Pre facility factors affecting the access to emergency obstetric care by mothers in Kibanda Health Sub District
Background: All pregnancies have a risk of developing complications and once these develop, access to Emergency Obstetric Care (EmOC) is all that is required to promote safe motherhood. However, globally, inequalities in access to EmOC exist and undermine safe motherhood. Access to care is affected by facility as well as pre-facility factors. The objective of this study was to identify the pre facility factors that impede access to EmOC facilities by mothers in Kibanda Health Sub District (HSD), so as to propose strategies to promote the access and hence safe motherhood. Methods. This was a descriptive cross sectional study employing qualitative and quantitative data. A structured questionnaire was administered to 400 mothers who had delivered within one year to the study and had experienced an obstetric danger sign or complication while an interview guide was administered to ten Key Informants. SPSS computer package was used in the quantitative data analysis for univariate analysis, bivariate analysis and multivariabe logistic regression. Thematic analysis was used for the qualitative data. Findings: The age range of respondents was 15-46 with an overall mean age of 27.1 and the proportion of mothers who had sought care at EmOC facilities was 45.3%. Mothers with parity > 3 were less likely to access EmOC than mothers with parity ≤ 3. OR: 0.88 (CI: 0.80 –0.96). Mothers who had ready funds for maternal care were more likely to access EmOC than those without OR: 1.24 (CI: 1.01 – 1.51). Mothers who knew of the services for the problems were more likely to access EmOC than those who did not. OR: 1.24 (CI: 1.00 – 1.52). Mothers who knew where to seek care were more likely to access EmOC than mothers who did not. OR: 1.14 (CI: 1.01 – 1.30). Mothers who did not attend Ate Natal Care (ANC) were less likely to access EmOC than mothers who attended OR: 0.77 (CI: 0.61 – 0.98). Mothers who used motorized transport were more likely to access EmOC than those who did not. OR: 1.25 (CI: 1.04 – 1.49). However, at multivariable logistic regression, only client satisfaction for services was found statistically significant with mothers who were satisfied with facility care being more likely to access EmOC than those who were not OR: 1.54 (CI: 1.01 – 2.34). Conclusions: Access to EmOC facilities in the Kibanda HSD is below national target. Low client satisfaction for facility services, low knowledge of mothers on EmOC, poor Ante Natal Care attendance, difficulties of transport and not having ready funds for maternal care were the main factors affecting the access. Traditional Birth Attendants (TBAs) were found to be active in delivering of mothers contrary to government policy.