................................2
1.3.2 Specific objectives................................................................................................2
1.4 Research questions...................................................................................................3
1.5 Conception framework.............................................................................................3
CHAPTER TWO: LITRATURE REVIEW..................................................................4
2.0 Introduction..............................................................................................................4
2.1 Effects of choices of location of delivery................................................................4
2.2 Causes contributing to choices of place of delivery.................................................5
2.3 How to mitigate choices of location of childbirth among women in Turkana
County............................................................................................................................6
CHAPTER THREE:METHOGOLOGY.......................................................................7
3.1 Study design..........................................................................................................7
3.2 Study population......................................................................................................8
3.2.1 Inclusion..........................................................................................................8
3.2.2 Exclusion...............................................................................................................8
3.3 Sampling Size...........................................................................................................8
3.4 Sampling techniques................................................................................................9
3.5 Data collection method............................................................................................9
3.6 Participant’s requirement.........................................................................................9
3.7 Data analysis.......................................................................................................9
3.8 Limitations and delimitation..................................................................................10
3.8.1 Limitations..........................................................................................................10
3.8.2 Delimitation.........................................................................................................11
3.9 Ethical Consideration.............................................................................................11
REFERENCES.............................................................................................................12
APPENDICES..............................................................................................................13
APPENDIX I: WORK PLAN......................................................................................14
APPENDIX II: BUDGET............................................................................................15
APPENDIX III: CURRICULUM VITAE...................................................................17
APPENDIX IV: CONSENT FORM............................................................................28
APPENDIX V: QUESTIONNAIRE............................................................................33
APPENDIX VI: STUDY AREA MAP........................................................................38
 ABSTRACT

Study background
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 Turkana County. Women in the northwestern region of Kenya
exhibit unfavorable traits (KDHS, 2022): limited educational attainment, precarious
economic status, and high number of childbirths (average children per woman 5), opt
for home deliveries, and prefer traditional birth attendants as their midwives. The
Turkanas are one of the nomadic communities in Kenya well known for pastoralism.
Over the years, they have moved from place to place in search of pasture. This
movement has prevented pregnant women from seeking important health care
services leading to many problems during pregnancy, delivery and after delivery.
Sadly, this has resulted in a high number of miscarriages, neonatal death, and
maternal death.

Objective
The aim of this project will be to identify the factors linked to postnatal women’s
decisions regarding the location of childbirth Turkana County, Kenya.

Methodology
An analytic cross-sectional study that will be done in Turkana County. Sociocultural,
socioeconomic, sociodemographic, obstetric experience, and distance to health
facilities are the characteristics compared among women during this study. This
comparison will also be done on ANC among health facility user with those who
delivered at home. The group under examination will be female ranging from 15 to 49
who delivered in the past 3-36 months in Turkana County and the sample size of 416

Expected outcome
The findings of this study is expected to be used to improve policy in post-natal care
among women in Turkana County Kenya.
 DEFINATION OF TERMS

Maternal Mortality
Demise of a woman during pregnancy or within 42 days of ending of her pregnancy,
Regardless of the duration and or location of pregnancy, due to causes related to or
exacerbated by pregnancy or its management.
Infant Mortality Rate
Number of deaths of infants under one year of age per 100,000 live births in the mid-
Year population. The “Infant Mortality Rate” always refers to the annual rate.
Safe Motherhood
Establishments of conditions that enable a woman to decide whether she become
expectant. If she does, it ensures she obtains care for preventing and treating
pregnancy complications, has access to trained care during childbirth, can access
emergency obstetric care if needed, and receives postpartum care to avoid disability
or death from pregnancy and childbirth.
Traditional Birth Attendant
A woman with experience in assisting with deliveries in her community, often
illiterate and acquiring knowledge through experience or generational transfer.
Skilled Birth Attendants
Trained professionals, including midwives, nurses, nurse-midwives, or doctors, who
have completed a prescribed course of study and are registered or licensed to provide
care during childbirth.
 LIST OF ABBREVIATIONS AND ACRONYMS

ANC: Antenatal Care

CDC: Center for Disease Control
GoK: Government of Kenya
IMR: Infant Mortality Rate
KDHS: Kenya Demographic Health Survey
KEMRI: Kenya Medical Research Institute
SDGs: Sustainable Development Goals
MoH: Ministry of Health
MMR: Maternal Mortality Rate
PHC: Primary Healthcare
TBA: Traditional Birth Attendants
UNICEF: United Nations Children’s Fund
UNFPA: United Nations Population Fund
WHO: World Health Organization
 CHAPTER ONE: INTRODUCTION

1.0 Background to the study

Motherhood is commonly viewed as a rewarding and a positive journey, but
numerous women connect it with pain, health issues, and mortality (WHO, 2022).
Assuming no complications, pregnancy is expected to be a straightforward, natural
progression leading to childbirth, with minimal need for external interventions.
Because of the unpredictable birth outcome, it’s recommended one to use skilled
attendance during delivery because of easy access of health facility, in order to
manage complications in case it occurs (WHO, 2022).
Kenya’s commitment to achieving the sustainable development goal of 70 maternal
deaths per 100,000 live births by 2030 is translated into an average annual rate of
reduction of 2.1%. While substantive, one third of 6.4% of annual rate is needed in
order to achieve (UNICEF, 2023).
The Kenyan Government has implemented a policy to guarantee that female can
access trained birth attendants during childbirth. Kenya’s national maternal mortality
rate stood at 362/100,000 live births in 2015 (KEMRI/CDC, 2015) however changes
in pattern were noted as the maternal mortality rate nationwide increased to 432
deaths per 100,000 live births in 2010, afterward it decreases to 353 deaths per
100,000 live births in 2015(USAID,2015; UNICEF, 2010).
The worldwide objective is to decrease the maternal mortality ratio to below 70
deaths 100,000 live births by 2030 as part of the Sustainable Development Goals. For
Kenya to achieve the maternal mortality rate target of 140 per 100,000 by 2030 an
annual rate reduction of at least 8.6% is required.

Women in the northwestern region of Kenya exhibit unfavorable traits (KDHS, 2022):
limited educational attainment, precarious economic status, and high number of
childbirths (average children per woman 5), opt for home deliveries, and prefer
traditional birth attendants as their midwives.

1
1.1 Problem statement

Despite the implementation of safe motherhood program in Kenya over two decades
ago, maternal deaths remain high at 362 deaths per 100,000 live births (KDHS, 2022).
Additionally, health indicators in Turkana County are alarming, with a maternal
mortality rate of 1,594/100,000 live births compared to national rate 362. The infant
mortality rate in Turkana is 140 per 1000 live births, significantly higher than the
national rate of 52, and the maternal and child immunization rates fall below the 90%
national average (KDHS, 2022; USAID, 2015).

According to the KDHS, 2022, Turkana County exhibit elevated antenatal care
utilization at 57.7% and a lower incidence of hospital deliveries at 43.2%.
High rates of infant and maternal mortality are significantly influenced by deliveries
that takes place at home.

The KDHS, 2022 indicated the substantial utilization of antenatal care at 99.5%,
while hospital deliveries in Turkana were reported at a lower rate of 43.2%. However,
the report did not show the quantity of ANC visits per woman.

1.2 Justification

This study aims to investigate how women perceive the ease of access, price, and
quality of the services they receive and also to investigate the maternal age, education,
socioeconomic and socio-cultural factors that contribute to choices of location of
childbirth amid postnatal females in Turkana County. The results of this study will be
utilized to formulate guidance for interruptions aimed at enhancing women’s access to
healthcare utility during childbirth.
1.3 Objectives

1.3.1 Broad objective

To identify factors linked to postnatal women’s decisions regarding the location of
childbirth Turkana County, Kenya.
1.3.2 Specific objectives.
1. To assess the level of awareness of safe delivery practices among women in
Turkana County

2
2. To determine the association of socioeconomic factors to choices of location of
childbirth
3. To identify cultural factors associated with maternity services utilization

1.4 Research questions

1. What is the relationship between sociocultural factors and maternity services

utilization?
2. What is the impact of socioeconomic factors on the choices of place delivery in
Turkana County?
3. What extent are women in Turkana county aware of safe delivery Practices?

