Determinants of institutional delivery in Kenya. Evidence from population and Demographic health survey,2014

Abstract Background: Maternal mortality in Kenya remains high. Analysis of the factors associated with institutional delivery is crucial to inform reproductive health policies and programs in public health. Objective: To identify the factors associated with institutional delivery among women of reproductive age in Kenya.Methods: Data sets for this study were extracted from the 2014 Kenya Demographic health surveys (KDHS, 2014); participants were 20,661 women between the age of 15-49-year. Data sets were analyzed using Chi-square tests, univariate and multivariable binary logistic regression. Factor analysis was used to explore potential subpopulation profiles related to institutional delivery. Results: On national average 62.10% of participant women utilized institutional delivery. Although all sociodemographic variables in this analysis were associated with institutional delivery, multivariable analysis show that women from urban place were 1.37 time (95%CI:1.14-1.65) more likely to delivery in health facility compared to women from rural place. Women with higher education level tended to deliver in health facility compared with no education (Secondary and above: OR:4.03; 95%CI:2.91-5.59; primary level: OR:2.03;95%CI:1.53-2.68). Household wealth status was positively associated, richest 11.12 times (95%CI:7.18-17.22), richer 3.88 times (95% CI:2.96-5.07), middle 2.33 times (95%CI:1.87-2.90), and poorer1.82 times (95% CI:1.40-2.23) more to use institutional delivery than the poorest. The odds of having institutional delivery was 2.58 times (95%CI:2.07-3.23) and 1.44 times (95%CI:1.20-1.71) higher among the first and second to fourth birth orders than five or above respectively. Three common factors with high loading socioeconomic on (Wealth quintile, TV watching, Mother’s education, Radio listening, and Place of residence), family support on (Wanted last child, Mother’s occupation, and Husband education), and women status on (Mother age group, Birth order, and Marital status) were found significantly (p<0.001) associated with institutional delivery. Women with high scores of these factors were tended to received more institutional deliveriesConclusion: Institutional delivery is low in Kenya. Maternal health programs focused on subpopulation profiles should be designed to encourage institutional delivery. Further efforts are needed to improve the accessibility and optimal up-take of institutional delivery.