Determinants Of Maternal Mortality In Kenya

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A Research Project Submitted in Partial Fulfillment Of The Requirements For The Award Of The Doctorate
Degree Of (Insert Name), (University Name).

April 2019
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I hereby certify that this research project is entirely my original work that has not been earlier
accepted. I have certified that this work is part of my exploration except whereby directly obtained
quotes from the sourced data though referenced to establish its originality. Hence, I give direct
consent for my research project, if approved by the University Panel to be present for future research
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 Abstract

Maternal death is high in Kenya due to obstructed labor, insecure abortion, hemorrhage, and
hypertensive conditions of pregnancy. The aim of this study was to asses determinants of maternal
mortality in Kenya from 2010 to 2014. In the introduction chapter, we are notified that socioeconomic
constraints affect the maternal mortality. On literature chapter, the empirical and theoretical research
on literature is backed up by credible authors. The methodology chapter involves the study that strives
to establish the determinants of maternal mortality. On data analysis, findings and discussion section,
the study established that that less age, single marital status, low education level, low wealth index, and
rural areas have a statistically significant difference with maternal mortality. On conclusion chapter,
the research project deduces that there is a statistically significance between socioeconomic constraints
and maternal mortality in Kenya.
 Acknowledgement

This project is based on the research conducted to evaluate the determinants of the maternal
mortality in Kenya. I am appreciative for some friends and staff of the academic institution for their
motivation, determinations, and suggestions that helped me to organize. With every chapter presented,
I accrued benefits from the willingness of many persons that I collected details from persons by
carrying out observations, though most significantly my supervisor. Mr/Mrs. (Insert Name) was
instrumental in helping me carry out the entire research exercise. I wish to thank my project
supervisor (Insert Name), the University academic library manager (Insert Name) for permitting me
get the significant research materials. Finally, i am grateful to my family for the support that they have
given me throughout the period of the exercise. Due to the demands of the study, i spent less time
caring and performing family chores. My thanks to them for their support and understanding. I
believed i had the capacity to overwhelm the issues that I encountered due to their continuous
encouragement.
Table of Content
 List Of Abbreviations

SPSS Statistical Package for the Social Sciences

ANC Antenatal Care

MDG Millenium Development Goals

 CHAPTER ONE: INTRODUCTION

1.1 Introduction of the Study

The International Statistical Classification of Diseases and Related Health Problem defines maternal

health as the demise of a woman whereas pregnant or within forty-two days of termination of pregnancy,

despite the duration and the site of the pregnancy, from any cause associated, or its administration though

not from accidental causes (Managou ,2015). The rates of maternal mortality rates are increasing in

developing nation and impact the population. (Daniel, 2008). Lincia approximates that 0.99 of the entire

maternal deaths happen in the developing nations are mainly the underprivileged and poorest women in

the society. Hemorrhaging during sepsis, insecure abortion, hypertension, and obstructed labor are

projected to account 80% of the global maternal deaths. In most instances, these causes are easily

preventable with sufficient resources (Daniel, 2008).

The nations that enjoy high maternal mortality ratios encounter two key issues: how to offer skilled birth

attendance for ordinary births and support complications for emergencies and to make the delivery care

cost-effective (Waterstone et al., 2001). The initial fundamental step in guaranteeing maternal health is

the provision of significant obstetric care such as basic and complex obstetric care. The United Nations

and World Health Organizations describe essential obstetric care as the potential to offer continuously,

timely, the particular intervention of obstetric into basic and comprehensive significant obstetric care

(Daniel, 2008).

The basic significant obstetric care constitutes uterotonics, parenteral antibiotics, and anti-convulsants,

treatment of partial abortion, vaginal extraction, and removal of the trained placenta which should be

present at the core of the health center level. The comprehensive essential obstetric care constitutes

everything in fundamental obstetric care alongside blood transfusion, major surgery, and treatment of

newborn and pregnancy complications (Daniel, 2008).

Maternal mortality in most third world nations impacts both the urban and rural population. The late

maternal demise is those that happen between forty-two days and less than an year after the pregnancy
termination. However, other researchers have continued to oppose the other author. Shiffman articulated

that the strongest correlation of maternal mortality in developing nations was the enrollment of secondary

school levels which we categorized under the empowerment (Storeng & Béhague, 2017). The health

education about pregnancy ad postpartum period, early detection and treatment of complications in

pregnancy, and preventable efforts outline the best examples of comprehensive antenatal care. Antenatal

care has been acknowledged for the enhancement in maternal health. However, this might not be the

instance. Shiffman discovered that antenatal care is not a statistical correlation between child deaths in

third world nations.

Childbirths and pregnancy are the natural processes in the life of a woman. Motherhood should be a

period of anticipation and joy for a woman, her family, and her community though by no means it lacks

risks. For some women in particular parts of the world especially the third world nation, the reality of

motherhood is always grim. According to these women, motherhood is always linked with unforeseen

complications. Some women lose the foetus before being born or shortly after birth whereas some people

lost both their lives and their precious baby.

William Farr was the first register general of Wales and England. He inquired about maternal mortality in

England. He said “A deep, dark continuous stream of mortality….. How long is this sacrifice to go on?”

However, this questions have been puzzling and remains unanswered for many decades to come whereas

the risk of perishing in pregnancy, childbirth or shortly after delivery is currently seldom in industrialized

nations. The regions of Asia, Africa, and Latin America are still a daily event. The World Health

Organization and United Nations Funds for Population Affairs (UNFPA) approximated that 515, 000

women perish yearly due to pregnancy complications. Nearly 6, 300 women perish annually during

childbirth and pregnancy, a tragic number that reflects insufficient progress towards offering the

fundamental health services to the whole population of women. The World Health Organization ranks

Kenya as among the top ten nations that constituted 58% of the worldwide maternal deaths in 2013. These

figures accounted for two percent of the deaths in Kenya. (Misati,2013). This extraordinary disparity in

the rates of maternal mortality between the third world nations and developed is the most striking aspect
across the universe regarding maternal health. The variation in the maternal mortality levels between the

developing and developed nations demonstrate the biggest disparity than abt other public health sign that

the organization monitors.

Millenium Development Goal 5 necessitates for the enhancement of maternal health and particularly to

decrease the 75% of the maternal mortality ratios. The latter is the number of maternal deaths per 100, 000

live births between 1990 and 2015. The maternal mortality has recorded its highest figures unlike any other

years at 400-600 deaths in every 100, 000 live births over the previous decades leading to little or no

progress that is made towards attaining the millennium developing goals(Friedman,2015).

Based on the national Demographic and Health Survey in 2008 and 2009, the maternal mortality ratio was

488 maternal deaths in every 100, 000 births. The previous year was 414 demises per 100, 000 live births

in 20003 due to the uncertainty emanating from these estimates. The 2008 and 2009 estimates epitomized

statistically significant change from the 2003 approximate. On the present progress, Kenya has fallen short

of attaining the mortality reduction target of 147 in every 100, 000 live birth in 2015. The proportion of

births that were attended by the health personnel is less than the 90% target by 2015 (Alkema et al..,2016)

The call for the decrease in maternal mortality is a global initiative that the United Nations, World Bank,

the Organization of Economic Cooperation, and the International Monetary Fund. The decrease of maternal

mortality was a predominant objective in many worldwide conferences such as Nairobi Safe Motherhood

Conference. The Safe Motherhood Conference that occurred in Nairobi, Kenya in February 1987. The

objective of the workshop was to elicit attention on maternal mortality and mobilize prompt and concerted

actions at the national and global levels to hinder incessant tragedy (Alkema et al..,2016).

1.1.2 2013 Maternal Policy

Kenya for a long time has suffered from a higher rate of maternal morbidity and mortality. The recent

estimates show the maternal mortality rate at approximately 488 deaths per 100,000 live births, which is

above the MGD target of 147 per 100000 in the year 2015.however, for every woman who dies in Kenya
due to childbirth translates to the estimate of 20-30 women suffer complications during pregnancy and

delivery. These rates have become consistently despite varies improvement in other health. The main

problem includes ante-natal, delivery, post-natal services. As a matter of facts, many women still in a

considerable distance from health facilities and even cannot afford to cater to fees for maternal services. In

2015 access to a skilled delivery was the main challenge. According to statistic carried out depicts that only

44% of births in Kenya undergo delivery supervision of the specialized birth assistance, less below the

target of 90% of deliveries by 2015.on the other hand 28% of births are delivered through help of traditional

birth attendants, 21% friends and relatives and 7% of births women receive no support (Abuya et al., 2018).

In the address of this problem, the government of Kenya initiates a policy of free maternity services in all

public facilities. Through this initiative, health facilities began to feel the effect of this policy. For instance

in Pumwani maternity hospital delivered an unprecedented 100 births. Additionally, the Director of Public

health and Sanitation approximated a 10% increase in deliveries across the country, with a 50% increase in

certain countries. The indicators in some facilities like Kenyatta National Hospital (KNH) with a month the

number of mothers seeking maternal care had risen by 100 percent. The government committed resource

to boost the program in July 2013 a total of 10.6 billion has funded to the maternal health care program.

The policy has registered a positive impact on women which has led to the reduction of the maternal

mortality by a considerable percentage (Njuguna et al., 2017).

1.2 Background

Most promising interventions coexist to decrease the rate of maternal mortality. However, communities

and families occasionally do not access care or practice preventive norm for a diversity of economic,

cultural, and social reasons. The adoption of a single action instead of a comprehensive strategy is one of

the arguments behind the slow progress in enhancing the maternal health. Liu, D. (2014).

In 2010, nearly 800 women perished because of the complications of pregnancy and childbirth such as the

serious bleeding after infections, childbirth, and insecure abortions. Four hundred forty deaths of thus

population happened in SUB-Saharan Africa and 230 in Southern Asia when compared to five in
developed nations. Kenya continues to encounter poor health results because of a rapidly growing

population, emerging illnesses, high rates of fertility, high levels of poverty, and social, economic

constraints (Liu.,2014).

The liability of high maternal mortality ratio is not reducing quickly sufficient to satisfy the needs of the

millennium development Goal. Maternal deaths increased from 414 deaths in every 100, 000 live births

from 2003 to 488 in every 100, 000 live births in 2008. It equates to nearly 21 mothers every day.

Whereas effective approaches to decrease the maternal mortality are recognized, distinct strategies and

interventions on maternal mortality have either partially been effective or ineffective because of the

number of resources. More focus is placed on interventions that illuminate the confounding aspects based

on the maternal mortality. These aspects revolve around the education, societal, and cultural deeds. (Yego

et al.., 2013).