1.5 Conception framework

INDEPENDENT VARIABLES DEPENDENTVARIABLES

Sociodemographic
factors
 Education level of
the partner
 Age
 Level of
awareness
Choice of place
of Delivery
1. Home
Level of awareness 2. Hospital

Cultural Factors
 Gender of skilled
care provider
 Reliance on
traditional healers
 Birthing position

3
 CHAPTER TWO: LITRATURE REVIEW

2.0 Introduction

In communities worldwide, delivering at home is widespread, but it comes with

heightened risk of maternal and prenatal mortality (WHO 2022). Annually around
280,000 women lose their lives due to pregnancy and childbirth complications, with
70% of these occurrences transpiring in developing nations (UNICEF 2020).
In Europe, over 90% of women give birth in healthcare facilities with trained
attendants, whereas in sub–Saharan Africa, only 46% of women have skilled
attendance at delivery. Similarly, in east, south East Asia, and North Africa, the figure
is 58%. (UNFPA, 2010). For instance, in Uganda, 65% of deliveries occur in health
facilities, with Traditional birth attendants and relatives 27% (UNFPA Uganda, 2023).
The variation in these differences can be explained by socio cultural factors, the
perceived necessity of skilled attendants, economic accessibility, and physical
accessibility. (Sabrine and Campbell, 2009, 2009). Conversely, high income countries
boast well established emergency obstetric care facilities and ample number of skilled
personnel, facilitating women access to skilled attendants during delivery, both at
home and in hospital. (UNFPA, 2023)
Across Kenya, 37.55 of women opt for home birth assisted by traditional birth
attendants rather than delivering in hospital, and there is a difference in the middle of
urban and rural areas. Women in the Urban at 56.5%, are twice as likely as their rural
counterparts, who have a rate of 27.5%, to receive medical care during childbirth.
(KDHS, 2022).
Rural women face challenges in accessing health utilities due to inadequate road
conditions, which exacerbate the distance to health facilities. Limited community
consciousness, largely stemming from high illiteracy rates among rural dwellers, and
an overreliance on Traditional Birth Attendants (TBAs) further contributes to their
disadvantage. (KDHS, 2022)

2.1 Effects of choices of location of delivery

The choice of location of childbirth can have effect on maternal health outcome
because delivering in a non-institutional setting or without skilled attendant may

4
 increase the risk of adverse maternal outcome while delivering in a healthcare
facility with skilled birth attendants can improve maternal health outcomes by
reducing risks of complications.
Delivering in a health facility increases the chances of receiving immediate
postnatal care, essential vaccination and also early detection of any health issues
in a newborn.
Delivering in non-institutional setting without skilled attendants increases the risk
of maternal mortality and morbidity
Choosing facility-based delivery increases the likelihood of timely access to
emergency obstetric care that helps reducing complications and negative
outcomes

2.2 Causes contributing to choices of place of delivery

Geographical barriers
Limited access to health facilities in rural areas can make it difficult for women to
access facility-based delivery due to the long distance the facilities and their homes,
poor roads, and transportation challenges, which contributes to tradition birth
attendants.
Socioeconomic factors
The cost of transport and medical fee can be prohibitive for many women, leading
them to choose home birth over facility-based delivery, due to poverty, limited
financial resources and lack of insurance covers.
Cultural and traditional beliefs
Some communities in Turkana County may have strong beliefs and cultural norms
that favors traditional way of delivery considering it to be more natural and
culturally appropriate.

Lack of awareness and knowledge

Women who are unaware of the advantages of facility-based delivery may not
prioritize services like access to emergency obstetric, and postnatal support. Also,
insufficient health education programs and low literacy level can add to lack of
awareness.
Fear of healthcare facilities

5
 Fear of medical interventions or complications during child birth may also
contribute to the preference for home birth.

2.3 How to mitigate choices of location of childbirth among women in Turkana

County

Improve access to health care

This include infrastructure development, ensuring availability of medical
equipment and supplies and also improving roads and transportation options in the
remote areas in order for it to be easy and timely to access health care facility.
Strengthen the health workforce
This can be done by increasing the number of trained midwives, nurses and other
healthcare professionals in Turkana County and also deployment of healthcare
professionals to the remote areas which can help to ensure adequate workforce to
provide quality maternal healthcare
Health education
Community leaders and local influencers should take the mandate in giving
accurate and culturally appropriate information to address misconception and also
promote informed decision making.

Address socioeconomic barriers

This can be done by implementation of health insurance schemes, providing
subsidies for transport, and ensuring the availability of affordable healthcare
services.
Enhance cultural sensitivity
Integrating culturally sensitive approaches in healthcare services delivery can help
to build trust and encourage women to seek facility-based deliveries, this can be
done by engaging with local communities, and community-based organization
which can help to reduce the gap between modern healthcare practices and
traditional customs.

6
 CHAPTER THREE:METHOGOLOGY

3.1 Study design

An analytic cross-sectional study that will be done in Turkana County. Sociocultural,

socioeconomic, sociodemographic, obstetric experience, and distance to health
facilities are the characteristics compared among women during this study. This
comparison groups will also be done on ANC among health facility user, with those
who delivered at home, this will enable the researcher to examine the factors that
contribute to their decision-making process. The study design will allow the collection
of data a specific point in time to understand the factors associated with their choice
of place of delivery.

3.2 Study population

The group under examination will be female ranging from 15 to 49 who delivered in
the past 3-36 months in Turkana County

3.2.1 Inclusion

The participants will be recruited based on the following criteria

i. Mothers who had deliveries in the last 3years
ii. Mothers who consented to the interview
iii. Mothers who are residents of Turkana County

3.2.2 Exclusion

The exclusion criteria will be:

i. Mothers who had deliveries less than 2months from date of interview
ii. Mothers who are not sure of their delivery time
iii. Women outside the age range of 15-49

3.3 Sampling Size

The sample size will be calculated using the formula below as described by Fischer et
al. (1998):

7
 n = z² p d
d²
Where;
z = standard normal deviate at 95% C.I (1.96)
p = (0.5) Assumed proportion of the population with desired characteristics
(43.2% hospital deliveries (KDHS, 2022)
q= (1-p=0.5) proportion without the desired characteristics
d=degree of accuracy at 95% confidence interval (0.05)
Substituting the values in the above formula, the sample size will be:
n = 1.96² x 0.432 x 0.568= 377.05
0.052
Add 10% for non-response to make the sample size 416

3.4 Sampling techniques

This study will target women that are in their reproductive age of 15 -49 years in
Turkana County. This study will focus on this population because it’s a group of
women who are at risk of experiencing childbirth and have the potential in deciding
the place of delivery. Mothers will be selected through to consecutive sampling
where the researcher will identify the eligible participants as they come to the facility.

3.5 Data collection method

Regarding the gathering of data, structured questionnaires, and secondary data

analysis will be used to collect data. Questionnaires will include questions related to
the factors influencing choices if delivery among women in Turkana County, such as,
sociocultural, socioeconomic factors, awareness level among others. This method
allows efficient data collection and ease of analysis. Secondary data analysis will be
used to collect data from existing secondary data sources related to the choices
associated with the location of childbirth, this can provide valuable information to
support the study findings.

8
3.6 Participant’s requirement

This study participants will comprise of mothers who delivered in the past 3- 36
months. The participant will give their informed consent and their confidentiality and
privacy right

iii.7 Data analysis

Statistical data will be performed using IBM SPSS. Descriptive statistics, including
mean, frequency and percentage, will be employed to summarize the data. Inferential
statistical methods, like correlation analysis and regression models, will be utilized to
explore the relationship between variables and identify significant factors influencing
women’s choices of delivery location in Turkana County. Qualitative data, thematic
analysis will be employed to identify key themes and pattern emerging from
interviews, results will be codded and categorized to extract meaningful insights
related to research objectives.

Below are tables that shows how data will be presented

DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS

DEMOGRAPHIC CHARACTERISTICS FREQUENCY (%)

Age group
15-19 years 20(10%)
20-24 years 40(20%)

FACTORS INFLUENCING CHOICE OF PLACE OF DELIVER

FACTORS FREQUENCY (%)

Cultural beliefs
Influence decision 95(47.8)
Do not influence decision 105(52.5%)
Cost of transport
Affordable 110(55%)
Not affordable 90(45%)

3.8 Limitations and delimitation

9
3.8.1 Limitations

1. It may not be feasible to include a large sample of women from the whole county
due to resource and time.
2. The participant may not accurately remember or report their experiences and may
not provide responses that are socially desirable
3. The findings may be specific about Turkana County and may not be directly
generalizable to other population with different sociocultural context

3.8.2 Delimitation

1. This research aims to provide insights into the factors associated with the choice of
location of childbirth within Turkana population
2. The research focusses on the women’s experiences and perspectives regarding the
decisions made while choosing place of delivery
3. This research allows a comprehensive understanding of the factors associated with
the choice of location of childbirth
4. This research is conducted within a specific time frame

3.9 Ethical Consideration

The Approval of data collection will be obtained from the Departmnt of Community
heath and development in Catholic University of Eastern Africa. Ethical clearance
will be sought from KNH-UoN ERC and permission to conduct research will be
obtained from NACOSTI. The researcher will seek informed consent from study
participant. Obtaining consents from parents or legal guardian of participants below
18 or participants of 18 years of age. Participants information will be kept confidential
and unique identifiers will be assigned instead of using personal names. Consent will
also be obtained from those women who are below 18 years, bur are pregnant or have
a child.

CHAPTER FOUR: RESULTS

10
4.1 DESCRIPTIVE ANALYSIS
4.1.1 Socio-Demographic Characteristics of Study Sample
The sample consisted of 304 women who delivered between 3 to 36 months. The age
range of the study population was 15 to 49 years but when data was collected, the
majority of the respondents’ age range was found to be 18 to 25 years. The mean age
was 30.4 years and the median age was 29.5 years. The age of the majority (39.5%) of
respondents ranged from 18 to 25 years. Only ten (10) out of 304 interviewed
respondents were above 41 years age. With respect to religious affiliation, the
majority (96.4%) were Christian and 3.6% Muslims. In terms of marital status, 61.5%
of the respondents were married, 8.2% divorced, 29.3% were single and 1.0%
preferred not to say. Most respondents 146 did attained tertiary form of education
(48%), a total of twenty nine (9.5%) had primary, and secondary level education had a
total of ninety five 31.3%, while thirty four (11.2%) were illiterate. Concerning their
occupation (income) status, 88 (28.9%) were employed, 18.4% were entrepreneurs
(business) and 52.6% were unemployed. The demographic profile of the women who
were interviewed is shown in Table 4.1 below.
Table 4.1: Socio-demographic characteristics of the study sample n=301

Age
<25yrs 26-30yrs 31-35yrs
>35yrs
Total Religion
Muslim Christian Total
Marital status
Married Divorced Widow Total

