| dc.description.abstract | Strong preferences are revealed when patients fail to utilize their nearby facilities and seek health care services at another facility. Bypassing rates for childbirth has been documented in literature and it ranges between 30% and 70 %. At Moi Teaching and Referral Hospital similar observation is made with majority of the women delivering at the facility having bypassed their nearby county health facilities. Thus, the current study sought to identify the individual and health facility factors that inform a woman’s decision to bypass county public health care facilities and seek childbirth services at Moi Teaching and Referral Hospital. A health facility based cross sectional study was conducted using quantitative approach of data collection. A total of 399 respondents were incorporated in the study. The independent variables studied were maternal age, marital status, level of education, occupation, parity, and previous pregnancy history, level of care at the public health facility, functionality of health facilities and ease of access of the nearest health facility. The dependent variable was bypassing health facilities. Descriptive statistics, bivariate and multivariate logistic regressions were used in data analysis. A p value less than 0.05 was considered statistically significant at 95% confidence interval. Results obtained showed that out of the 399 study participants, 76.7% of the women who delivered at Moi Teaching and Referral Hospital bypassed their nearby health facilities. Among the individual characteristics that significantly influenced bypassing were home county of residence (OR: 4.9; 95% CI: 2.2-11.1; p= 0.0001), having received ANC at MTRH (OR: 9.6; 95% CI: 8.1-14.6; p= <0.0001) history of assisted delivery or CS (OR: 0.2; 95% CI: 0.1-0.6; p= 0.006)and history of pregnancy related complications (OR: 0.1; 95% CI: 0.04-0.42; p=0.0004). Health facility factors that were significantly associated with bypassing were ambulance availability (OR: 0.4; 95% CI: 0.2-0.9; p= 0.03) and the availability of functional theatre and doctor to handle emergency cesarean sections (OR: 0.4; 95% CI: 0.2-0.8; p=0.01).Bypassing county health facilities therefore is a common phenomenon in Uasin Gishu County, especially among women residing within the county. Women are less likely to bypass facilities that are well equipped with a functional theatre as well as a standby doctor who can handle obstetric emergencies. The study recommended that there is need to create more awareness on the delivery service availability at the county health facilities. There is also the need to strengthen referral guidelines between the different tiers of care emphasizing the need to utilize nearby facilities for childbirth. More health facilities should also be equipped with drugs and supplies as well as functional theatres that can handle emergencies. | en_US |