There is a craving to attain the millennium development goals of decreasing the maternal mortality ratio

by 2020. The government of Kenya has been exploring the distinct innovative ways that constitute the

eradication of the fees for pregnant mothers that attend an Ante natal clinic (ANC) in public hospitals,

intensifying health education on skilled deliveries, and providing the underprivileged mothers that face

financial implications with voucher for health in the rural areas. However, the mothers still pay some

concealed expenses when they deal with the health facilities.

In the pretext of emergency preparedness, a precise referral strategy, enhanced institutional,

infrastructural development, skilled manpower, and presence of medical products are significant in

illumiantin the maternal demises at the levels of the cimmunity. Education of the mothers is a key

determinant in making better decisions. Education imrpoves the caapbility of women to access the

coexisting health resources that constitute skilled attendants for child births, institutional deliveries and

this decreases the risk of perishing during the pregnancy and child birth.

1.3 Statement of the Problem

Newborn, child mortality, and morbidity are restraining the development of Kenya. The preventable

maternal mortality and morbidity are agitating for the human rights issues that infringe the life, education,
dignity, and details of the woman. The response to maternal morbidity and mortality will entail the

enforcement of specific ethical and legal obligations such as the establishment of effective mechanisms of

responsibility (Misati,2013).

High maternal mortality rates gives an insight of the poor functioning of the health systems. The

likelihood of a woman perishing or becoming disabled during childbirth and pregnancy is closely related

to the economic and social status, the behaviors and values of her culture and the geographical location of

her household. When the woman is marginalized and underprivileged in the society, the risk of her

perishing is high. The rates of maternal mortality reflect the differences between the developing and

developed economies more than any other measure of health. It is approximated that annually about 210

women conceive, 515, 000 perish, and 30 million women experience pregnancy complications.

Nonetheless, three million babies are still born whereas three million perish in the initial week of the

initial week if life ad most bear distinct levels of disability. These are bad lucks which can be eluded.

Maternal health care is instrumental in decreasing childbirth maternal mortality particularly, skilled

attendance at birth and postnatal care and antenatal care. (Misati, 2013).

Maternal health care in Kenya has been remarkable because of the positive changes though it is not

sufficient particularly the ratio of women who make four antenatal care visits who deliver at the health

facility and who get postnatal care. This hinders the progress of attaining the vision 2030 that focuses on

lowering the maternal mortality ratio to less than 200 in every 100, 000 livebirths. The government in

Kenya enforced the free maternal care in June 2013 to improve the utilization of maternal healthcare

services. There has been an initiative that aims at raising the use of maternal health services. Despite these

endeavors, the use of maternal care services is low.

The Uhuru government has been striving to improve the maternal healthcare. Kenya lingers to male; less

progression in this context. The year 2015 discloses that the maternal mortality rate was 488 deaths in

every 100,000 live births. Evidently, the nation is off track in attaining the United Nations Millennium

Development Goal numbers four and 8 five by 2015. Kenya had set targets to decrease the demise of
children to 147 per 100,000 live births in every 2015. There is less use of maternal health care services in

Kenya which can hurt the maternal mortality rate (Misati,2013).

1.3 Aims and Objectives of the Study ‘

1) What are the interventions to decrease mortality?

2) What are the determinants of mortality in Kenya?

1.4 Hypothesis of the Study

H01: Utilization of services in health facilities by maternal mothers does not depend on the level of

education.

H02: Utilization of services in health facilities by maternal mothers does depend on the level of education.

1.5 Significance of the Study

The importance attempted to provide proof on the extent to which socioeconomic constraints for health

can increase maternal mortality. The resources will form a basis in brainstorming the solutions to the

causes of maternal mortality and programming of maternal health service in the country.

1.6 Scope of the Study

The study will focus on conducting an experiment in the 47 counties of Kenya to understand the impact of

socioeconomic constraints on maternal mortality in Kenya.

1.7 Research Question

1) What are the determinants of maternal mortality in Kenya?

1.8 Justification of the Study

The Millennium Development Goal Five seeks to improve maternal health and reduce maternal deaths by

three-quarters by 2015 and improve skilled attendants to 95 percent by 2015. The government of Kenya

development partners and other stakeholders have implemented programs in pursuit of improving

maternal health and in effect reducing maternal mortality. Despite these laudable policies and programs,

maternal mortality in Kenya is still unacceptably high. Although high maternal mortality rates and

absence of gynaecologists and obstetricians are positively correlated, many of the programs established in

the developing countries to improve maternal health care have not been shown to reduce maternal
mortality. The findings of this study will therefore be relevant to all stakeholders concerned about

reducing maternal mortality by promoting maternal health in the study area and the country at large. The

findings would also provide the needed statistical evidence to justify the success or failure of programs

implemented so far.

1.9 Limitation of the Study

Some of the maternal deaths files that were revised contained missing information. However, after cross

checking with the death register and demise notification records in the facilities disclosed that all the

missing information were corrected. In the evaluation of the determinants of maternal serve utilization,

there approximated after investigating further with the customer. The study was narrowed to Nairobi City

because of the financial repercussions and restrained timeline of which the study was to be finalized and

submitted for academic motives.

Chapter 2: Literature Review

1.1 Introduction
 The motive of this chapter is to review the literature of credible researchers on the determinants of

maternal mortality in Kenya. The chapter will constitute of the empirical, theoretical, and conceptual

framework of the determinants of the deaths of children. The study explores the variables such as maternal

mortality, level of education, marital status, and wealth index. First, it gives a presentation of the recent

trends in maternal mortality in Kenya. Secondly, it reviews the determinants of the maternal deaths during

childhood. The relationship between the variables and the increase of maternal deaths in Kenya will be

reviewed. Maternal mortality is a problem facing the health care sector. Various solutions require to be

brainstormed to solve the menace. Thirdly, the paper will review the intervention that the government of

Kenya should embrace to tackle the maternal mortality in Kenya. In addition, the theoretical framework

will discuss the theories associated maternal mortality. In addition, a conceptual framework will be drawn

to give an insight to the audience on the relationship between the dependent and the independent variables.

Lastly, a conclusion will give the summary of the review of literature by acknowledging the contributions

of others to the topic under study.

2.2 Empirical Review

2.2.1 Definition of Maternal Mortality

The definition of maternal mortality has been similar among various people and organizations. It is

defined as the demise of a woman whereas pregnant or in 42 days of pregnancy termination, regardless of

its duration and site, from any cause associated or aggravated by the pregnancy though not from the

accidental causes. This description constitutes the direct obstetric death where the demise happens due to

obstetric complications including eclampsia. On the other hand, it involves the indirect obstetric deaths that

happen when an underpinning previously coexisting medical disorder which evolved during pregnancy

though is aggravated by pregnancy. As demises that are parenthetic require to be omitted, then the

information on the triggers of demise is necessitated to use this definition.

2.2.3 Determinants of Maternal Mortality

2.2.3.1 Education
Maternal education is a significant determining factor of maternal mortality and mostly utilized as a proxy

for socioeconomic mother status. The illiterate mothers experience high levels of child mortality. Various

individuals have given an insight into how maternal education impacts the health of a woman. The more

educated mother adopt less sophisticated health knowledge in contrast to the fatalistic acceptance of health

results because they adopt the alternatives to child care.

These women have the liberty to feed their children and practice child care more suitably. The educated

women are more probable of enjoying the contemporary world. Continuous communication with nurses

and doctors should be easier for the literate women. In addition, they might change the ancient equilibrium

of family relationships. In different nation, education might have an impact over the health of the mother

through a distinct channel. The literate mothers might use the health inputs more efficiently and

productively to grasp of more information on the best allocation of health inputs. Nonetheless, the mothers

might have more resources of the family when marrying more affluent men or working outside. These

actions might enhance the mother health.

The lack of education contributes to maternal mortality. Pembe et al., (2009) articulates that the lack of

education can impede the knowledge of deadly obstetrical complications which decreases the

acknowledgment of women of the need to pursue the risk-suitable health care. These women have less

awareness that prevails in obstetric complications. However, the authors suggest various measures to tackle

the menace. They articulate that continuous counseling and engaging with other family members in

postnatal care and antenatal car as well as telecasting sessions that target the entire community will increase

the awareness of obstetrical complications stipulated in the second-millennium development goal (Pembe

et al., 2009).

An ecological study carried out in Iran discovered equivalent results to the examination conducted in

Uganda. The gathered data constituted the maternal mortality ratio, urban residency, and unemployment.

There was a statistically significant relationship between maternal mortality and male literacy. The authors

deduced that focus should be based on the literacy of the male gender especially in patriarchal societies as

a means of decreasing maternal mortality. The initiatives aimed at raising the rates of male literacy could
enhance the mother health and that of the society. In addition, the authors suggested the mothers should be

supported with enough capital and health practitioners (Zolala et al., 2012).

Few studies show the protective impact of education on maternal deaths though the size of the impact differs

between the studies. One argument is that the distinct measurements are utilized to evaluate education. The

level of education is occasionally evaluated by the duration of school and groups span from any schooling

to more differentiated evaluations including one to four years of schooling at the different education levels.

The UNESCO International standard Classification suggests the public use various groups. Primary

education level ranges from one to six years while lower secondary spans from seven to nine years. The

upper secondary level is based on individuals from ten to twelve years. This has been utilized in a Global

Survey on Birth Outcomes by world health organization. Maternal education has been commonly evaluated.

Few studies probed the linkage between education and maternal mortality.

The pathway by which education might influence maternal mortality is via increased utilization of health

care but also better health status. Better education might also reflect family and childhood background,

which might reduce the likelihood of harmful traditional practices such as food restriction being present in

familial norms and beliefs. Higher levels of education might relate to higher economic and social status,

and thus they decrease maternal mortality. Education has consistently been acclaimed as a significant

determining factor of health results. Various studies show a protective impact of higher education on

maternal mortality. As aforementioned, the impact of education on maternal mortality might be effective

in enhancing access to medical care. The impact of education on accessibility to skilled attendance appears

to be strong, consistent, and dose-dependent. Education has created awareness on the importance of

Caesarean section in preventing maternal mortality. Education strongly impacts the uptake of antenatal

care.

2.2.3.2 Marital status

Marital status is measured with the relationship status. The distinction between polygamous or

monogamous marriage is predominantly evaluated. The pathway illustrating how marital status might

impact maternal mortality could be through impacting the social-economic situation and decision making
of the woman. Some studies show that single mothers have a higher risk of perishing though always the

impact is small when changed for other aspects.