Highest level of education

None Primary Secondary
College & above Islamic school Total

Occupation
Housewife Salaried worker Business Farmer/livestock Total

No %
11
46 (20.5%)
81 (36.1%)
42 (18.8%)
55 (24.6%)
224 (100%)

No %
194 (86.6%)
30 (13.4%)
224 (100%)

No %
205 (91.5%)
15 (6.7%)
4 (1.8%)
224 (100%)

No %
117 (52.2%)
37 (16.5%)
22 (9.8%)
19 (8.5%)
29 (13.0%)
224 (100%)

No %
143 (63.8%)
24 (10.7%)
28 (12.5%)
29 (13.0%)
224 (100%)
12
How the working women were netted is captured in the data collection procedure.
4.1.2 Objective 1: level of awareness of safe delivery practices among women
(n=304)
4.1.2.1 Awareness of the maternal Healthcare services availability
One hundred and forty nine (49%) of women were very aware of the maternal
healthcare services, one hundred and sixteen (38.2% ) somehow were aware while
thirty nine (12.8%) were not aware of maternal Healthcare services available in
Turkana County. The multiple views of women who respondented were presented in
Table 4.2 below.
Table 4.2: Respondents’ reasons for delivering at home ( n=304)

Frequency Percent
I fear male midwives 60 21
No transport 51 18
Hospital is dirty/poor services 46 16
No one to leave house with 37 13
No money 29 10
Baby came too soon 29 10
Others 34 12
Total 286 100
*Nb: others in this table refer to rude midwives & TBA is cheap.
*there is a high number of women who said they fear male midwives. The
cultural values attached to this is captured in the discussion.There are more
male nurses in the hospitals than female nurses; this is due to the low

13
education level of women in the area. Government workers posted from other
regions in the country resist their postings due to the hardships in Garissa.

The survey assessed if attendance of ANC was related to selection of delivery

site; a total of 156 (69.6%) of respondents attended ANC while 68 (30.4%) did
not attend. Over forty per cent (44%) of the women who attended ANC
(n=156) delivered in hospital.When asked what reasons motivated them to
attend ANC, they gave the multiple responses indicated in Table 4.3 below.
Similarly, those who did not attend ANC gave various multiple response
reasons for not attending ANC; hospital is far 58 (79.5%), got services from
TBA 11 (15%), no money to pay for services 4 (5.5%).

Table 4.3: Respondents reasons for attending ANC ( n=331)

Frequency Percent
Acquire antenatal card 145 44
To get immunized 76 23
Know the lie position of baby70 21
Others 40 12
Total 331 100
*Others in this table refer to; “I got problems during previous birth” and “I am
aware of importance of antenatal care”.

In terms of attitude of women towards hospital midwives, nearly half (41%) of

the women (n=224) perceived the hospital midwives to be rude across all the
health facilities they have attended based on their previous experience: 31.3%
percieved them to be friendly and 27.7% said ‘I don’t know’. Out of the 92
(41%) women who described the hospital midwife to be rude, only 12 (13.0%)
delivered in hospital and the rest at home; 70 (31.3%) described the midwives
to be friendly out of which 53 (75.7%) delivered in hospital. Regarding who
assisted the women during their last birth, the study showed the TBA was the
most preferred assistant as shown in Table 4.4 below.

14
Table 4.4: Who assisted the respondent during the last birth n=224

Frequency Percent
TBA 134 60
Nurse 56 25
Doctor 17 7.5
Others 17 7.5
Total 224 100
*Others in this table include neighbor, friend, husband and relatives

4.1.3 Objective 2: Preferences of Antenatal Care Attendees of Place of

Childbirth
Of the 82 respondents who were interviewed in the MCH/ANC clinic, 71
(86%) said they were looking forward to delivering in hospital while 12 (14%)
said they would deliver at home. Since a follow-up was not done to confirm
this pledge, it is not known where the women actually delivered; in addition,
women who were interviewed in their homes were not asked this question
since they were not in the ANC at the time of the interview.

4.1.4 Objective 3: Maternal Factors Influencing Choice of Place of

Childbirth
Maternal factors such as age, marital status, religion, level of education,
occupation, parity, knowledge and experience of previous obstetric
complications were considered under this objective. The survey did not find
women’s age, marital status and religious affiliation to be significant
indicators (P>0.05) in the choice of place of child delivery; delivering at home
or hospital did not follow any specific pattern regarding the aforementioned
independent variables.

In terms of women’s level of education, 117 (52.2%) did not have any form of
education and only 15 (12.8%) of these women without any form of education
delivered in hospital while the rest delivered at home. A total of 107 (47.8%)
of women had some form of education; primary school 37 (34.6%), secondary
22 (20.6%), college and above 19
15
(17.8%), Islamic school 29 (27%); Table 4.5 below shows the pattern of
home/hospital delivery for the women with some form of education:

Table 4.5: Level of education and place of delivery n=107

Level of education Place of delivery Total

Hospital Home
Primary 37 (34.6%) 20 (54%) 17(46%) 37
Secondary22 (20.6%) 15 (68%) 7 (32%) 22
College & above 19 (17.8%) 15 (79%) 4 (21 %) 19
Islamic school 29 (27%) 9 (31%) 20 (69%) 29
Total 107 (100%) 60 (56%) 47 (44%) 107 (100%)

Regarding occupation (income) of respondents, the study found more

housewives delivered at home than women in some form of employment.
Majority, 143 (64%) of the respondents were housewives without any form of
employment and only 37 (25.9%) of them delivered in hospital while the rest
delivered at home. Moreover, a total of 81 (36%) of women were in some
form of employment; salary, 24 (11%); business 28 (34%); farming/livestock
trade 29 (36%). Among these women in some form of occupation, 37 (45.7%)
delivered in hospital. Although women in some form of employment mainly
delivered in hospital, women in farming and livestock trade mainly delivered
at home; the latter cited distance rather than cost as a hindrance to reaching the
hospital because they migrate a lot with livestock. Table 4.6 below shows the
pattern of home/delivery for women in some form of employment.

Table 4.6: Occupational status and place of delivery n=81

Occupation Place of delivery Total

Hospital Home
Salary 24 (29.6%) 18 (75%) 6 (25%) 24
Business 28 (34.6%) 13 (46%) 15 (54%) 28
Farmer/ livestock trade 29 (35.8%) 6 (20.7%) 23 (79.3%) 29
Total 81 (100%) 37 (45.6%) 44 (54.3%) 81(100%)
16
Regarding parity and choice of place of delivery, birth order between one and
three children was mostly delivered in hospital (45%), lesser use of hospital
for birth was noted as birth order increased: four to six births 19 (21.6%),
above 7th child 6 (22.2%).
The study assessed the level of women’s knowledge and experience about
obstetric complications. A total of 201 (90%) women knew about obstetric
complications (bleeding, delayed labour, abnormal baby position, infection,
tears and caesarean section) and 70 (35%) of these women delivered in
hospital. Knowledge of risks did not translate to increased use of hospital for
birth. In addition, 84 (37.5%) women reported they had experienced obstetric
complications during previous births; hence, 45 (53.6%) of those who
experienced previous obstetric complications delivered in hospital for fear of
repeat of a similar experience. Table 4.7 below shows the multiple responses
regarding complications suffered by those women who experienced previous
obstetric complications.

Table 4.7: Complications experienced by respondents during previous birth

n=112

Complications suffered Frequency Percent

Delayed labor 40 36.0
Bleeding 16 14.0
Caesarean section 15 13.0
Infection 13 12.0
Tears 11 10.0
Abnormal baby position 10 9.0
Retained placenta 7 6.0
Total 112 100
*It has not been possible to probe the participants on the indepth of
complications they experienced in terms of maternal versus fetal factors
because this was a cross sectional survey and not a qualitative study. As
mentioned prior, majority of the respondents were illiterate and did not
understand the inner details of what entailed the complications they suffered
17
whether it was a fetal issue or maternal issue. In addition, women believe that
ceaserean section (which they call operation) is an indication of only
complicated labour. However, they could clearly tell about some of the more
obvious complications such as bleeding, infection and retained placenta.

4.1.5 Objective 4: Health- service-related Factors Influencing the Choice of

Place of Childbirth
Health service-related factors assessed in this study include access measured
in terms of distance and cost. Distance was measured in terms of time taken to
reach the hospital by walking one-way. Cost was assessed by asking
participants if they perceived the health services charges to be expensive or
affordable. Participants were also asked about their perception of the quality of
care they received while in the hospital. Forty-five (20.1%) of the respondents
(n=224) said the hospital was dirty and services were poor. Regarding
distance, 148 (66%) of the respondents (n=224) lived at a distance less than
one hour one-way walking time to reach a facility with delivery service and 59
(26%) lived within one to two hours walking time to a facility with delivery
service. The perception of cost of services was about half-half; that is, 105
(47%) said delivery services were affordable while 119 (53%) said the cost
was expensive; even women who had no employment did not see the cost to
be expensive since the husbands paid for the hospital costs. Table 4.8 below
shows the time taken by respondents to reach the nearest hospital by walking
one way.

Table 4.8: Time taken by respondents to reach the hospital by walking one
way (n=224)

Frequency Percent
Less than 1hr 148 66.0
1-2hrs 59 26.0
More than 2hrs 17 8.0
Total 224 100
*More sedentary strata were selected for the study and the justification for this
mode of sampling is explained in the sampling procedure section.
18
4.1.6 Objectiv 5: Cultural Factors Influencing Choice of Place of Childbirth
Cultural factors assessed under this objective include: decision-making
regarding where to give birth, which gender of midwife is prefered to assist
during childbirth and the percieved qualities that make the traditional birth
attendant important in this community.

