The Socio-Economic Determinants of Maternal Health Care Utilization in Kailahun District, Sierra Leone, 2020

Abstract

BACKGROUND: Ascertaining the key determinants of maternal healthcare service utilization and their relative importance is critical to priority setting in policy development. Sierra Leone has one of the world’s highest maternal death ratios in the context of a weak health system with poor health facilities. The objectives of this study were to determine; the level of utilization of Antenatal Care (ANC), Skilled Birth Attendants (SBA), Postnatal Care (PNC) services, and factors that influence the utilization of these services. METHODS: A retrospective community-based cross-sectional study involving 554 women of reproductive age between 15-49 years who had at least one delivery in the last 3 years before this study in Kailahun District, Sierra Leone. The outcome variables were the utilization of skilled ANC, skilled birth attendants, and postnatal care services. The independent variables were categorized as enabling and predisposing factors. Data were analyzed using Excel 2018 and Stata IC 15.0. Bivariate, multivariate, and multinomial regression models were used in the analysis. The study was carried out from November 2019 to October 2020. RESULTS: The median age of respondents was 25 years (Q1=17 years, Q3=30 years). Seventy-eight percent (78%) of women had ANC from a skilled provider. Fifty-five percent (55%) made their first ANC visit in the first trimester, 88.63% had 4 or more ANC visits. Only 35.92% of women were delivered by a skilled birth attendant. Education of women, residence, parity, occupation of women, husband's education, and proximity to the health facility was significantly associated with the use of maternal healthcare service. Women that live in the city (AOR 6.20, 95% CI 3.61-10.63, P=<0.001) and women whose husbands completed primary education (AOR 2.38, 95% CI 1.30-4.35, P=0.005) were more likely to use skilled birth attendant. Women that walked 30-60 minutes to seek healthcare were more likely to use a skilled birth attendant than those that walked <30 (AOR 2.98, 95% CI 1.67-5.33, P=<0.001). Women who had a secondary/vocational level of education had 2.35 times increased odds of utilizing the standard PNC category as compared to those with no education (OR=2.35, 95% CI=1.19-4.63, P=0.013). CONCLUSION: The majority had 4 or more ANC visits yet the use of skilled birth attendants was low. Urban residence and education were significantly associated with the use of the standard PNC category. Education level and occupation of women, Husband's education, urban residence, and distance to health facilities were significant determinants of SBA use. To improve the utilization of maternal health care services, national healthcare policies should target the advancement of education, rural infrastructure, and the empowerment of women