2.2.3.3 Wealth Index

Income is the financial assets at the disposal of the family, and this does not affect the mother mortality

directly. The income might impact the health of the mother through the inputs presents to the family. Hence,

the only way it can impact the mother health is through the excluded variables in the model and the health

inputs over the unobserved frailty. To approximate the impacts of health inputs on the equation of health

hybrid are established which constitute prices and wealth index due to the data limitations on health inputs.

It is difficult to interpret a hybrid model. The change in health inputs will influence other behavior through

changing economic resources left for other variables. Hence the effect of the inputs of health will not be

observed in their effect, and they will constitute the impacts of other norms that change.

The income that is not included in the equation of infant health does not often refer to income at the level

of households. Some studies constitute the income per capital to assess the factors that create variation in

the survival of a child. The aspects measuring structural instead of personal phenomena are not discovered

to exercise any effect because of the lack of variation in these aspects of one nation. The time series analysis

is appropriate to assess the likely impacts of income per capital.

2.2.3.4 Age

Age is a risk factor of maternal mortality and should be considered due to child brides. Notably, a girl who

is obliged to marry before eighteen years. It happens as a way to settle a debt and to safeguard a girl from

financial independence. In South Asia and Sub-Saharan, 50% to 70% of females are married before eighteen

years despite an infringement of human rights (Raj & Boehmer, 2013). the prevalence of child marriages

happen in developing nations, risk factors for girls obliged to marry in their teenage years are low

socioeconomic status (Raj & Boehmer, 2013). the social context of child brides entails the topic of gender

disparity and the undermining of females where they face hardships such as limited job opportunities and

increased violence against them by the opposite gender.

Girls that are married in their teenage years are more probable to become pregnant. This raises the level of

risk for maternal mortality such as low birth weight, anemia, and preterm birth. The use of contraceptive is

less among the adolescent wives. There is less regulation over reproductive options; early spacing between

pregnancy negatively impacts the maternal health. There is a close relationship that exists between the

prevalence of child marriage and poor signs of maternal health. 63% of the girls were impacted by the

nations that were under study. Child marriage was linked with the decrease levels of skilled birth attendant

utilization during labor. Also, this decrease was more probable to happen in South-Saharan Africa and

South Asia than in other areas across the world. The nations with a high prevalence of adolescent marriage

are at an increased danger for maternal issues, higher rates of fertility, and increased usage of skilled birth

practitioners (Raj & Boehmer, 2013).

2.2.3.5 Place of Delivery

Place of delivery influences the frequency of maternal mortality. Women who deliver in public hospitals

are more probable to suffer maternal mortality than those in private hospitals. Public hospitals have been

neglected by the government and lack the modern equipment to conduct cesarean section. Private hospitals

are run by proprietors and private hospitals (Khowaja et al., 2018).

2.2.3.6 Type of Residence

Type of residence influence the rate of maternal mortality in Kenya (Yaya et al., 2016). In the case of post-

natal care, mothers aged 30 years and above appear to be significant and positive determinant in both urban

(OR=1.37, CI=1.17-1.62) and rural (OR=1.32, CI=1.15-1.52) areas. Women with higher birth orders and

≥24 months of the birth interval were more likely to utilize post-natal care than women who experienced

childbirth for the first time. Urban and rural women from the richest wealth quintiles were about four times

(OR=3.94, CI= 2.96-5.24 and OR=4.22, and CI=3.55-5.02 for urban and rural areas respectively) more

likely to use post-natal care compared with poorest women. Women of ‘Other' castes are more likely to use

post-natal care compared with Scheduled Caste/Tribes women. Freedom of movement has a positive and

significant influence on receiving post-natal care in urban and rural areas. Use of post-natal care was
significantly higher in southern and western regions compared with the northern region in both urban and

rural areas (Chauhan & Kumar, 2016).

2.2.4 Interventions to tackle maternal mortality

2.2.4.1 Advancing Quality, Respectful Care

Family planning, maternity care, infectious disease, and nutrition programs are all critical to reduce

maternal mortality. In addition, there are previously neglected maternal and fetal health issues along with

the behaviors of childbearing women and their caregivers that relate to quality respectful care and the

protection of human rights.

Family planning forms a fascinating aspect of the improved element of maternal health. Nearly 57% of

women of reproductive age in the low and middle-earning nations or nearly 870 million women require

contraception and of these nearly 74% used a contemporary contraceptive (Singh and Darroch 2012).

Contraceptives are an emerging trend in the modern world. They are helpful to elude unwanted pregnancies,

and therefore the frequency in which women are exposed to pregnancy and morbidity is decreased. It

decreases healthy timing and spacing of pregnancy and thus decreasing the number of life-threatening

pregnancies. It satisfies the requirements of contraceptives of the women who desire to impede pregnancy.

To satisfy the needs for family planning among the rest of the 222 million women and to raise opportunities

for health planning of pregnancy among the women before menopause. The government should be at the

forefront to educate women on the role of family planning in guaranteeing that pregnancies are timed and

spaced to happen at the healthiest times in the life of a woman. It is crucial to expand the mix and presence

of contraceptives to assist the women to delay the space, time, and restrain pregnancies from attaining their

motives about fertility. Advocating the post-abortion planning care that provides a diversity of family

planning constituting the amenorrhea technique at the healthcare structure for the vulnerable people in the

society. Increasing the number of policies to attain the informed decisions, empowerment operations, and

gender equality as well as satisfying the health and family planning needs of women is crucial.

Most of the influence of contraceptives to impede maternal mortality is derived from decreasing the

frequency of births (Ahmed et al., 2012). However, hindering pregnancy decreases the maternal mortality
ratio as the increasing risks of insecure abortions, and preterm births are more probable to be hindered.

More dangerous pregnancies constitute those that have poor timing or pregnancy among women with

greater parity. Also, studies have discovered that the risk of maternal mortality, serious perinatal results,

and demises in children with less than five years, increases as the number of children in every woman rises

from two to six. The latest study discovered that even regulating for income; high parity women were less

probable to access the health services (Stover & Ross, 2010). Perinatal mortality is less among infants born

with children ages ranging from 20-29 than those born to adolescents.

Spacing pregnancies to less than two years after a live birth are significant particularly for the newborn.

Repetitive pregnancies are linked with increased risk for miscarriage, preterm birth, and stillbirth. In

children that are less than five years are three or more years after a preceding birth have less risk of death

and malnutrition. The women who in need are the ones who are presently utilizing a contraceptive method

are viewed to have an unsatiable need for the contemporary techniques (Singh and Darroch, 2012). The

unsatisfied need is greater in the sub-Saharan Africa than in South Asia. For each woman that utilises the

contemporary contraceptive in Sub-Saharan Africa, it is approximated that between one to five years have

unmet needs and wants. The ratio is 1:1 in the vast South Asian nations.

Nearly eighty million unintended pregnancies occurred in the LMIC during 2012. Approximately 39

million women with unintended pregnancies yearly select abortion and more than 50% of the procedures

are insecure (Singh and Darroch, 2012). In addition, insecure abortion claim the lives of 68, 000 women

annually (Haddad and Nour, 2009). Satisfying the unmet wants for contemporary contraceptives in the

developing nations would decrease maternal deaths by an astounding 80, 000 and impede 1.1 million

demises of children yearly (Singh and Darroch, 2012). The increased advocacy and programming for family

planning is vital in helping individuals volunteer with focus on vulnerable populations. It is vital for

enhancing maternal health.

2.2.4.2 Scale-up Quality Maternal and Fetal Health Care

The direct causes of maternal maternity are famous. They constitute hypertensive conditions, insecure

abortion, and hemorrhage cause maternal deaths because there are fewer interventions to decrease the risk.
These interventions can be delivered via quality maternal care offered by trained health providers in

facilities that liaise in teams to guarantee that the whole population of women can be attended in all the

periods with after-support via referral mechanisms (Campbell & Graham, 2006). These care illuminate the

predominant causes of maternal mortality enhance maternal health. The government of Kenya should come

up with strategies to combat the menace. It should bolster, enhance, and scale quality intrapartum, antenatal,

and post-abortion services spanning from hospital levels that entail elongating and increasing the

interventions to explain the key direct obstetric factors that cause maternal death. Also, it should support

the combination of interventions that illuminate the preterm and stillbirth. Bolstering and enhancing the

referral system and feedback to administer complications and deadly emergencies with comprehensive care

are crucial. Furthermore, the government of Kenya should advocate for the use of evidence-oriented

guidelines for enhanced quality care. Increasing the application of evidence-oriented process improvement

and regulatory strategies is emphasized. Postpartum hemorrhage accounts for 0.27 of maternal mortality

cases across the world (Say et al., 2014). It can cause the long run complications of the pregnancy nearly

12% of the women who endure the condition to suffer from stringent anemia (Abouzahr, 2003). Based on

the prompt post-birth, uterotonics in amenities are the preferable intervention. They reduce the loss of blood

and impede 0.5 to 0.6 of the disorder (Tuncalp et al., 2012). The suggestions of the World Health

Organization for the prevention and treatment of the Post-partum hemorrhage acknowledge uterotonics as

the preferable first intervention treatment preceded by interventions and surgical interventions.

The hypertensive disorder is maternal morbidity that is defined by increased blood pressure and protein

constituted in the urine can go to convulsions and demise if not approached timely. It accounts as the second

greatest direct obstetric cause of maternal death after hemorrhage representing 0.14 of maternal demises

(Say et al., 2014). Magnesium sulphate poses a higher risk to eclampsia and decreases maternal mortality.

To hinder pre-eclampsia, the calcium supplements and low-dosage aspirin are recommended. Anti-

hypertensive medications are essential for the treatment of stringent pre-eclampsia.

Maternal sepsis remains a significant cause of maternal deaths where the citizens are low and middle-

earning persons. The aspects predesposing women to puerperal infections constitute poor nutrition, anemia,
and premature membranes. A thriving review of literature acclimatizes that Caesarean section is the single

most significant risk factor for the evolution of puerperal sepsis. Additionally, unhygienic water and

sanitation aspects are related to maternal mortality and thus a logical way path of obvious infection at the

time of birth. Convenient and appropriate use of antibiotics is suitable to manage and treat this effect of

maternal mortality.

At the national level, the availability and effective use of interventions for obvious causes of maternal death

are increasing hence requires more promotion for constantly use. On the other hand, community making

use of uterotonics, that has been utilized in most countries, also requires additional promotion. Above the

significant interventions of therapeutic and prophylactic utilization of uterotonics and magnesium sulfate,

its calls for interventions of prophylactic antibiotics for cesarean section, parenteral antibiotics for sepsis,

anti-hypertensives to boost sever complications of care, including surgery, management shock, and

hypertension control. The potential to manage these complications, through assisted vaginal births or via a

cesarean section, is also vital elements of life-saving maternity care. Distinctive approaches to stop stillbirth

and preterm birth are control of sexually transmitted infection while screening of blood pressure diabetes;

focusing on women care at impending risk of preterm birth and provision of education on the specific use

of cesarean and induction. Antibiotics for initial rupture of the membrane are among the antepartum

intervention which can improve the probability of survival of preterm newborns.