Analysis of the data revealed that 201 (90%) of the women preffered to be
assisted by a female midwive while 23 (10%) said they did not mind any
gender. In addition, nearly all the women who delivered at home prefered the
tradtional birth attendant to assist them during birth because of the challenges
in accessing health facilities due to transport and cost hence the TBA is the
only available option. The majortity of the women could make an independent
decision regarding where to give birth; Tables 4.9 and 4.10 below show the
results of the analysis on decison making and the multiple responses regarding
the perceived quality of the TBA .

Table 4.9: Who decides where respondent gives birth n=224

Frequency Percent
Myself 133 59.3
Husband 45 20.1
Me and husband 40 17.9
Mother in-law 6 2.7
Total 224 100

Table.4.10: Qualities that make the TBA important in the community n=421

Frequency Percent
TBA is always available 164 39.0
TBA is cheap 136 32.3
TBA can assist women for free 41 9.7
TBA is friendlier than hospital 80 19.0
19
midwives
Total 421 100

4.2 BIVARIATE ANALYSIS

Bivariate analysis was performed to find out if the frequencies reported in the
above- mentioned descriptive analysis section were statistically significant. In
particular, analysis was run for the following variables in line with the study
objectives using P≤ 0.05 to be statistically significant:
i) Socio-demographic correlates for choice of place of childbirth
ii) Maternal factors (obstetric correlates, attitude towards midwives)
correlate for choice of place of childbirth
iii) Health service –related factors correlates for choice of place of
childbirth
iv) Cultural factors correlate for choice of place of childbirth

4.2.1 Socio-Demographic Correlates for Choice of Place of Childbirth

In terms of socio-demographic characteristics, the study did not find a
relationship between age of the respondents and place of delivery; the
statistical test is not significant; p=0.208. Similarly, no relationship was noted
between marital status of respondents and place of delivery; p= 0.172.
However, education and occupation were positively associated with delivering
in hospital (p=0.000); Table 4.11 below shows the socio- demographic
correlates for place of delivery.

Table 4.11: Socio-demographic correlates for choice of place of childbirth

(n=224)

Independent variables Dependent variable: Place of delivery Statistical

test

Mother’s age group (years) Hospital (n=74) Home (n=150)

<25 years 45.7 % (21) 54.3 % (25) X²= 4.546: 3df:
20
25-30 years 32.1 % (26) 67.9% (55) P>0.05 (0.208)
31-35 years 28.6 % (12) 71.4% (30)
>35 years 27.3 % (15) 72.7% (40)
Marital status
Married
32.7 % (67)
67.3 % (138)
X²= 0.136; 1df;
Others (widow and divorced) 36.8 % (7) 63.2% (12) P>0.05 (0.172)
Highest level of education
None
12.8% (15)
87.2% (102)
Primary 54.1% (20) 45.9% (17)
Secondary 68.2% (15) 31.8% (7) X²=59.442; 4df;
College and above 78.9% (15)
21.1% (4) P<0.05 (0.000)
Islamic school 31.0% (9) 69.0% (20)
Occupation of respondents
Housewife 25.9% (37) 74.1% (106)
Salaried worker 75.0% (18) 25.0% (6) X²=26.689; 3df;
Business 46.4% (13) 53.6% (15) P<0.05(0.000)
Farmer/livestock 20.7% (6) 79.3% (23)

4.2.2 Objective 3: Maternal Factors Correlates for Choice of Place of

Childbirth Regarding maternal factors, parity (p=0.001), knowledge of
obstetric complications (p=0.040), experience of previous obstetric
complications (p=0.000), attending ANC (p=0.000) and perceiving the
midwife to be friendly (p=0.000) were positively associated with delivering in
hospital; Table 4.12 below shows the results of the obstetric correlates.

21
Table 4.12: Obstetric correlates for choice of place of childbirth (n=224)

Independent variable Dependent variable:

place of delivery Statistical test
Hospital (n=74) Home (n=150)
Number of children
1-3 45% (49) 55.0% (60) X²=13.637; 2df;
4-6 21.6% (19) 78.4% (69) P<0.05(0.001)
7+ 22.2% (6) 77.8% (21)
Knowledge of pregnancy/
birth complications
Yes 35 % (70)
17.4% (4) 65% (131)
82.6% (19) X²=4.206; 1df; P<0.05(0.040)
No
Experience of previous birth/pregnancy complication
Yes
53.6% (45)
20.7% (29)
46.4% (39)
79.3% (111) X²=24.906; 1df; P <0.05(0.000)

22
4.2.3 Objective 4: Health- Service-related Factors Correlates for Choice of
Place of Childbirth
Health Service-related factors assessed in this objective include: access, cost
and quality of hospital care. Access in this study was measured in terms of
distance and cost. Distance was assessed by time taken by walking one-way to
the nearest health facility. The cost was assessed by perception of the
participants; that is, if they termed the cost of delivery and other service
charges to be affordable or expensive. Proximity to the hospital

and perceiving the cost of delivery and other charges to be affordable were
positively associated with hospital delivery (p=0.000) while poor quality of
hospital care was significantly associated with delivering at home (p= 0.000);
Table 4.13 below shows this result.

Table.4.13: Service-Related Factors Correlates for Choice of Place of

Childbirth (n=224)
Independent variables Dependent variable: Place of delivery Statistical
Hospital (n=74) Home (N=150) test
Time taken by respondents to
reach hospital by walking
Less than 1hr 41% (61) 59% (87) X²=60.268;
1-2hrs
More than 2hrs 11.9% (7)
35.3% (6)
88.1% (52)
64.7% (11) 3df; P<0.05(0.000)
Respondents’ perception of cost
of health services
Affordable 53.3% (56) 46.7% (49) X²=36.809;
Expensive 15.1% (18) 84.9% (101) 1df; P<0.05(0.000)
Quality of hospital care
Hospital is dirty and services
poor
Yes 2.2 %( 1) 97.8 %( 44) X²= 24.169;
23
No 40.8 %( 73) 59.2 %( 106) 1df;
P<0.05
(0.000)

4.2.4 Objective 5: Cultural factors Correlates for the Choice of Place of

Childbirth n=224
Preference for female midwife was significantly associated with delivering at
home (p=0.000). In addition, making self-decisions (p=0.000) and cheap
traditional birth attendant (p=0.019) were positively associated with delivering
at home as shown in Table

4.14 below.

Table 4.14: Cultural Factors Correlates For Choice of Place of Childbirth

(n=224)

Dependent variable: Place of delivery Statistical

Hospital (n=74) Home (n=150)test
Preferred gender of midwife
X²=33.687
; 1df; P<0.05(0. 000)

X²=38.174
; 3df; P<0.05(0. 000)

24
X²=1.503;
1df; P>0.05(0. 220)

X²=5.512;
1df; P<0.05(0. 019)

X²=7.501;
1df; P<0.05(0. 006)

X²=0.431;
1df; P>0.05(0. 508)
during delivery
Female
I don’t mind any 26.9 %( 54)
87.0 %( 20) 73.1 %( 147)
13.0 %( 3)
Decision-making; who decides
where respondent gives birth
Myself 17.3 %( 23) 82.7 %( 110)
42.5 %( 17)
Husband and myself 57.3 %( 23) 42.2 %( 19)
Husband only 57.8 %( 26)
66.7 %( 4)
Mother in-law 33.3 %( 2)
Availability and cultural value
of TBA
TBA is always available
Yes 35.4 %( 58) 64.6 %( 106)
No 26.7 %( 16) 73.3 %( 44)
TBA is cheap
Yes No 39.0 %( 53)
23.9 %(( 21) 61.0 %( 83)
76.1 %( 67)
25
TBA can assist women for free
Yes
No 51.2 %( 21) 48.8 %( 20)
TBA is friendly 29.0 %( 53) 71.0 %( 130)
Yes
No 35.8 %( 29) 64.2 %( 52)
31.5 %( 45) 68.5 %( 98)

4.3 MUTIVARIATE ANALYSIS: Binary Logistic Regression Results

This section displays the results of binary logistic regression analyses

predicting factors influencing place of child delivery using various
independent variables mentioned in the section of univariate analysis. Binary
logistic regression analysis using the Enter Method was employed to
determine which variables could best predict determinants of hospital or home
delivery. Those variables which were found to be statistically significant at the
univariate level were included in the model. At α=0.05; 95% CI, the model
predicted correctly 67% for home delivery and 33% for hospital delivery.
Table 4.15 below shows the odds ratio results for the logistic regression.

Table 4.15: Binary logistic regression results for socio-demographic variables

Variable Odds ratio

(OR) Confidence interval
95%
No education 8.36 4.12 – 17.17
No occupation 1.43 1.08 – 5.49
No ANC attendance 1.11 1.03 – 1.51
Experience of previous 1.38 1.15 – 2.12
obstetric complications
Rude midwife 5.60 2.66 – 11.96

26
CHAPTER FIVE: DISCUSSION OF FINDINGS

The age range of the study population was 15-49 years but when data was
collected the age range was found to be 18-47 years. Majority 57% (n=224)
were within the age category of 18 – 30 years while 43% were within the age
category of 31 -47 years; there was only one participant who was 47 years of
age. The minimum age of the respondents was 18 years while the maximum
was 47 years. The mean age was 30.4 years, median age was 29.5 years with a
standard deviation of ± 6 years; it is noteworthy that the mean and median
ages in this study are not far apart. The findings indicated majority of the
women were in the prime fertile age period and there was high rate of early
marriage denying most of them education opportunity; this finding
corroborates the low level of literacy reported among women in Garissa
District (USAID, 2009; MoH, 2006; MoH, 2003); studies done in six West
and East African countries (Ivory Coast, Burkina Faso, Ghana, Kenya,
Malawi, and Tanzania) have reported similar findings (Stephenson et al.
2006).
This survey did not find age, marital status and religious affiliation to be
predictors in the choice of place of child delivery (P > 0.05) but other studies
have revealed the age group below 35 years has higher utilization of health
facilities for both ANC and delivery than older women and that age and
marital status are significant predictors of place of childbirth (WHO, 2011;
KDHS, 2009; Line, Johanne, & Chimango, 2006; Stephenson et al. 2006).

