Thesis:

Determinants of uptake of free maternal health services among women in Turkana central sub-county, Turkana county, Kenya

Turkana Central Sub-County, situated in arid and semi-arid Turkana County in Kenya faces unique challenges that make access to maternal healthcare particularly difficult. Addressing these diverse barriers requires a comprehensive understanding of the factors influencing maternal healthcare uptake. This study aimed to determine the determinants of uptake of free maternal health services among pregnant women in Turkana's central sub-county. Specifically, it sought to establish knowledge of pregnant women on the use of free maternal health services, maternal health-seeking behaviour of pregnant women, and establish health facility characteristics affecting free maternal health services in Turkana's central sub-county. The cross-sectional study targeted 210 pregnant women and those who had been pregnant within the last six weeks before the commencement of the study. Turkana Central Sub-County, specifically Lodwar Township, was purposively sampled for this study because of its centrality and accessibility. The respondents were identified through snowballing. In cases where there was more than one qualified respondent, a coin was tossed as a way of picking one respondent and at the same time controlling bias in sample selection. A structured questionnaire was the main tool used to collect quantitative data. A chi-square test was used to examine associations between predictors and the utilization of maternal health services, while binary regression was employed to compare knowledge levels among different demographic groups. The significance level was set at p < 0.05 to determine statistical significance. Socio-demographic factors associated with the utilization of maternal health services were women aged 25-29 (OR = .141, p = .007), households with a monthly income of 5,001-10,000 (OR = .141, p = 0.18) and Kshs. 10,001 - 15,000 (OR = .114, p = .011). Women who were aware of what free maternal health services entail specifically skilled delivery were also a predictor of maternal health services uptake (OR = .163, p =.039). Those who sought treatment in case of complications (OR = .208, p =.001), who made self-health decisions in the household (p = .041) or through the help of a guardian (OR = 6.121, p = .012), perceived health workers as friendly (p = .004), or harsh (OR = 4.655, p < .001), and women located < Km 30 (p = < .001) or > Km 60 (OR = 3.227, p = .006) also influenced uptake. Structural barriers like distance and transportation challenges remain critical obstacles, particularly for low-income households. Specific knowledge about services like skilled delivery significantly influences uptake, underscoring the importance of targeted awareness campaigns. Women who previously faced barriers or negative experiences with professional care were less likely to return, emphasizing the need for quality improvements and positive patient experiences. Knowledge, distance, and provider attitude critically affect maternal health service uptake in Turkana Central. Improving awareness, access, and healthcare worker training to boost maternal service utilization.