Most public and private entities services and programs do not apply the accepted low cost or high effect

interventions as well as a higher level of coverage. To a certain quality of care needs an appropriate,

evidence-measured standard of care and a procedure to ensure application of the standards. The process

improvement method that ensures response which is evidence-measured for each implementation goes

beyond compliance with standards to involve community services and better management that incorporates

institutionalization and sustainability. Improving quality care in the private entity has more challenges. In

this case, regulatory institutions such certification, licensing and accreditation need both facilities and

practitioners to come in terms with externally defined factors. Promoting improvement is voluntary: the

private institution would require to encourage a learning-focused approach to improve the quality of care
of the standard needed. Through a systematic structure supporting demand, enabling environment,

sustainable service quality, implementation, and assessment of integrated strategies to improve fetal and

maternal care.The integrated strategies such as integration of maternal care, obstetric quality care that has

referral care, neonatal care, and care associated with infectious disease and malnutrition and management

prevention during pregnancy as expected.

2.2.4.3 Improvement and support health systems

During the year 1987, the initiative known as the Safe Motherhood was established to determine the

improvement of maternal health care demanded a health care systems initiative that required employees to

work within the existing service framework while seeking specific outcomes. Consequently, improving

maternal health better results calls for increasing inputs that particularly support maternal care while

empowering health system governance via policies and application of regulations. Moreover, considering

the government of Kenya strategies to boost and empower health systems of maternal has played a key role

such as; promoting private and public institutions to do resource mobilization to transform the sustainability

of health system by establishing the competency of health providers. In this case, the government focuses

on midwifery shortage. In this regards to these, the government roll out the policies, budget and proper

regulation to address the required skill, deployment of appropriate health working conditions, motivational

inputs and retention during task shifting. Furthermore, the government of Kenya play a crucial role in

boosting supply systems, encouraging regulatory efforts, and ascertaining the availability and newborn

health commodities. The specific overlooked commodities, availability and necessary maintenance

equipment. These issues may include manufacturing of supplies and procurement of drugs for maternity

care required, with good agreements on financial sustainability budget plan. Notably, the government

through affirmative programs have established referral facilities across the country at all levels. These will

ensure women receive timely and satisfying quality emergency obstetric service at their disposal.

2.2.4.4 Improve Equity of Access to and Use of Services by the Most Vulnerable

Provisions of affordable, better quality with respect to maternal health care is significant to the survival of

pregnant and childbearing mothers and girls. It involves access to services, the right information, goods and
the omission of inequities because of age or marital status, culture costumes, racial biases, geographical

and political hindrances.

All stakeholder and other decision-makers must be involved as change and advocates agents. Promoting

maternal health strengthens not only mothers but also her entire family and community at large. By

attempting to improve equity availability and utilizing health services by mothers and girls who are the

most vulnerable. The key vital issues of inequity must be addressed so that women and girls will benefit

from access to proper services, goods and information without barriers that endangered their newborns.

Sub-nationally, mothers who live in rural homes have less opportunity to utilize maternity services than

those in urban centers. The approximate of 35 percent of mothers in rural homes of the have skilled birth

attendant in comparison to those in urban areas. The access is taken as life-saving basing on the gender

issue, consequently death and suffering consistently is due not only the failure to offer quality services but

also to mother's lack of agency to use services.

Lack of decision-making authority, women have less control over financial resources required to pay for

transport cost and directly incurred fee for maternal services. All in all the disparities in utilizing maternal

facilities for birth can be contextualized in terms of racial, ethnic, social, religious and age variation. For

instance, only 35 percent of rural areas mothers have institutional deliveries as compared with 75 percent

of urban women. However, in most cases, adolescents may utilize the services less than other age groups,

incase this happens adolescents like to face higher maternal mortality than other age groups. In spite of the

quality service that facilities the is also discrimination; for example, in country survey, adolescent were

indicated to have poorer coverage of poor pregnancy outcomes in respect of prophylactic antibiotics for

cesarean section and uterotonics, thus ultimately leads to prematurity, poor birth weight, and severe

neonatal conditions.

2.2.4.5 Increase focus on avoiding and addressing maternal mortality

A fully recovered pregnant woman has the potential to feed the infants, nurture them, and their families and

become productive in the society. It is approximated that 10% of women who deliver children annually
suffer from pregnancy or birth-related complications. Most women who do not perish at that time endure

short and long term disabilities emanating from the pregnancy and its administration (Ferdous et al., 2012).

These complications and disabilities have repercussions on the welfare of the pregnant woman, the expense

of nurturing the family, and the capacity of the woman to make a positive contribution to the society. These

deeds might cause poor relationships among the members of the family because of the continuous

antagonism that exists between them. Furthermore, the complications during the pre and post-pregnancy

period allow the health care system to incur more expenses.

The obstetric complications are deadly and most of the times cause the death of the pregnant woman. They

entail puerperal sepsis, hemorrhage, and insecure abortion. Murray et al., (2012) noted that this leads to

sixteen million years in which individuals ensured the pregnancy-associated disorders. The disabilities that

emanate from pregnancy constitute the anemia, fistula, hypertension, and incontinence. Postpartum

depression has claimed the lives of many individuals in the last few years. Furthermore, after the pregnancy,

malnutrition might occur. When a woman suffers from maternal morbidity, she is bound to experience poor

birth results for the health of the mother. In addition, the biomedical disorders might surpass conditions

such as physical, emotional, and sexual violence, the financial liability of the family, and costliness of the

health care system (Stanton & Brandes, 2012).

2.2.4.6 Advance Choice and Respectful Maternity Care and Improve Working Conditions for

Providers

The increasing proof is emerging of disrespect and abuse of women delivering giving birth. This proof

constitutes the documentation that abuse is spread across the world, the manifestation isatly differ, and the

view of abuse vary between women and their health care provider. The disrespect has been observed in the

environment of childbirth in family planning clinics. The disrespect is an infringement of the fundamental

rights of women though it is a deterrent to using life-saving health services. The environment of silence has

obscured humiliation and disrespect of women in facilities during childbirth, a period of intense
vulnerability for women. Most women might have normalized this abuse or are incapable to select personal

procedures independently.

A likely contributing aspect to abusive and disrespectful care is that most skilled birth attendants

particularly female providers work in challenging, strenuous, and insecure settings. These health care

employees and attendants are occasionally lowly paid, demoralized, and treated with abuse. The attention

should be on the topic of positive provider approaches, and hence fundamentally, it aims at guaranteeing

that the rights of health staffs and delivering high-quality medical care.

The abuse of women in childbirth across the world has been reported in various reports. Bowser & Hill

(2010) articulates that infringements such as humiliation, verbal abuse, discrimination, and confinement of

mother and infants in amenities. Courteous, attentive providers and reliable access to medicines and tools

have the biggest impact on the decision of a woman to give birth in a social amnesty. These characteristics

were discovered to have a more significant impact on the choices of the patient in a facility setting than the

provision of transport and the decrease in expenses. The universal rights of nursing mothers illuminate the

rights in maternity care and require to be enforced.

There is a choice out of the service that constitutes the opportunity to get a desirable, legal, and shown

medical intervention including pain alleviation for post-abortion care incurred during child birth. The

decision requires details on the advantages and limitations of the use of service and medication. It can be

elongated to tastes and preferences for confidentiality, perception during the birth period, and incorporation

of harmless cultural and traditional practices that involve prayers, rituals, and food. The enforcement of a

proactive action to the choice of a woman should be cautiously enhanced with the present resources, proof,

and moral codes of ethics that the practitioners should comply with. It is illegal for the health practitioners

to offer practices that are insecure, inaccessible or surpass the legal requirements.

The sophisticated and in-depth attitudes cause the absence if safety, dignity, and security among health care

providers. Aspects such as race, class, and cultural values are the origin of these attitudes. These attitudes
dehumanize the resilience of skilled birth providers and might hurt the capacity to offer quality care and

engage in policy and future of the health care sector. The proof of the application of strategies to ameliorate

scornful behaviors and poor working settings such as their expenses and effectiveness is restrained, and the

evolving of the programing in the emerging region is a necessity. Nonetheless, the ethical codes of conduct

are restrained because there is less accountability to implement these codes and standards and to strengthen

the sensitiveness of the health system. The interventions allow advocacy with the presence of the media,

government, and skilled birth providers for policies and costs plans to enhance the working environments,

allowances, respect, and acknowledgment for health practitioners of maternal care and family planning.

.2.2.4.7 Promote Data for Decision-Making and Accountability

It is essential to strengthening the presence and quality of data on maternal mortality and health to make

better decisions and enable accountability. These actions will be instrumental at tracking progress at

national, local, and national aims and objectives. The mobile applications suitable in the health care sector

will make this a reality. It is essential for a call to enhance data to more effectively track the outcomes at

various levels via active engagement of worldwide partners, societies, and communities to enable to the

promotion of accountability and monitoring targets.

There is a diversity of globally accredited metrics to track the processes and results of maternal health. The

measures that involve the health system are the delivery of antenatal and postpartum care though they do

not show the quality of medical care that the patients receive or the telecasting of interventions for treatment

of deadly complications.

The challenges on methodology make it difficult to measure the maternal mortality. Maternal mortality is

vital due to its repercussions on the family, society, and community. The routine health information systems

and vital registration are occasionally noneffective in regions that the lower and middle-income individuals

reside. Due to this, the household survey allows the gathering of the data on mortality data. These surveys

necessitate large sample sizes because of the increased maternal deaths. The household surveys are costly
and generate the approximate of maternal deaths with large variations of uncertainty. The census data is

suitable for estimating the maternal mortality at the national level. Despite its benefits, it still faces various

shortcomings based on its capacity. The approximates of maternal deaths are developed to be tracked at the

national and worldwide levels. The low frequency of maternal deaths makes it difficult to disaggregate the

approximates at the sub-national levels.

2.2.4.8 Improve Individual, Household, and Community Behaviors and Norms

The likelihood for a health result for both the baby and mother enhances when the women and families such

as women have awareness. Their families encourage them to participate in healthy behaviors. The norms

entail selecting whether and when to become pregnant. The women who consume a balanced diet and

conform to practices during the period of birth, pregnancy, and postpartum. This entails services such as

family planning, skilled care for delivery, and postnatal care.