Mother’s level of education is a significant determinant of place of child

delivery. The study found education to be a significant predictor in hospital
delivery (P< 0.05). Further analysis showed that women with no education had
higher Odds (>1); OR=8.36 (95% CI; 4.12-17.17) of delivering at home than
women with education. Lack of education will limit women’s decision-making
ability, access to employment and health service utilization; other studies have
reported similar findings (WHO, 2011; Amy et al. 2010; WHO, 2009; Line,
Johanne, & Chimango, 2006).

27
In this study, more housewives delivered at home than women in some form
of employment. Higher income is a significant predictor of hospital birth given
that women with some form of income delivered more in hospital (P<0.05); at
multivariate level, women with no occupation had higher Odds; OR= 1.43
(95% CI; 1.08-5.49) of delivery at home than women with occupation. Low
socio-economic status has been found as a predictor for home delivery in
addition, research consistently shows that high cost is an important constraint
to service utilization particularly for the poor (Amy et al. 2010). Other studies
have additionally implicated different socio-economic factors as determinants
of place of delivery. In a Nigerian study, 41% of the mothers who did not
deliver in hospital explained that they could not afford the hospital bill and
31% said they had inadequate transportation possibilities (WHO, 2011; Line,
Johanne, & Chimango, 2006; Rajendra, Svend & Birgitte, 2004).

An overwhelming majority (87.9%) of the respondents (n = 224) had 1 – 6

children; and only 12.1% had more than 7 children; in this study I asked about
where the last child was born because I want the information from the findings
to be current and the study to measure. The findings of high parity in this
community is due to low acceptance of family planning and high fertility rate
reported among women of child bearing age in Garissa District (KDHS, 2009;
KDHS, 2003). Although the Kenya government has clear policies on
reproductive health which advocate for family planning, the policies do not
limit the number of births (KDHS, 2009); in addition, cultural factors which
prohibit contraceptive use and inaccessible health facilities are also
attributable to this finding. Women who had given birth to 1-3 children mainly
delivered in hospital. Delivering at home increased with increased parity
P<0.05 (women believe higher parity is less risky); other studies have reported
similar findings (KDHS, 2009). Those who previously delivered in hospital
were likely to use hospital for the next subsequent delivery. Similarly, women
who attended antenatal clinic in their previous pregnancy mainly delivered in
hospital (P< 0.05) and vice versa. This was proven at multivariate level, where
women who did not attend ANC were found to have higher Odds (>1); OR=
1.11 (95% CI; 1.03-1.51) of delivery at home than women who attended ANC.
The women
28
who attended ANC cited different reasons for attending ANC; reasons most
frequently mentioned were (n=331): to acquire ANC card 44%; this group
believed the antenatal card guaranteed them hospital admission during labour
if complications arose (the number of ANC visits was not asked as this was
not part of the objectives); check the lie position of baby 21% (hence went to
the hospital to get assurance that everything was fine): this has been reported
as an important determinant of ANC use in many other studies as cited later in
this paragraph; to get a tetanus injection 23% (this group felt a tetanus
injection will protect them from infection if they delivered at home) and I get
problems during birth (5%). Population based cross sectional studies in
Nigeria and rural Western Kenya have reported similar findings (Babalola &
Adesegun, 2009; Van Eijk et al. 2006). There is ample evidence that lower
level of education, low income and higher parity increase delivery at home
(P< 0.05). Hospital facility use in the previous delivery and antenatal care use
are also highly predictive of health facility use for delivery; though this may
be due to confounding by service availability and other factors; the same was
reported elsewhere in other studies (WHO, 2011; Sabine & Campell, 2009;
Borghi et al. 2008; Rajendra, Svend & Brigitte, 2004).

Knowledge and experience of obstetric complications was found to be a

significant predictor to hospital facility use for delivery in this study (P <0.05).
Further analysis showed that women who previously experienced obstetric
complications had higher Odds OR= 1.38 (95% CI; 1.15-2.12) of hospital
delivery than women who did not experience previous obstetric complications.
Obstetric complications experienced by these women include bleeding,
delayed labour, tears, infection, retained placenta and Caesarean Section. All
these women confirmed they delivered in hospital because they did not want
to risk delivering at home in case complications recurred (p<0.05); other
studies have found similar findings (WHO, 2011; UNICEF, 2008; Line,
Johanne, & Chimango , 2006; Adamu et al. 2002; Banyana, 2001).

29
Service-related factors can have a vast influence on whether a woman would
choose to deliver in a health facility or not. The parameters considered under
service-related factors

in this study were; distance measured in terms of time taken to reach the
nearest health facility by walking, cost of hospital services and quality of care
the women received once they reached the health facility. This study found
accessing health facilities is a challenge; this is attributable to the high poverty
levels previously mentioned in the document and the migratory nature of this
pastoralist community. Women who lived near the hospital but delivered at
home 36 (24.3% ) cited these reasons for delivering at home; hospital is dirty
and services poor, lack of money to pay for service, fear of male midwifes and
inability to make an independent decision. In addition to the aforesaid reasons,
women who lived far cited lack of transport and accessible roads as hindering
factors to reach the hospital; furthermore, these women counted the cost of
transport as part of the cost of services and said the cost of services is
expensive. Similar studies done elsewhere found that many pregnant women
do not get quality and timely obstetric services because there are no services
where they live, they cannot afford the services because they are too expensive
or reaching them is too costly. Some women do not use services because they
do not like how care is provided or because the health services are not
delivering high- quality care (WHO, 2011; WHO, 2009; Josephine et al. 2008;
Line, Johanne, & Chimango, 2006; Wilkinson et al. 2001).
The Somali community has cultural practices related to pregnancy and
childbirth which influence health seeking behavior and selection of place of
child delivery. It is against this background that this thesis assessed cultural
factors such as; preference of gender of midwife, cultural value attached to the
TBA, influence of decision-making at household level and attitude of women
towards hospital midwives to see if these factors were related to where women
gave birth. The study found preference for a female midwife is a predictor to
home delivery (p<0.05); this finding is attributable to the community’s
cultural belief which prohibits male assisted deliveries to preserve women’s
chastity (USAID, 2009). In this study, majority of the women could make
their own decisions regarding where to give birth and making self-decisions
30
increased delivering at home (P<0.05); though the opposite can also be true
for those who financially depend on their husbands, the assumption is that it is
swift to make an individual decision than to consult.

This study did not find correlation between age and decision-making; this
finding is contrary to findings of studies done in Nepal where women could
not access health facilities for lack of independent decision-making (Furuta &
Salway, 2006).
The study found perceiving the midwife to be friendly to be a predictor to
hospital delivery and vice versa (P<0.05). This finding was corroborated by
further analysis which showed women who perceived the midwife to be rude
to have higher Odds; OR=
5.60 (95% CI; 2.66-11.96) of home delivery than those who perceived the
midwife to be friendly. Some of the respondents declined to describe the
midwives as either rude or friendly hence chose the option I don’t know. The
assumption is that this cadre of women did not want their stand on the
midwives to be known for whatever reason; it is not known if this response
was influenced by the presence of nurse interviewers. Home delivery will
increase maternal and infant morbidity and mortality. Studies done elsewhere
have reported similar findings (Line, Johanne, & Chimango 2006; Stephenson
et al. 2006).

The overwhelming majority of women who delivered at home said they were
assisted by TBA. Women were quick to elucidate the cultural value they
attached to the traditional birth attendant; the TBA is always available, she is
cheap, she can assist women for free and she is friendlier than hospital
midwives in that order. This response is expected as the TBA is part of the
community and probably a neighbor and a friend. The TBA also gives advice
on maternal nutrition and infection prevention (AMREF, 2008). Statistical
analysis was run for each of the variables used to describe the cultural value
attached to the TBA: the results did not reveal significant correlates for
availability/friendliness of the TBA and place of childbirth (P>0.05) however,
there is a significant correlate between ‘cheap TBA/ TBA can assist women
for free’ and delivering at home (P=0.019). Community based cross-sectional
31
surveys done in Zimbabwe, Zambia and other studies done elsewhere have
revealed similar findings (Sabine & Campell, 2009; Hazemba & Siziya, 2008;
Furuta & Salway, 2006).

CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS

6.1 Conclusion

The results of this survey show that institutional care seeking for childbirth in
Garissa District is low given that 67% women delivered at home. This
outcome is influenced by lack of community access to maternal health
services in terms of long distance and lack of reliable transport and
inaccessible roads, low economic status, low education level, decision-
making, birth order, preference for a particular gender of midwife, availability
of traditional birth attendants, knowledge and experience of obstetric
complications. This finding supports the view that low-income residents in
Garissa District face significant obstacles in accessing healthcare; as a result,
home delivery related morbidity due to anaemia, obstructed labour, obstetric
fistula and haemorrhage accounts for the high number of hospital admissions
in Garissa District (MoH, 2006). The findings of this study call for an urgent
attention by Kenya’s Ministry of Health (MoH) and local authorities to
increase the number of maternity facilities in the District and advocate for
increased use of the existing ones.

