Social determinants of maternal healthcare-seeking behaviour in the informal settlements of Nairobi city, Kenya

Abstract

Despite the fact that the government of Kenya has taken several steps to make it easier for all women to access maternal healthcare services (MHS), studies show that utilization of these services continues to be poor in the informal settlements of Nairobi, resulting in adverse pregnancy outcomes. In view of the aforementioned, this study sought to investigate the social determinants of maternal healthcare-seeking behaviour (MHsB) in informal settlements. The specific objectives of the study were to establish the level of MHsB among women in the study area; examine the effects of availability of MHS on MHsB; determine the influence of socio-demographic factors on MHsB; and evaluate the relationship between women’s status and their MHsB. The hypotheses of the study were that maternal MHsB is low in the study area; availability of maternal healthcare services does not influence maternal healthcare-seeking behaviour; there is a positive and strong association between socio-demographic factors and MHsB; and that women of a higher status are more likely to have better MHsB than their counterparts of a lower status. A thematic literature review was conducted based on the objectives of the study. The three delays model was applied as the theoretical framework for this study. The study was conducted in Korogocho slums, Nairobi, due to evidence that among all informal settlements of Nairobi, Korogocho has persistently recorded the worst pregnancy outcomes despite apparent availability of healthcare facilities. The study adopted a mixed method approach, which involved a survey and analysis of secondary data. The survey had 512 main respondents, who were drawn from among women who delivered in the 12 months preceding data collection and 46 key informants drawn from healthcare practitioners. Respondents were selected through cluster and systematic random sampling technique, while Key informants were selected through purposive sampling method. Data was collected from main respondents using questionnaires and focus group discussions, and from key informants through in-depth interviews. Qualitative data was summarized into themes and analyzed through content analysis. Descriptive statistics were applied to present the characteristics of the respondents, which have been displayed in frequency tables and charts. Inferential statistics were used to determine the association between socio-demographic determinants and status of women and MHsB. The study established that 39%, 33%, and 28% of the respondents had high, mediumand lowMHsB respectively. The study found that there is a statistically significant relationship between MHsB and indicators of availability of MHS, like perceived quality of MHS, perceptions about the cost of services, and perceived availability of medical personnel and equipment. The study also revealed that demographic factors such as age, marriage, ethnicity and religious affiliation have a weak association with MHsB. Other socio-demographic factors like previous pregnancy outcomes and maternal knowledge were also found to influence MHsB. The study established that there is a strong and positive association between MHsB and indicators of socio-economic status (Gamma = 0.5872, 0.7494, 0.5928, and 0.5283 for level of education, income, occupation, and autonomy respectively). The study recommends that the Kenyan national and Nairobi County governments put in place measures to improve and monitor quality, and conduct awareness campaigns with targeted messages to improve maternal knowledge, with a view to improving MHsB in informal settlements