The women always have restrained knowledge of maternal health particularly those who become pregnant

at a tender age. Nearly, 40% of girls are married by the age of 18. Nonetheless, the women might have

restrained power of making decisions about maternal health. In most instances, men make health care

decisions particularly when to become pregnant, the frequency of seeking medical attention. Due to this,

most women always have high unmet needs for family planning and restrained power in making decisions

on medical care. It is crucial to acknowledge the roles of family members about maternal care.

Health communication and other behavior change interventions are vital to enhancing the knowledge of

maternal care. Family planning is important to enhance the household behaviors and care to pursue the

likely deadly maternal morbidity. The mass media will be vital to disseminate the suitable information and

messages. The latter should be tailored to the boys, context, target men, and their families. However, the

health communication that distorts the awareness is more effective when it entails the skills of problem-

solving and dialogue, and it is offered via the participatory approaches that back up the long-term processes

whereby communities are actively engaged in impacting their health. Interventions such as understanding
the causes, demanding rights to healthcare, advocating for supportive community behavior, and

community-grounded identification of problems is crucial.

2.3 Theoretical Framework

The McCarthy and Maine are the main proponents of qualitative framework presentation that dealt with

the determinants factors and relationship that contribute to the maternal mortality. However, the model

was established due to an alarming rate in the increase of maternal health issues. The model area of

concern was to address a wide range of controversies from women's affair and emergency obstetric care.

In their model, they demonstrate explicitly about systematic consideration of the right mechanism in

which these range of issues impacted maternal mortality. Despite the fact McCarthy and Maine

acknowledged other scholars and researchers who attempted to understand the process, such as the Three

Delays model, they felt that no one had been fully –developed. Additionally, McCarthy and Maine

deliberately expounded in scope. The model clearly shows quite an improvement concerning distant

determinants such as cultural and socioeconomic factors, recommended to work about intermediate

factors to impact maternal health outcomes. In particularly, McCarthy and Maine claim that all

determinants of maternal mortality and its effort should operate via three intermediate factors, I) the

probability that the women are pregnant ii)the like hood that a pregnant women may experience

complication of pregnancy or childbirth and ii) the chance of an adverse outcome for women with

complications.

In this Three Delays model, the proponents acknowledged that their model is simply in nature and that the

elements can be divided into varies sub components.Notably, they emphasize the significant of the model

to provide a framework for researchers and program organizers to put into consideration various

intervention programs. They also recognized the fact that not all the relationships are featured in this

model but only those mostly affecting women.

The significant strength of this model is its concentrate on the bigger picture, paving the way for planners

to contrast and compare more distant factor from the intermediate ones. McCarthy and Maine make
consideration of mediation in the structure of their model compels the organizers to a particular chain of

events by which a program likely to reduce maternal mortality. Hence, during the comparison of two

interventions, lawmakers may utilize this model to assist in the reduction of maternal mortality.Lastly, the

model does not real predict how such interventions might work against each other. A part from the issue

of distant and intermediate there no specific relative's indications in the McCarthy /Maine model against

the compare programs.

The Three Delays Model is drawn under two assumptions. Firstly, it is approximately eighty percent of

maternal deaths outcome directly caused by obstetric, and the other is most of the deaths can be prevented

with conscious, timely medical treatment. However, the Three Delays model adopted a distinctive view of

maternal mortality by considering the aspect of women who experiencing complication of obstetric.

However, this model explains that once an obstetric complication is identified, the primary aspect

attributed to maternal deaths if above assumptions are a delay. In this case, the these delays are divided

into three distinct phases; The individual‘s or family's decision to seek car, Identification and reaching out

a health care facility, and adequate reception at the care facility. In this case, any break along the chain of

above phases might increase the chances of the maternal morbidity. Additionally, the model illustrates

how these three phases are influenced by the following aspects: cultural factors, socioeconomic factor,

quality care and accessibility of facilities. Cultural and Socioeconomic factors, the perceived quality of

care and accessibility is reflected the impact of phase I, that is individual's and family‘s decision to seek

care.

This step one is crucial, not until the mother or family decide to seek care, obviously the other, phases of

delay rendered irrelevant that is identifying and reaching a facility, receiving quality care once in the

facility. The time a decision is made to seek care, access to facilities such as real estimation of distance,

availability of transport options, the total cost of transport, impacts Phase II, the opportunity of reaching

the facility. Lastly, if the mother has ability to reach the facility, the quality of care and availability of

trained staff, equipment, drugs and blood is reflected in phase III, the probability of receiving enough and
correct treatment.

2.4 Conclusion

This chapter has reviewed the literature of authors on their views on the determinants of maternal mortality

in Kenya. The empirical studies of Fotso et al., (2009) and Hacker & Ryan (2003) confirm that the place of

delivery and type of residence as affecting the increase in maternal mortality. The findings of the authors

confirm that the increase in maternal death can be explained by many factors.
 CHAPTER THREE: METHODOLOGY

3.1 Introduction

In this case, it involves research design adopted, study of pollution, and the sampling techniques, collection

of data techniques and data assessment adopted in the research. The research procedural is among relevant

aspects of research task that helps to acknowledge the methods, tools that are adopted to the work. This

study constantly assists the research to select valid and appropriate methods in tandem with research

techniques to effect out the research effectively. The scholars are essential needs to identify the most

appropriate methodologies to propagate efficiency research study. Thus methodologies must correlate with

the study. However, the concern gives priority notification of best skills to back up the study work and the

indicate aims to completely assessing the information which is collected through the relevant investigation.

3.2 Research Philosophy

For every research to be established, it is essential to stick to some principle that will guide the scholars

on process for smooth completion of the research accuracy and obtain the desired results. It can be

elaborated as a background set up, form of knowledge concerning the study. Key features which affirm

each aspect can be justified through evidence. From the reliable point of view which create reality is

consistency and can be seen and described from objective perception and described from an objective

perspective. His philosophy has been utilized in this study to enable the researcher to collect suitable

evidence and determine the impact of mortality rates and establishing the socio-economic and entity

factors influencing maternal mortality (Abuya et al.., 2011). Additionally, this philosophy assists a

scholar and to examine the health care targeting behavior for pregnant mothers and factors that influence

the implementation of health services. This has enabled the gain of proper outcomes and reveal effective

inferences. Data, which gathered via a series of source, will enable the scholar to analyze the data

effectively. It is a The two aspects of the philosophy adopted were, qualitative and quantitative

methods.De livery and maternal deaths results analysis was carried out through a designed checklist for

whole maternal deaths and proportion delivery outcomes that featured facilities in the study region to

better comprehension aspect s that contributed to mortalities (Free et al..,2013).

The qualitative procedure was via the establishment of insights interview of irregular sampled antenatal

mothers reflecting ANC at that period using a framed questionnaire. While the cross-sectional design was

adopted to gives a fast snapshot of the behavior of the partaker within the shortest period (Murray et

al..2017).

3.3 Research Approach

Most approaches are instrumental in the section and implementation of the appropriate procedure of

research. In the entire section, an effective research design can be involved to boost the research study

effectiveness. It has a vital impact on developing the research question and implementing a proper

research structure. Deductive and inductive approaches are main forms of research approaches which can

be utilized to perform the study efficiently and effectively. The inductive research approach describes the

scholars must develop new theories by undertaking the process of data analysis and observation

effectively (Green et al.., 2018). Through the application of inductive, the research study can be based on

the research questions and master of the scope of the study, and this can assist in attaining the primary

aims and objective of the research.T o utilize this approach effectively, the scholar needs to maintain a

clear mind and ought not to develop any predetermined concept about the topic

Basically, the research task can be conducted effectively and efficiently. The deductive research approach

is linked to the development of theories are the opposite of the ones that are prepared using the inductive

approach. The approach state that the researcher must shift the general concepts to specie one

related.Deductive research one of [prevalent research approach as the redevelopment of a result of its

association in the development of a hypothesis.T his approach assist the research in concentrating on

continuous work and also achieved the goal of study with great ease (Green et al..,2018).

This inductive approach has enabled the research study to change from the observation of many

phenomena associated with the topic and compute relevant theories and principles. By utilizing the

approach, specifically observations have been conducted, a diversity of patterns has been developed, and

a tentative hypothesis has been prepared, and most suitable theories have been determined. This approach
has justified being essential to the research study, and it has led to developing successful conclusions and

getting desired results (Green et al.., 2018).

3.4 Research Strategy

All in all the strategic structure plans back up to answer research questions accurately and help to decide

on the most suitable research methodology. Establishing appropriate strategic structure is essential to

conduct the research smoothly ion about, and it offers basic information about the research topic.An

effective research study entails different phenomenon contains a research question, goals and objective,

and research methods. (Anders et al.., 2013).

To develop a well-formulate strategic plan, the research needs to carry out a background check

concerning the research topic and collect information for the work. There is a variety of research

strategies involving observatory, exploratory, interviewing and experimentation. Though, the strategic

plan of the research study involves questionnaire research to collect primary data forheir work. By

utilizing the questionnaire survey, the research study will acquire substantial and in-depth knowledge

about the phenomena. Hence, the study will be conducted effectively, and also obtain suitable results.

Therefore, the stakeholders will be interrogated varies questions that are aligned to research topic (Anders

et al.., 2013).

3.5 Research Design

A research design is a procedural and systematic plan, and the research question can be assessed by

utilizing accurate research design. It forms a demoralizing part of the research methodology, and in

addition it useful investigation to describe the research study, from data collection to its analysis. The two

aspects of the design adopted were qualitative and quantitative methods.De livery and maternal deaths

result analysis was carried out through a designed checklist for whole maternal deaths and proportion

delivery outcomes that featured constituted facilities in the study region to better comprehension aspect s

that contributed to mortalities (Kitui et al., 2013).

The qualitative procedure was via the establishment of insights interview of irregular sampled antenatal

mothers reflecting ANC at that period using a framed questionnaire. While the cross-sectional design was

adopted to gives a fast snapshot of the behavior of the partaker within the shortest period.Application of

qualitative to all aspects where the study seeks to develop different theories that are included on collected

data (Kitui et al., 2013).

The study will use data from secondary sources from cross sectional study CDC in collaboration with

Kenya Demographic and Health (KDHS) utilized between the year 2009 t0 2014. The KDHS is always

performed every five years for the aim of monitoring the status of health of the national population. The

information in the database involves health behaviors towards medication, the status of mothers and

children and women.T he data is mostly utilized as means of approximating fertility rates, immunity,

maternal and neonatal mortality rates (Kitui et al., 2013).