6.2 Recommendations

Providing Focused and Sustained Health Education

Health education programme should seek to correct common misconceptions

(for example, the belief that higher parity is associated with lower risks) as
well as socio- cultural barriers that hinder women’s utilization of maternal
health services. To ensure wider reach, health education programme should be
channeled through a mix of avenues including the mass media (especially
community radios, which are becoming common in rural settlements in
32
Kenya), organizations working in the communities, community-level
authorities such as chiefs, community outreach activities, posters and leaflets.

Improving the Quality of Care Accessed by Women

The second Kenya National Health Sector Strategic Plan (NHSSP-II) for the
period 2005–2010 (GOK, 2005-2010) identified equitable access to care and
improved quality of services as key policy objectives. The document also
recognized that the public sector alone will not be able to provide the
necessary services to all population groups; it valued partnerships with the
private sector and communities as a vehicle to achieve the NHSSP goals
(Ziraba et al. 2009). In regard to these commitments, the Kenya MoH should
design and implement a two-pronged strategy of partnership with the private
sector and the communities aimed at bringing quality health services closer to
women in Garissa District.

First and second level maternal health facilities in Garissa District should be
given technical support and supplied with drugs, equipment and emergency
backup referral services to improve the quality of care. There should be
continuous education programmes for hospital midwives to inculcate attitude
change to overcome staff/client interaction barriers; there is also need to
perform a qualitative study on the existing negative attitude between midwives
and clients.

Given the government’s commitment as spelt out in the NHSSP-II to involve

communities in healthcare provision through the formation of community
owned resource persons and village health committees, the MoH needs to
explore the implementation of the community midwifery model which has
been tested and found to be successful in Kenyan rural Districts. This model
focuses on empowering qualified midwives (retired or unemployed) living in
communities to assist women during pregnancy, childbirth, and the post-
partum period in their homes, manage minor complications and facilitate
prompt referral when necessary with backup referral mechanism to ensure
speedy transfer to a hospital (GoK, 2005-2010).
33
 Empowering Women and Ensuring Choices

It is a fact reported in this study, frequently observed and documented in many other
studies that women’s use of maternity service is greatly influenced by their education
and economic status. In view of this finding, the government of Kenya in
collaboration with the Kenya Ministry of Education and development partners should
strive to empower women in terms of education and economy and ensure choices; the
culture of early marriage which denies many women a chance to education should be
tackled.

34
 REFERENCES

WHO. (2020). Trends in maternal Mortality, 1990 to 2008 Geneva WHO,

UNICEF, UNFPA and the World Bank.

Kenya National Bureau of statistics. (2022). Kenya demographic and health survey
2022: final report.

United Nation. (2015). transforming our world: the 2030 agenda for sustainable
development goals.

WHO. (2020) Managing complications in pregnancy and childbirth: A guide for

midwives and doctors. Geneva: WHO, UNICEF, UNFPA, World Bank.

WHO. (2024) Making a difference in countries: A strategic Approach to improving

Maternal Mortality and Newborn survival and health. Geneva: WHO

WHO, ICM, FIGO. (2010). Making pregnancy safer (MPS). The critical role of
skilled attendant.Geneva: WHO.

Kenya National Bureau of Statistics. Kenya Demographic and Health survey 2022:
final report 2022

GoK. (2019). Kenya household economic indicator survey. Nairobi: ministry of

planning and national developments.

GoK. (2009). Millennium development goals status report for Kenya.

GoK. (2005-2010). Kenya National Health Sector Strategic Plan 2005-2010.

UNICEF. (2022). report for maternal death review for northern region,

35
UNICEF. (2022). Trends in Kenya maternal mortality ratio 2005-2010

UNICEF. (2022). the state of the world’s children in 2005

UNFPA. (2022). How universal is access to reproductive health: Impoverished

and rural women gets fewer skilled attendants at delivery.

36
 APPENDICES

APPENDIX I: WORK PLAN

ACTIVITY SEPTEM OCTO NOVEMB DECEMBER JANUARY- MARCH- MAY-

BER BER ER FEBRUARY APRIL JUNE
2024 2024 2024
INTRODUC
TION
LITRATUR
E REVIEW
DEVELOPM
ENT OF
INSTRUME
NTS
SUBMISSIO
N OF
PROPOSAL
PRE-
TESTING
OF
INSTRUME
NTS
DATA
COLLECTI
ON
DATA
ENTRY
DATA
ANALYSIS
REPORT

37
WRITING
SUBMISSIO
N OF FINAL
REPORT

APPENDIX II: BUDGET

ITEM COST
Transport 7500
Internet 3000
Lunch 5000

Data analysis 2500

Proposal printing 700

Proposal binding 500

Final research report printing 1000

Report binding 500

Stationary 1500
Miscellaneous 5000

Total cost 27,200

38
 APPENDIX III: CURRICULUM VITAE

Felix Blair Odhiambo

P.O. Box 2122 -00202 Nairobi
0723914385
odhis.felix@gmail.com

I am a Public Health Professional (Specialist)/ Epidemiologist and Disease Control Expert

with 10 years of experience in public health research and training. I am a creative and
highly motivated individual with good analytical skills. My greatest desire is to see Africa
free from communicable diseases and doing quality health research. I have a great passion
for health research and higher education training.

Current position
Lecturer – Catholic University of Eastern Africa
Department of Community Health and Development
1. Lecturing, exam setting, marking and supervision, grant writing, student supervision.

Previous experience
Research Assistant –International centre for Insect Physiology and Ecology.
Data collection, Sample storage, sample analysis and Quality control.

Education
2024 PhD in Public Health (Epidemiology and Disease Control) graduating July 2024-
Kenyatta University
2022 Higher National Diploma in Community Health- Amref International University
2012 M.sc – Epidemiology Jomo Kenyatta University of Agriculture and Technology-
Jomo Kenyatta University
2012 Certificate and Advanced Certificate in Epidemiology and Biostatistics –
University of Washington/University of Nairobi
2008 BSc-Biochemistry University of Nairobi
2003 Kenya Certificate of Secondary Education - Homa Bay School

Selected Publications

 Okenyoru, D. S., Matoke, V., Odhiambo, F., Salima, R., Anyika, D., & Ogutu, G.
(2023). Social-cultural factors influencing modern contraceptive uptake among
women of the reproductive age in Turkana County, Kenya. International Journal

39
 of Community Medicine and Public Health, 11(1), 51–56.
https://doi.org/10.18203/2394-6040.ijcmph20234107.

 Odhiambo, F. B., Oyore, J. P., & Agina, B. (2023). Knowledge, attitude, and
practice towards breast cancer and breast cancer screening among women in
Homa Bay County, Kenya. International Journal of Community Medicine and
Public Health, 10(6), 1994–2000. https://doi.org/10.18203/2394-
6040.ijcmph20231673.

 Tarbo Nguveren Irene (S.O.N), Felix Blair Odhiambo*, Vincent Omwenga,

Daniel Kwalimwa, Salima Ruth Kihamba, Malusha James and Ogutu
Gideon. Exclusive Breastfeeding and Its Associated Factors Among Working
Mothers Presenting at The Sisters of The Nativity Hospital Jikwoyi, Urban –City,
Abuja, Nigeria. International Journal of Research and Innovation in Social
Science (IJRISS) |Volume VI, Issue IX, September 2022|ISSN 2454-6186.

 Felix Blair Odhiambo, John Paul Oyore and BOM Agina. Determinants of
Breast Cancer Screening among Rural Women, Homa Bay County, Western
Kenya. International Journal of Research and Innovation in Social Science
(IJRISS) | Volume VI, Issue VI, June 2022 | ISSN 2454–6186.

 Collins Oduor Owino and Felix Blair Odhiambo. Hepatitis B Virus: The Silent
Killer.July 23, 2020.https://uonresearch.org/blog/hepatitis-b-virus-the-silent-killer/

 Odhiambo F B, Kikuvi G, Omolo J, Wanzala P. Factors Associated with Uptake

of
Voluntary Counselling and Testing Services among Boda Boda Operators in
Ndhiwa
Constituency, Western Kenya. Africa Journal of Health Sciences. 2012; 21:133-
142

 Odhiambo FB, Kikuvi G, Omolo J, Wanzala (2012) Utilization and Awareness of

HIV/AIDS Voluntary Counselling and Testing Service among Boda Boda
Operators in Ndhiwa Constituency, Homa Bay County- Conference Proceedings,
4th annual Institute of Tropical Medicine and Infectious Diseases Scientific
Conference, Jomo Kenyatta University of Agriculture and Technology

 Odhiambo F, Chek JBL, Moro J. Effects of Phenobarbital and Carbon

tetrachloride on liver enzymes, Journal of Applied Biosciences 56: 4097– 4107

Referees
Dr. John Paul Oyore
Kenyatta University
Department of Community Health and Epidemiology
Position: Senior Lecturer
40
Email: jpoyore@gmail.com/ oyore.john@ku.ac.ke; Phone: 0722335878
Relation: PhD supervisor

Prof. Bonaventure Again

Organization: Kenyatta University
Position: Associate Professor and Executive Dean
Email: agina.bonventure@ku.ac.ke; Phone: 0722 526728
Relation: PhD Supervisor

Mr. Gideon Mauti

Organization: Catholic University of Eastern Africa
Position: Lecturer and Head of Department
Department of Community Health and Development
Email: gmauti@cuea.edu; Phone: +254713731147
Relation: Work supervisor

41
 APPENDIX IV: CONSENT FORM

PARTICIPANT INFORMATION AND CONSENT FORM

FOR ENROLLMENT IN THE STUDY
Title of Study: Factors associated with choices of place of delivery among post natal
women in Turkana County, Kenya

Principal Investigator\and institutional affiliation: DOYE NAMORU CINTHIA

Co-Investigators and institutional affiliation:

Introduction: I would like to tell you about a study being conducted by the above
listed researchers. The purpose of this consent form is to give you the information
you will need to help you decide whether or not to be a participant in the study. Feel
free to ask any questions about the purpose of the research, what happens if you
participate in the study, the possible risks and benefits, your rights as a volunteer,
and anything else about the research or this form that is not clear. When we have
answered all your questions to your satisfaction, you may decide to be in the study
or not. This process is called 'informed consent'. Once you understand and agree to be
in the study, I will request you to sign your name on this form. You should
understand the general principles which apply to all participants in a medical
research: i) Your decision to participate is entirely voluntary ii) You may withdraw
from the study at any time without necessarily giving a reason for your withdrawal
iii) Refusal to participate in the research will not affect the services you are entitled to
in this health facility or other facilities. We will give you a copy of this form for
your records.