3.6 The Negative Binomial Regression Model

The model indicates the linear estimate of parameters included is used by maximum estimation. This

typical linear model is applicable for analysis of any data count. This type will essential in the situation

where the dependent variable will not be similar. Generally, the result of the variable represents the

neonatal and mortality (Anders et al.., 2013).

Negative binomial regression model formulae, i is represented as:

yi~Negbin (µi, k)

By applying log as the link function

Log µi ⁼⁼ Оi + хi1ß i1+хi2ß i2 + …+ хinß in

E (yi) ⁼⁼ µi + kµi2

Where:
yi represents the outcome variable for the individual i, in this study it will represent the maternal and

neonatal mortality rates

µi this represents the expected value of yi

Оi represents the offset variable for individual i

ß i represents the coefficient of variable i

k represents the dispersion parameter

3.7 Description of the study area

The study will cover the whole part of Kenya, the country within the sub-Saharan region. The country is

divided in national and county governments where the counties is subdivided into 47 countries with

approximately of 43-million by 2014. This study covered in the population includes pregnant mother and

those who have just given birth including the newborn babies, living or dead ones. (Anders et al.., 2013)

3.8 Inclusion and Exclusion Criteria

The data that will be adopted for this study will focus on major women between aged 15 to 49 years.H

owever, the data will involve specific pregnant women and lactating mothers as indicated in the data.I n

this data collection, the mother and children might have die or alive, within the period of conducting the

study.

3.9 Sampling

Essentially, sampling is an important and crucial aspect of research study. It useful to investigation to be

successful and recognize as a process through which individual, who will be engaged in the interrogation

as a participant, can acknowledge. From an insightful point of view, randomly and non-randomly are two

kinds of sampling. Randomly sampling is the non-procedural selection approach through which persons

will be selected from the research-associated industry without any particular pattern, and it also the
universal sampling technique. The philosophy assumption in these techniques is that every person has a

similar probability of being involved in the sampling category (Anders et al.., 2013).

Inversely, the non- random sampling perspective is a technique in which there is not similarities

probability or change for selecting individuals; some got more opportunities to be chosen than others.I n

this research study, seven – ten participants who were interrogated came from rural varies hospitals. The

respondents of the questionnaire have selected by utilizing non-random sampling, and research

contributors have a great impact in the research study as its assist in the completion of aims and objectives

(Anders et al.., 2013).

4.0 Research Validity and Reliability

Crucial attention is given to each part, and all section of the study has been conducted with a great focus

that got outcomes that are considered reliable and related to the aim and objective. Validity is a vital part

of efficient research, and with appropriate validity, the research study struggles to convey correctness and

accuracy that final results reflect the objectives of the study. The reliability is guaranteeing that no

detective of discrepancy in the study and indiscretions in generated results. (Anders et al.., 2013).

However, the study has been established in suitable and accurate steps by focus on the primary date

collection and by concentrating on raw and fresh data to guarantee that it reliable and valid. Thus, the

processing and collecting of data have become effective and efficient. As the generated results hence lead

the social industry to comprehend better the mortality and maternal rates in Kenya and how they assist in

curbing it.

4.1 Data Collection

The key part of the research methodology is data collection. Its significant can be grasped via the fact that

it helps both the research study and audience to recognize and understand the methods through which

study –associated information are collected.T he competence and success of the investigation major rely

on the gathering of data (Anders et al.., 2013).

Thus, this part is instrumental in research studies and in the scenario that defective tools and methods,

there are likely that study might not be successful and desired results will not be obtained. Despite,

secondary and primary are the primary sources of data. However, primary data are important, for relaying

helpful information concerning the topic and also ensuring that the research will be conducted effectively

and efficiently. A questionnaire survey has been employed to gather the primary data by rolling out a

diversity topic –related to inquiries and respondents from health facilities entities.

4.2 Data Analysis

After the collection of the data, the researcher should be a certain the consistency and thoroughly edited

it. However, numerical collected data was analyzed while using analytical descriptive tools for instance

distribution frequencies and percentages The Likert scale was utilized to analyze most opinions from

respondents via mean and deviations standard thus assisting in determining the maternal mortality in

Kenya. Lastly, the data was presented inform of frequency tables, and column charts. Finally, the

researcher does multiple regression analysis. (Anders et al.., 2013).

4.3 Data Storage and Security

In this study, the data will be stored by external backup storage and also using application and devices

such as Cloud, Dropbox and Google Drive.T his will be updated regularly to avoid any loss data and

assist in the future references

4.4 Ethical Considerations

To attain a successful and effective research study, it is notably to pay attention to the ethical components

of the study accurately. Diversity of ethical should be put into consideration by the research study,

ensuring that the collected data from the respondents are confidential. In case the gathered data is released

to the third party, there is a possibility that it influences the process negatively thus jeopardize the

completion of the desired aim and objectives. Additionally, the research study that it socialize with
participants to fill the questionnaire having pre-consent and without given permission, the research study

cannot be considered as morally right and effective.

4.5) Research limitations

In any research study, the tend to be limitation encounter which act as a barrier in gathering data, and it is

useful to identify this limitation and to seek a solution so that it will not hinder the research process.
 CHAPTER FOUR: RESULTS, FINDINGS, AND DISCUSSION

4.1 Introduction

This chapter highlights the research findings on the determinants of maternal mortality in Kenya. It gives

the analysis and presentation of the findings that were derived from the participants in alignment with the

study objectives.

4.2 Response rate

A total of 39, 679 households were chosen for the sample of which 36, 812 were discovered at the period

of the fieldwork. Out of these households, 36, 430 were interviewed effectively. This reflected a response

rate of 99%. The decline of households accommodated was mainly because of the structured that were

discovered to be vacant or destroyed, and households were absent for an elongated period.

According to Mugenda (2003), 60% is good, 50% is adequate, and eventually, 70% is excellent. In this

context, the recommended response rate was attained by the scholar giving the questionnaires and even

assisting in illuminating some of the inquiries to the respondents. The inferential and descriptive statistics

were utilized to analyze the data. For effective visualization, the data was presented using tables and charts

(Mugenda & Mugenda, 2003).

4.3 General Information

Table 3.1 Background characteristics of respondents

Percent distribution of women and men age 15-49 by selected background characteristics, Kenya 2014

Women Men
Background Weighted Weighted Unweighted Weighted Weighted Unweighted
characteristic percent number number percent number number

Age
15-19 18.7 5,820 6,078 21.1 2,540 2,811
20-24 18.5 5,735 5,405 17.6 2,125 1,981
25-29 19.6 6,100 5,939 17.4 2,104 1,942
30-34 14.5 4,510 4,452 14.8 1,785 1,701
35-39 12.1 3,773 3,868 12.3 1,483 1,486
40-44 9.3 2,885 2,986 10.1 1,224 1,198
45-49 7.3 2,257 2,351 6.6 800 895

Religion
Roman Catholic 20.3 6,315 6,229 21.4 2,583 2,551
Protestant/other Christian 71.1 22,091 20,072 67.5 8,141 7,500
Muslim 6.8 2,107 4,161 6.5 784 1,460
No religion 1.5 466 506 4.1 492 449
Other 0.2 65 73 0.5 59 51

Ethnic group
Embu 1.0 312 398 1.0 118 170
Kalenjin 12.0 3,718 4,335 12.2 1,467 1,729
Kamba 11.4 3,543 2,950 12.6 1,521 1,275
Kikuyu 21.9 6,798 5,033 20.9 2,523 1,946
Kisii 5.7 1,771 1,788 5.9 712 680
Luhya 15.0 4,667 3,653 16.0 1,927 1,555
Luo 11.1 3,453 3,060 10.9 1,311 1,179
Maasai 1.9 589 655 1.8 220 235
Meru 5.6 1,749 1,593 5.9 717 682
Mijikenda/Swahili 5.3 1,642 1,708 5.2 623 648
Somali 2.6 816 1,815 2.2 260 616
Taita/Taveta 0.9 295 452 1.1 134 199
Turkana 1.3 394 717 0.9 106 191
Samburu 0.5 143 620 0.1 12 45
Other 3.8 1,186 2,294 3.3 399 848

Marital status
Never married 28.9 8,997 8,575 44.4 5,350 5,384
Married 54.6 16,961 17,751 48.4 5,839 5,748
Living together 5.1 1,588 1,285 2.1 256 241
Divorced/separated 7.7 2,394 2,277 4.7 567 585
Widowed 3.7 1,139 1,191 0.4 50 56

Residence
Urban 40.8 12,690 11,614 43.9 5,300 4,648
Rural 59.2 18,389 19,465 56.1 6,762 7,366

Region
Coast 9.9 3,076 3,902 10.4 1,260 1,505
North Eastern 2.1 648 1,664 1.9 227 591
Eastern 14.1 4,375 5,247 15.1 1,825 2,144
Central 12.9 3,994 3,114 13.0 1,564 1,248
Rift Valley 25.6 7,953 9,059 25.3 3,050 3,484
Western 10.4 3,225 2,840 9.6 1,164 1,130
Nyanza 13.0 4,038 4,254 11.6 1,405 1,542
Nairobi 12.1 3,770 999 13.0 1,568 370

Education
No education 7.0 2,176 4,183 2.9 345 663
Primary incomplete 25.7 7,989 8,431 25.5 3,071 3,466
Primary complete 24.6 7,637 7,182 22.7 2,734 2,720
Secondary incomplete 15.8 4,922 4,537 16.2 1,960 1,850
Secondary complete 15.7 4,880 4,058 18.9 2,282 1,980
More than secondary 11.2 3,475 2,688 13.9 1,671 1,335

Wealth quintile
Lowest 15.6 4,838 7,262 14.0 1,691 2,504
Second 17.6 5,457 5,970 17.8 2,145 2,443
Middle 19.4 6,032 5,946 19.7 2,370 2,466
Fourth 21.1 6,550 5,958 24.5 2,959 2,579
Highest 26.4 8,203 5,943 24.0 2,897 2,022

Total 15-49 100.0 31,079 31,079 100.0 12,063 12,014

50-54 na na na na 756 805

Total 15-54 na na na na 12,819 12,819

Note: Totals may not add up to 100 percent because women and men with missing information are not shown separately.
60% and 51% of women and men are married and currently living in an informal union respectively.

Approximately 44% and 29% of men and women are unmarried respectively. 11% of women are more

probable than 5% of women to be separated or divorced. 56% and 59% of men and women living in the

rural regions respectively. Rift Valley has 26% and 25% of women and men respectively. The North Eastern

Region has 2% of both genders. The rest of the regions account between 10% and 15% of the rest of the

population. 7% and 3% of women and men lack the necessary education. Hence, women are likely to suffer

from maternal mortality more effectively. 26% of both men and women did not complete the primary

school. 25% and 23% of women and men ended their academic journey by completing the primary

education level. 16% and 14% of women and men are in the lowest wealth quintile implying that the women

are likely to suffer from maternal mortality because of the less income they are accrue daily.

4.3.1 Education level

The capacity to peruse and compose engages ladies and men. Proficiency measurements are essential for

policymakers to decide how best to achieve the populaces they serve. In the 2014 KDHS, proficiency was

dictated by respondents' capacity to peruse all or part of a straightforward sentence. Amid information

gathering, questioners conveyed a lot of cards on which straightforward sentences were imprinted in 17 of

the nation's real dialects (English, Swahili, Borana, Embu, Kalenjin, Kamba, Kikuyu, Kisii, Luhya,

Maragoli, Luo, Maasai, Meru, Mijikenda, Pokot, Somali, and Turkana) for testing a respondent's perusing

capacity. The individuals who had never been to class and the individuals who had just an essential

instruction were approached to peruse the cards in the language they were most acquainted with. Those

with an auxiliary training or higher were thought to be literate.

The table 3.2.2 demonstrates the percent dissemination of ladies age 15-49 by the dimension of tutoring

visited and the dimension of proficiency, alongside the rate educated, as indicated by foundation attributes.

The extent of educated ladies (88 percent) was somewhat greater than in 2008-09 (85 percent). Eight percent

of ladies could peruse some portion of a sentence. Literacy decays with age and shifts by spot of living

arrangement. Ninety-four percent of ladies dwelling in urban regions are proficient, as contrasted and 84
percent of country ladies. Provincial contrasts are striking, with the extent of proficient ladies being most

elevated in Nairobi (97 percent) and least in North Eastern (24 percent). Proficiency increments with riches;

all ladies (97 percent) in the most astounding quintile are educated, contrasted and 58 percent of ladies in

the least quintile. Literacy among the women whose age ranges from fifteen to forty-nine at the county

level was highest in Nandi and Nyamira. These two counties had 98%. The counties with the lowest

proportion of literate women were Wajir, Mandera, Turkana, Garissa, and Marsabit.

4.3.2 Interventions to Decrease Maternal Mortality

Analyzing the present use of contraception by background characteristics is vital as it assists recognize
the subgroups of the population to target for family planning services. The table highlights the percent
distribution of presently married women age 15-49 by their use of family planning methods.
Table 7.4C Current use of contraception by county

Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to county, Kenya 2014

Modern method Traditional method

Any
FemaleAny Male Not cur-
tradi-
modern sterili-Any sterili- Inject- Im-Male Female rently
tionalWith-
County method method sation sation Pill IUD ables plants condom condom LAM Other using
method Rhythm drawal Other
Coast 43.9 38.3 1.6 0.0 4.7 2.2 18.7 9.4 1.5 0.0 0.1 0.0 5.6 4.2 1.4 0.1 56.1
Mombasa 55.0 43.6 0.2 0.0 6.5 3.2 17.7 12.6 2.9 0.0 0.4 0.0 11.4 9.0 2.4 0.0 45.0
Kwale 41.5 38.2 3.0 0.0 4.3 1.6 21.6 6.8 0.8 0.0 0.0 0.0 3.3 2.2 1.1 0.0 58.5
Kilifi 34.1 32.8 2.8 0.0 2.7 1.1 15.9 10.0 0.3 0.0 0.0 0.0 1.3 0.9 0.3 0.0 65.9
Tana River 28.7 20.5 0.2 0.0 1.1 0.4 13.1 2.7 3.0 0.0 0.0 0.0 8.2 3.9 4.3 0.0 71.3
Lamu 42.2 39.5 1.2 0.0 10.2 1.0 19.0 6.4 1.2 0.0 0.5 0.0 2.6 2.6 0.1 0.0 57.8
Taita Taveta 68.0 61.3 0.4 0.0 10.0 6.9 34.1 8.6 1.5 0.0 0.0 0.0 6.6 5.4 0.5 0.7 32.0

North Eastern 3.4 3.4 0.0 0.0 0.6 0.1 1.9 0.6 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 96.6
Garissa 5.5 5.5 0.0 0.0 1.1 0.2 2.4 1.5 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 94.5
Wajir 2.3 2.3 0.0 0.0 0.2 0.0 1.6 0.2 0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 97.7
Mandera 1.9 1.9 0.0 0.0 0.4 0.0 1.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 98.1

Eastern 70.4 63.9 4.8 0.0 8.9 2.9 37.9 7.8 1.5 0.0 0.0 0.0 6.5 5.6 0.5 0.3 29.6
Marsabit 11.7 10.9 0.4 0.0 1.1 0.3 6.3 2.7 0.0 0.0 0.0 0.0 0.8 0.8 0.0 0.0 88.3
Isiolo 27.0 26.3 0.8 0.0 7.2 1.4 13.2 3.3 0.4 0.0 0.0 0.0 0.7 0.6 0.1 0.0 73.0
Meru 78.2 73.2 4.3 0.0 12.3 5.4 44.8 3.5 2.8 0.0 0.0 0.0 5.0 4.3 0.7 0.0 21.8
Tharaka-Nithi 74.0 67.2 1.8 0.0 7.0 7.2 44.1 5.5 1.3 0.2 0.0 0.0 6.8 4.3 0.6 1.9 26.0
Embu 70.6 67.2 3.8 0.0 15.2 4.6 31.2 11.0 1.5 0.0 0.0 0.0 3.4 3.2 0.2 0.0 29.4
Kitui 57.3 55.1 3.0 0.0 4.5 1.1 36.9 9.5 0.0 0.0 0.0 0.0 2.2 2.0 0.0 0.2 42.7
Machakos 75.9 67.5 5.5 0.0 9.1 0.5 41.6 10.4 0.5 0.0 0.0 0.0 8.3 7.5 0.5 0.3 24.1
Makueni 80.3 65.0 10.2 0.0 5.9 1.8 33.8 10.3 2.9 0.0 0.0 0.0 15.3 13.4 1.1 0.8 19.7

Central 72.8 66.9 3.5 0.0 19.5 9.0 21.6 10.7 2.4 0.0 0.2 0.0 5.9 4.9 0.7 0.3 27.2
Nyandarua 65.6 60.4 2.8 0.0 13.8 8.0 22.9 10.8 0.9 0.0 1.3 0.0 5.2 5.0 0.2 0.0 34.4
Nyeri 73.1 67.1 7.3 0.0 16.7 10.0 22.3 9.2 1.6 0.0 0.0 0.0 6.0 5.3 0.6 0.2 26.9
Kirinyaga 81.0 75.6 0.9 0.0 26.0 13.2 20.4 13.0 2.0 0.0 0.0 0.0 5.4 4.3 1.1 0.0 19.0
Murang’a 68.9 63.4 4.0 0.0 22.1 6.3 20.6 7.8 2.5 0.0 0.0 0.0 5.5 4.3 0.0 1.2 31.1
Kiambu 74.0 67.8 2.7 0.0 19.2 8.9 21.9 12.0 3.1 0.0 0.0 0.0 6.3 5.3 1.0 0.0 26.0

Rift Valley 52.8 46.8 2.2 0.0 5.5 2.9 26.8 7.2 1.9 0.0 0.2 0.0 6.0 4.7 1.0 0.3 47.2
Turkana 10.4 10.1 0.0 0.0 0.5 0.5 5.7 3.0 0.4 0.0 0.0 0.0 0.3 0.3 0.0 0.0 89.6
West Pokot 14.2 13.3 0.4 0.0 0.7 0.2 9.0 3.1 0.0 0.0 0.0 0.0 0.9 0.2 0.0 0.7 85.8
Samburu 22.7 20.0 0.5 0.0 2.9 0.6 10.9 4.4 0.8 0.0 0.0 0.0 2.7 2.4 0.3 0.0 77.3
Trans-Nzoia 63.9 56.4 4.0 0.0 4.9 0.7 38.7 4.6 3.2 0.1 0.2 0.0 7.5 5.9 1.1 0.4 36.1
Uasin Gishu 62.6 56.0 1.8 0.0 7.4 2.7 28.7 12.9 2.4 0.0 0.0 0.0 6.6 5.3 0.8 0.5 37.4
Elgeyo Marakwet 55.2 43.6 1.1 0.0 1.6 1.3 28.5 8.7 2.1 0.3 0.0 0.0 11.6 10.6 1.0 0.0 44.8
Nandi 64.5 59.2 1.8 0.0 5.5 0.9 40.3 9.1 1.6 0.0 0.0 0.0 5.4 3.9 1.5 0.0 35.5
Baringo 41.4 33.1 0.7 0.0 4.6 3.2 16.2 5.5 2.3 0.0 0.6 0.0 8.3 6.5 1.4 0.4 58.6
Laikipia 59.1 51.3 5.0 0.0 12.5 5.1 20.8 4.5 3.1 0.0 0.0 0.4 7.8 6.6 0.6 0.7 40.9
Nakuru 56.8 53.5 1.4 0.2 10.4 6.7 25.4 7.6 1.4 0.0 0.4 0.0 3.2 2.6 0.4 0.2 43.2
Narok 47.8 38.1 1.9 0.0 3.7 1.1 25.3 3.8 2.2 0.0 0.0 0.1 9.7 6.9 2.4 0.4 52.2
Kajiado 54.5 45.2 1.5 0.0 6.5 5.9 20.0 8.9 2.2 0.0 0.2 0.0 9.3 6.7 2.1 0.6 45.5
Kericho 62.9 56.9 3.5 0.0 3.2 2.1 35.8 9.9 1.9 0.0 0.3 0.2 6.1 5.1 1.0 0.0 37.1
Bomet 54.8 50.4 4.9 0.0 0.4 1.7 33.9 7.5 2.0 0.0 0.0 0.0 4.4 3.5 0.6 0.4 45.2

Western 58.6 56.9 5.9 0.0 4.6 1.3 27.5 15.2 2.5 0.0 0.0 0.0 1.7 1.1 0.3 0.3 41.4
Kakamega 62.1 60.3 6.9 0.0 5.4 1.0 30.4 14.1 2.6 0.0 0.0 0.0 1.7 1.0 0.5 0.3 37.9
Vihiga 59.5 56.6 3.9 0.0 4.8 3.3 25.3 16.2 3.1 0.0 0.0 0.0 2.9 2.9 0.0 0.0 40.5
Bungoma 55.5 53.9 5.1 0.0 4.4 0.8 29.0 11.8 2.9 0.0 0.0 0.0 1.6 0.9 0.2 0.5 44.5
Busia 57.5 56.5 6.5 0.0 3.5 1.8 20.2 23.6 1.0 0.0 0.0 0.0 0.9 0.9 0.1 0.0 42.5