May I continue? YES / NO

This study has approval by The Kenyatta National Hospital-University of

Nairobi Ethics and Research Committee protocol No._____________

42
WHAT IS THIS STUDY ABOUT?

The researchers listed above are interviewing individuals who gave birth at home
or hospital. The purpose of the Interview is to find out the factors that influence
the choice of place of delivery among post natal women in Turkana County.
Participants in this Research study will be asked questions about level of awareness
and cultural factors. Participants will also have the choice to undergo test such as
interview. There will be approximately 400 participants in this study randomly
chosen. We are asking for your consent to consider participating in this study.

WHAT WILL HAPPEN IF YOU DECIDE TO BE IN THIS

RESEARCH STUDY? If you agree to participate in this study, the
following things will happen:

You will be interviewed by a trained interviewer in a private area where you feel
comfortable
answering questions. The interview will last approximately 15 minutes. The
Interview will cover topics such as choices of delivery. .

After the interview has finished, (explain in details any procedures that are
necessary e.g blood draws, counseling etc.)

We will ask for a telephone number where we can contact you if necessary. If you
agree to provide your contact information, it will be used only by people working
for this study and will never be shared with others. The reasons why we
may need to contact you include: clarification and instructions,

Obtaining concent from participants, to monitor participant’s

wellbeing throughout the study, to maintain participant’s interest
and commitment to the study, and also to gather feedbacks from
participants about their experiencein the study.

43
 ARE THERE ANY RISKS, HARMS DISCOMFORTS ASSOCIATED WITH
THIS STUDY?
Medical research has the potential to introduce psychological, social, emotional and
physical risks. Effort should always be put in place to minimize the risks. One
potential risk of being in the study is loss of privacy. We will keep everything you
tell us as confidential as possible. We will use a code number to identify you in a
password-protected computer database and will keep all of our paper records in a
locked file cabinet. However, no system of protecting your confidentiality can be
absolutely secure, so it is still possible that someone could find out you were in this
study and could find out information about you.

Also, answering questions in the interview may be uncomfortable for you. If there are
any questions you do not want to answer, you can skip them. You have the right to
refuse the interview or any questions asked during the interview.

It may be embarrassing for you to answer some questions,______________we will do everything we

can to ensure that this
Is done in private. Furthermore, all study staff and interviewers are professionals
with special training in these examinations/interviews. Also, opening up may be
stressful (e.g event recalls).

You may feel some discomfort when recalling and you may have a small bruise or
swelling in
Your hands. In case of an injury, illness or complications related to this study,
contact the study
Staff right away at the number provided at the end of this document. The study
staff will treat you for minor conditions or refer you when necessary.

ARE THERE ANY BENEFITS BEING IN THIS STUDY?

You may benefit by receiving free advice, health information and testing, (list e.g.
counselling, Health information etc)

44
We will refer you to a hospital for care and support where necessary. Also, the
information you provide will help us better understand. This
information is a contribution to science and advances our understanding of
the topic, benefiting both current and future generation.

WILL BEING IN THIS STUDY COST YOU ANYTHING?

(Explain)

No, participation in this study will not incur any cost for you. Your participation
if entirely voluntary and does not involve any financial obligations or
reimbursements.

WILL YOU GET REFUND FOR ANY MONEY SPENT AS PART OF

THIS STUDY?

No, as there are no expences associated with this study, there will be no
refunds for any money spent.

WHAT IF YOU HAVE QUESTIONS IN FUTURE?

If you have further questions or concerns about participating in this study, please call
or send a text message to the study staff at the number provided at the bottom of this
page.

For more information about your rights as a research participant you may contact
the Secretary/Chairperson, Kenyatta National Hospital-University of Nairobi Ethics
and Research Committee Telephone No. 0793039923, email
doyenamoru@gmail.com .Or telephone no. 0723914385, email:
bodhiambo@cuea.edu

The study staff will pay you back for your charges to these numbers if the call is for
study-related communication.

WHAT ARE YOUR OTHER CHOICES?

45
Your decision to participate in research is voluntary. You are free to decline
participation in the study and you can withdraw from the study at any time without
injustice or loss of any benefits.

CONSENT FORM (STATEMENT

OF CONSENT) Participant’s
statement

I have read this consent form or had the information read to me. I have had the
chance to discuss this research study with a study counselor. I have had my questions
answered in a language that I understand. The risks and benefits have been explained
to me. I understand that my participation in this study is voluntary and that I may
choose to withdraw any time. I freely agree to participate in this research study.

I understand that all efforts will be made to keep information regarding my

personal identity confidential.
By signing this consent form, I have not given up any of the legal rights that I have
as a participant in a research study.

I agree to participate in this research study: Yes No

I agree to have (define specimen) preserved for later study: Yes No

I agree to provide contact information for follow-up: Yes No

Participant printed name:__________________________________________________

Participant signature / Thumb stamp ____________________________Date__________

Researcher’s statement

I, the undersigned, have fully explained the relevant details of this research study to
the participant named above and believe that the participant has understood and
has willingly and freely given his/her consent.

Researcher‘s Name: Date:

Signature____________________________________________________________________

46
Role in the study: ___________________[i.e. study staff who explained informed consent form.]

Witness Printed Name (If witness is necessary, A witness is a person mutually

acceptable to both the researcher and participant)

Name___________________________________ Contact information_______________

Signature /Thumb stamp:____________________ Date;_____________________________

47
FOMU YA IDHINI YA WASHIRIKI
Ningependa kukueleza kuhusu utafiti unaofanywa na watafiti waliotajwa hapo juu.
Lengo la fomu hii ya ridhaa ni kukupatia habari ambazo zitakusaidia kuamua ikiwa
utakuwa mshiriki katika utafiti huu au la. Unaweza kuuliza maswali kuhusu lengo la
utafiti, kinachotokea ikiwa unashiriki katika utafiti, hatari na faida zinazowezekana,
haki zako kama mchangiaji wa hiari, na chochote kingine kuhusu utafiti au fomu hii
ambacho hakieleweki. Baada ya kujibu maswali yako yote kwa kuridhika, unaweza
kuamua ikiwa utashiriki katika utafiti au la. Mchakato huu unaitwa 'ridhaa
iliyofahamishwa'. Mara tu utakapoelewa na kukubali kushiriki katika utafiti,
nitakuomba uisaini jina lako kwenye fomu hii. Unapaswa kuelewa kanuni za jumla
ambazo zinatumika kwa washiriki wote katika utafiti wa matibabu:
i) Uamuzi wako wa kushiriki ni kikamilifu kwa hiari
ii) Unaweza kujitoa katika utafiti wakati wowote bila lazima kutoa sababu ya
kujitoa kwako
iii) Kukataa kushiriki katika utafiti hautaathiri huduma unazostahili katika kituo
hiki cha afya au vituo vingine. Tutakupa nakala ya fomu hii kwa ajili ya
kumbukumbu yako.

Naweza endelea? Ndio au la

Utafiti huu umepata idhini kutoka Kwa Kamati ya Maadili na Utafiti ya Hospitali ya
Taifa ya Kenyatta- Chuo Kikuu cha Nairobi, kwa mujibu wa itifaki No.

UTAFITI HUU UNAHUSU NINI?

Utafiti huu ni ya kuhoji wanawake walio jifungulia manyumbani au hospitalini,
sababu ya hii mahojiano ni kujua sababu zipi zilizo changia kwa mahali pa
kujifungulia. Washirika wa utafiti huu watapata kuulizwa maswali. Kutkuwa na
washirika karibu 400 kwa utafiti huu.