Nyanza 56.4 53.9 3.6 0.0 3.4 2.0 29.3 12.4 2.9 0.0 0.1 0.1 2.5 2.0 0.3 0.2 43.6
Siaya 55.0 51.0 3.2 0.0 5.8 1.8 19.3 15.3 5.7 0.0 0.0 0.0 4.0 3.3 0.7 0.0 45.0
Kisumu 62.4 59.3 5.2 0.0 3.7 1.5 24.3 21.1 3.5 0.0 0.0 0.0 3.1 3.1 0.0 0.0 37.6
Homa Bay 46.7 45.5 3.8 0.0 2.1 1.1 26.1 8.6 3.5 0.0 0.0 0.3 1.2 1.2 0.0 0.0 53.3
Migori 44.6 43.9 1.9 0.0 2.3 1.1 24.6 10.6 3.1 0.3 0.0 0.0 0.7 0.2 0.3 0.3 55.4
Kisii 66.1 62.8 3.2 0.0 4.0 3.5 41.8 9.2 0.8 0.0 0.3 0.0 3.4 2.2 0.7 0.4 33.9
Nyamira 67.9 64.2 4.2 0.0 3.5 3.9 42.6 8.2 1.2 0.0 0.3 0.3 3.7 3.0 0.3 0.3 32.1

Nairobi 62.6 58.3 2.0 0.1 12.5 4.5 23.6 12.1 3.3 0.0 0.0 0.0 4.4 3.2 0.3 0.9 37.4

Total 58.0 53.2 3.2 0.0 8.0 3.4 26.4 9.9 2.2 0.0 0.1 0.0 4.8 3.8 0.7 0.3 42.0
4.3.3 Delivery and Postnatal Care

It is reported that 6 out of 10 live births we delivered in a hospital or dispensary. Both public and

the private sector accounted for 46% and 15% of the healthcare sector. Currently, more than one-third of

births were delivered at home. The delivery in a hospital or dispensary increases the education and income

of the mother. Hence, a woman who delivers in hospital is at less risk than the one who delivers at home.

The delivery in a hospital or dispensary increases the education and income. Only 25% to women that lack

education was delivered in a hospital compared to 0.84 of births to women who have higher education.

Health facilitates births are predominant in the urban areas that account 82% and rural areas 18%. More

than 0.9 of births in Kiambu and Kirinyaga counties were delivered in a hospital or dispensary whereas

Wajir has the lowest prevalence of facility deliveries. Also, 60% of birth are delivered with the help of a

skilled provider. It is acknowledged that the midwives and doctors accounted for 36% and 26% of the

healthcare practitioners that helped the pregnant mothers during the delivery of the baby. Notably, 5%

of the pregnant mothers were delivered alone in live births.

Postnatal care impedes maternal morbidity. 53% of women who ranged from 15 to 49 years with a live

birth in the previous two years received a postnatal review in two days of delivery. Two in every five

women did not get postnatal care. The newborns are less probable than women to get a postnatal check-up.

It is noted that 36% of birth had obtained a postnatal checkup in the initial two days after birth and that 62%

lacked a postnatal checkup.

4.3.4 Trends in Maternal Health

The maternal health indicators are enhancing in Kenya. Delivering in a health facility has improved

drastically from 2008-09. In 2014, the number of births was 61% up from 43% in 2008-09.

Maternal Mortality
The 2014 survey inquired women about the demises of their sisters to evaluate their maternal mortality. It

is noted that there were 362 demises in every 100, 000 live births that had an interval of 254-471. There is

less than maternal mortality rate acknowledged in the 2008-09 KDHS (520, with a confidence interval of

343-696). The decline is not having a statistically significant difference. There is an absence of proof that

the maternal mortality ratio has decreased in the latest times in the nation (Dahiru et al.. 2015).

4.4 Discussion

The finding of this study disclosed that Kenya is predominated by young mothers. This was disclosed that

in both `maternal review studies, the mean age is 32 years. Age is discovered to be a risk factor in this

exploration; young mothers aged 16 to 23 years are exposed to more risk of demise than the old mothers.

The case scenario is credited to the many factors such as age, marital status, type of residence, place of

delivery, and education level. WHO (2012) articulates that the young age combined with restricted access

to health information and fewer regulations for making decisions that led to life-threatening pregnancies.

Kathryn Graczyk (2007) asserted that adolescent who ranges from 15 to 19 years are as two times

probable during pregnancy or childbirth as those over twenty years. The study discovered that the

utilization of ANC services were risk factors to birth outcome. Clinic visits affect the use of the services

and skilled delivery. It is a likelihood that the diagnosis of the risk factors is linked with maternal

mortality. Although this study did not examine child spacing, Sonneveldt et al., (2013) addressed that

higher parity with short-term birth order exposes mothers to maternal mortality.

Education was discovered to be linked and affects health pursuing maternal use and death. The mothers

who are less elite make fewer visits during the period of pregnancy and are not likely to deliver the baby

in the hospital and pre-expose themselves to a great risk of perishing compared to the other group of

women. In the duo approaches, the mothers who had attained post-secondary education had a higher

utilization level and greater predictive level of skilled delivery than those who lacked primary education.

The restrained access to maternal education among mothers led to low maternal utilization and was linked

with the risk of perishing in the exploration. Mats Malqvist et al., (2012) argues that maternal education
has been taking into account as a significant determining factor for maternal health. Education can

influence the health of a pregnant woman in various ways via the increased awareness of the risks and an

in-depth comprehension of the healthcare structure and a higher capability to adapt to change. The

education level of the entire family and even the greater education level of the community affects health.
 CHAPTER FIVE: SUMMARY, CONCLUSION, AND RECOMMENDATIONS

5.1 Introduction

This chapter highlights a summary of the findings of the study, conclusions, recommendations,

shortcomings, and potential for future research on the determinants of maternal mortality in Kenya.

5.2 Summary of the Findings

The findings support the reviews of notable authors that socioeconomic constraints affect the maternal

mortality in Kenya. It was found out that cultural practices of certain tribes force their women to drop out

of school to get married. These have forced the women to lack the education necessary to help them to

avoid maternal mortality. Kenya is a developing nation, and the gene coefficient is low as well as the wealth

index. The lower levels of income have forced the women to attend the healthcare facility that does not

offer the best medical care. When there is a lack of essential healthcare facility, then the pregnant woman

would perish.

The type of residence affects the likelihood of maternal mortality. The women from rural areas are more

probable to succumb to maternal mortality because of poor education and less wealth than those from urban

areas. Age is a key determinant of maternal mortality. Women who are in their tender ages are more likely

to suffer from maternal mortality because they have feeble pelvic muscles. Marital status will have less

significance on the maternal mortality.

5.3 Conclusion

Maternal mortality is the aspect that sadly remains notably affects the developing regions globally which

led to an increase in the Millennium Developments Goals (MDGs) in 2000. In consideration of inclusion

of maternal mortality in the MDGs, the reduction of maternal mortality has been seen worldwide, from

approximately 450 deaths per 120,000 live birth pre-1991 to 230 deaths per 120,000 live births in 2011.

However, Kenya has experienced the most reductions in maternal deaths. Some of the causes of maternal

mortality has been curb through access to maternal health services such as female education, antenatal care,
skilled birth specialist and access to another source like employment.as matter of fact, it is established the

major causes of maternal issues are associated with severe bleeding and infectious disease such as

hypertensive disorders, obstructed labor, and maternal sepsis. On the other hand, the reduction is a

continuous process that only needs an allocation of resources and application of various strategies. Also,

some the methods of reducing maternal deaths include increase of maternal medical staff via allocation of

resources and training, promoting access to maternal health services, and raising the number of female

enrollment in all levels. Finally good infrastructure network and improve modthe e of transportation go in

handy with the reduction of maternal mortality since it will boost the chances of mothers to access health

care services and make the health workers reach the women.

5.4 Recommendations

The subsequent suggestions are deemed to reverse the determining factors of maternal mortality in Kenya.

They are categorized into three levels on managing health care delivery: National level (Ministry of Health),

District level (District Medical officers of Health) and the Community.

National level

1) Improve access to quality maternal care and facility coverage by:

 Training and equipping skilled birth attendants with the necessary knowledge and skills to handle

emergency obstetric care.

 Provision of adequate personnel and creating mechanisms of the employee's retention whereas

reducing staff abrasion by providing an encouraging welfare attribution and conducive environment

to perform.

 Improve communication system like radio sets in parts with unreliable communication phone

networks to facilitate referrals in case of emergence.

 In this sense it will call for the provision of better means of transport to reach the varies levels of

care.
  Provision of affordable service such as universal cards of maternal health services, for example,

NHIF cards to increase utilization of the facility.

District level

2) Enhance the coexisting health facilities and management by:

 Build, rehabilitate, and equip maternity wards.

 I am increasing the coverage of the facility by building more health facilities to the population.

 Build outreach and mobile clinics to enhance the access of such population t crucial health care

services.

 Streamline logistics associated with medicines and medical supplies to elude interruption of service

delivery to the population.

 Provision of clean delivery kits for use during home assisted deliveries and secure clean water to

uphold the levels of hygiene during and after interventions.

 Plan, coordinate, and enforce safe motherhood practices within the district steering committee to

maintain focus on safe motherhood to maintain focus in the district.

 Create awareness of the presence of services via intensified health education and community health

staff.

 Support supervision and monitoring of safe motherhood activities among the entire health stakeholders

enforcing the programs.

 Intersectoral collaboration among the pertinent sectors to health, for instance, giving information on

sexual productiveness, water sanitation, and sanitation from the regulatory bodies

Community level
3) Engage the community in their health particularly with emphasis on decreasing delay and enhancing

referrals at the community level.

 I am engaging the community health staffs to conduct health education on maternal health via materials

and women health clubs.

 Offering thorough training to community health workers to enable them to detect and refer to maternal

morbidity.

 Advocate that the community should develop community-based emergency fund and transport to

facilitate referrals at the community level to hospital care.

 Familiarize the community with waiting delivery households to enhance access to skilled birth

attendants.

5.5 Limitations of the Study

Even though the study successful attained the objective of finding the determinants of the maternal

mortality, it was discovered that there are fewer shortcomings in the study. There was data that was missing

in the data. The presence of this data could have assisted in improving the results of the study.

5.6 Areas of Further Research

The earlier studies have centered on the determinants of maternal mortality in Kenya. Future studies should

draw a comparison of Kenya with other nations on maternal mortality trends and a deeper analysis of the

best interventions to curb the menace in the society.

 6. References

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