NINI KITATENDEKA UKIWAUTAKUBALI KUSHIRIKI KATIKA UTAFITI

HUU?
Ikiwa utakubali kushiriki katika utafiti huu, mambo yafuatayo yatatendeka:
Utafanyiwa mahojiano na mwandishi mahiri katika eneo binafsi ambapo utajisikia
huru kujibu maswali. Mahojiano yatachukua takriban dakika 15. Mahojiano
yatajumuisha masuala kuhusu chaguzi za kujifungua.
48
Baada ya mahojiano kukamilika, kutakuwa na taratibu nyingine kama vile kupima
damu au ushauri, kulingana na mahitaji maalum ya utafiti. Pia, tutakuomba namba ya
simu ambayo tunaweza kuwasiliana nawe ikiwa itahitajika. Ikiwa utakubali kutoa
taarifa yako ya mawasiliano, itatumika tu na watu wanaofanya kazi katika utafiti huu
na kamwe haitashirikishwa na wengine. Sababu za kuwasiliana nawe zinaweza kuwa:

JE, KUNA HATARI, MADHARA AU USUMBUFU WOWOTE

UNAOHUSIANA NA UTAFITI HUU?
Utafiti wa kisayansi una uwezo wa kuleta hatari za kisaikolojia, kijamii, kihisia, na
kimwili. Juhudi zote zinapaswa kufanywa ili kupunguza hatari hizo. Hatari moja
inayoweza kutokea katika utafiti huu ni kupoteza faragha. Tutahifadhi kila kitu
unachotuambia kwa kiwango cha juu cha usiri. Tutatumia nambari ya kanuni
kuwatambulisha wewe katika kompyuta iliyo na ulinzi wa nenosiri na tutahifadhi
rekodi zetu zote za karatasi katika kabati lililofungwa kwa ufunguo. Hata hivyo,
hakuna mfumo wa ulinzi wa faragha ambao unaweza kuwa kabisa salama, kwa hivyo
bado kuna uwezekano kwamba mtu anaweza kugundua kuwa ulishiriki katika utafiti
huu na kujua habari zako.
Pia, kujibu maswali katika mahojiano kunaweza kuwa usumbufu kwako. Ikiwa kuna
maswali ambayo hauitaki kujibu, unaweza kuyaruka. Una haki ya kukataa mahojiano
au kujibu maswali yoyote yaliyoulizwa wakati wa mahojiano.
Inaweza kuwa aibu kwako kujibu baadhi ya maswali, Tutafanya kila tuwezalo
kuhakikisha kuwa hii inafanyika kwa faragha. Zaidi ya hayo, wafanyakazi wote wa
utafiti na wawahojiwa ni wataalamu wenye mafunzo maalum katika
uchunguzi/hijasisho kama huu. Pia, kufunguka kunaweza kuleta msongo wa mawazo
(kama kukumbuka matukio fulani).
Unaweza kuhisi usumbufu kidogo

JE, KUNA FAIDA YOYOTE YA KUWA KATIKA UTAFITI HUU?

Unaweza kunufaika kwa kupokea ushauri wa bure, habari za afya na vipimo,
(orodhesha kwa mfano: ushauri nasaha, habari za afya nk).
Tutakuelekeza kwa hospitali kwa huduma na msaada ikiwa ni lazima. Pia, habari
unazotoa zitasaidia sisi kuelewa vizuri zaidi. Habari hii ni mchango kwa sayansi
JE, KUWA KATIKA UTAFITI HUU KUTAKUGHARIMU KITU
CHOCHOTE?
49
(Eleza)
Hapana, hautapata marejesho ya pesa yoyote uliyotumia kama sehemu ya utafiti huu.

IKIWA UNA MASWAKI SIKU ZIJAZO

Ikiwa una maswali au wasiwasi zaidi kuhusu kushiriki katika utafiti huu, tafadhali
piga simu au tuma ujumbe wa maandishi kwa wafanyakazi wa utafiti kwa namba
iliyotolewa chini ya ukurasa huu.
Kwa habari zaidi kuhusu haki zako Kama mshiriki wa utafiti, unaweza kuwasiliana na
Katibu/Mwenyekiti, Kamati ya Maadili na Utafiti ya Hospitali ya Taifa ya Kenyatta-
Chuo Kikuu cha Nairobi kwa namba ya simu 0793039924 au barua pepe kwa
doyenamoru@gmail.com au 0723914385

Wafanyakazi wa utafiti watakulipa gharama zako kwenye namba hizi ikiwa simu ni
kwa mawasiliano yanayohusiana na utafiti.

CHAGUO ZINGINE NI GANI?

Uamuzi wako wa kushiriki katika utafiti ni wa hiari. Una uhuru wa kukataa kushiriki
katika utafiti na unaweza kujitoa katika utafiti wakati wowote bila kuteswa au
kupoteza faida yoyote.

FOMU YA IDHINI (TAARIFA YA IDHINI)

Taarifa ya Mshiriki
Nimesoma fomu hii ya idhini au nimepewa habari hiyo. Nimepata nafasi ya kujadili
utafiti huu na mshauri wa utafiti. Maswali yangu yamejibiwa kwa lugha ninayoelewa.
Hatari na faida zimenielezwa. Naelewa kuwa ushiriki wangu katika utafiti huu ni wa
hiari na naweza kuchagua kujitoa wakati wowote. Ninaridhia kwa hiari kushiriki
katika utafiti huu.
Naelewa kuwa jitihada zote zitafanywa kuweka habari kuhusu utambulisho wangu
binafsi kuwa siri.
Kwa kusaini fomu hii ya idhini, sijapoteza haki zangu za kisheria kama mshiriki
katika utafiti.
Nakubali kushiriki katika utafiti huu: Ndiyo Hapana

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Nakubali kuwa na (taja kipande) kuhifadhiwa kwa ajili ya utafiti wa baadaye: Ndiyo
Hapana
Nakubali kutoa taarifa za mawasiliano kwa ajili ya ufuatiliaji: Ndiyo Hapana

Jina la Mshiriki (limeandikwa):

Sahihi ya Mshiriki / Muhuri wa Kidole Tarehe:

Taarifa ya Watafiti
Mimi, mwenye sahihi hapa chini, nimeelezea kikamilifu maelezo muhimu ya utafiti
huu kwa mshiriki aliyetajwa hapo juu na naamini kuwa mshiriki ameelewa na ametoa
idhini yake kwa hiari na kwa uhuru.

Jina la Watafiti : Tarehe:

Sahihi:

Jukumu katika utafiti: [Kwa mfano, wafanyakazi wa utafiti waliyeelezea fomu ya

idhini.]

Kwa maelezo zaidi wasiliana:

Kutoka
Hadi
Jina la Shahidi (Ikiwa Shahidi ni muhimu, Shahidi ni mtu anayekubalika Kwa pande
zote mbili, mtafiti na mshiriki)

Jina Maelezo ya mawasiliano

Sahihi / Muhuri wa Kidole: Tarehe;

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 APPENDIX V: QUESTIONNAIRE

Socio-Demographic information:
1) Age (umri) ……….

2) Marital status (hali ya ndoa) ……….

3) Occupational status (hali ya kazi) …………….

4) Educational level (kiiwango cha elimu) ………………

5) Number of household members (Idadi ya wanafamilia) ……………….

6) Religion (dini) ……………………

Previous birth experiences:

1) How many pregnancies have you had? (Umepata mimba ngapi?)

……………….
2) Where did you deliver your previous children? (Umejifungulia wapi watoto
wako wa mbeleni?)

a) Formal healthcare facility

b) Home

c) Traditional birth attendants

3) If you delivered at the formal healthcare facility, what were the reason for your
choice? (Ukipata kulifungulia katika kituo cha afya rasmi, ni sababu gani
zilizochangia uamui wako?)

a) Proximity to my residence

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 b) Safety and cleanliness of the facility

c) Trust in healthcare providers

d) Others (please specify)

4) If you did not deliver at a formal healthcare facility, what were the reasons for
your choice? (Ukipata hukujifungilia katika kitua cha afya rasmi ni sababu gani
zilizochangia uamuzi wako?)

a) Traditional beliefs and practices

b) Lack of trust in formal healthcare facilities

c) Proximity to my residence

d) Cost of services

e) Lack of transportation

f) Others (please specify)

Maternal factors influencing choice of place of delivery

5) Did you experience any complications during previous delivery? If yes please
describe (je, ulipata matatizo yoyote wakati wa kujifungua awali? Kama ndio,
tafadhali elezea)

…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
………………..

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Cultural factors
6) Are there any specific cultural or traditional beliefs and practices that influence
your choice of place of delivery? If yes please describe (je Kuna Imani au mla za
kitamaduni maalum zinaziathiri chaguo lako la mahali pa kujifungulia? Kama
ndo tafadhali elezea)

…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………….

7) Who decides where to go to deliver a baby? (Nani ndio anatoa maamuzi ya

mahali motto anazaliwa?)
 Myself
 Husband
 mother-in-law

8) Have you faced any barriers or challenges in accessing formal healthcare

facility? If yes please specify (je, umekumbana na vikwazo au changamoto
katika kupata huduma za afya rasmi? Kama ndio, tafadhali eleza)

…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………

9) Which gender of midwife do you prefer? (Unapendelea jinsia gani ya ukunga?)

 Male midwife
 Female midwife
 I don’t mind

Level of awareness

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10) How are you aware of the maternal healthcare services available in Turkana
County? (unajuaje kuhusu huduma za afya ya uzazi zinazopatikana katika kaunti
ya Turkana?)

a) Very aware
b) Somehow aware
c) Not aware
11) Have you received any information or education on importance of giving birth in
a formal healthcare facility? (Umewahi pata ujumbe au mafunzo kuhusu
umuhimu wa kujifungulia kwa huduma za afya rasmi?)

a) Yes

b) No

12) How knowledgeable are you about the potential risks and complications
associated with home birth or traditional attendants?

a) Very knowledgeable
b) Somehow knowledgeable
c) Not knowledgeable

13) What measures do you think can be made to encourage more women to choose
formal healthcare facilities for deliveries?
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
……………………………………………………………………

14) Are there any specific resources that would make you more likely to choose a
formal healthcare facility for delivery?

…………………………………………………………………………………
…………………………………………………………………………………

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…………………………………………………………………………………
…………………………………………………………………………….

APPENDIX VI: STUDY AREA MAP

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