Mwaisaka Jefferson, Sripad Pooja, Olum Melanie, Owira Patricia, Mwaura Samuel, Njeru Rhoda, Muli Daniel, Mutisya Faith, Hyre Anne, Noguchi Lisa, Suhowatsky Stephanie
International Center for Reproductive Health, Mombasa, Kenya.
Jhpiego, DC, WA, USA.
Reprod Health. 2025 Aug 22;22(1):150. doi: 10.1186/s12978-025-02107-w.
Group antenatal (G-ANC) care has been introduced in Kenya and is associated with increased ANC contacts. Previous studies did not report higher likelihood of facility-based deliveries, where facility delivery rates are high (> 80%). It is unknown whether G-ANC influences women's choice of delivery facility. This study sought to understand if and how exposure to and experience of G-ANC, among other factors, influence women's decisions on which facility to deliver. Study findings can inform health system strategies including the Service Delivery Re-design.
We conducted a cross-sectional survey from December 2023 to January 2024 in eight health centers in Machakos County, Kenya with women who participated in G-ANC and had a facility delivery to understand women's choice of health facility for childbirth, i.e., whether they returned to the same G-ANC facility for delivery or went to another facility. The survey interviews were administered through telephone, as a nested component of a larger implementation research focused on the adoption of G-ANC.
Of the 470 women who participated in the phone survey, 29.8% of women returned to deliver at the facility where they received G-ANC and 70.2% delivered elsewhere. Most women (84.3%) delivered in the public sector. Regression analysis models revealed two significant predictors for delivery in the same G-ANC facility: proximity to the facility (adjusted AOR 4.13, 95% CI: 2.73-6.23, p < 0.001); and positive staff attitudes (adjusted AOR 4.68, 95% CI: 2.06-10.60, p < 0.001). Two significant predictors of delivering in a different facility were being "told/advised to give birth there during pregnancy/ANC" (adjusted AOR 0.23, 95% CI: 0.15-0.35, p < 0.001) and high household wealth status (quintile four AOR 0.29, 95% CI: 0.09-0.91, p = 0.034; quintile five AOR 0.23, 95% CI: 0.07-0.72, p = 0.011). Intervention exposure was not significant.
Most women participating in G-ANC chose to deliver in another facility. The choice of facility for childbirth was most strongly influenced by factors other than the intervention, such as proximity, positive staff attitudes, health advice, and household wealth status.
肯尼亚已引入小组产前（G-ANC）护理，且这与增加产前护理接触次数相关。以往研究未报告在设施分娩率较高（>80%）的情况下，基于设施的分娩有更高的可能性。目前尚不清楚G-ANC是否会影响女性对分娩设施的选择。本研究旨在了解接触G-ANC及其体验等因素是否以及如何影响女性关于在哪个设施分娩的决定。研究结果可为包括服务提供重新设计在内的卫生系统策略提供参考。
2023年12月至2024年1月，我们在肯尼亚马查科斯县的八个卫生中心对参与G-ANC且在医疗机构分娩的女性进行了横断面调查，以了解女性对分娩卫生设施的选择，即她们是回到提供G-ANC的同一设施分娩还是前往其他设施。调查访谈通过电话进行，作为一项侧重于采用G-ANC的更大规模实施研究的嵌套部分。
在参与电话调查的470名女性中，29.8%的女性回到接受G-ANC的设施分娩，70.2%的女性在其他地方分娩。大多数女性（84.3%）在公共部门分娩。回归分析模型揭示了在同一G-ANC设施分娩的两个显著预测因素：距离设施较近（调整后的比值比[AOR]为4.13，95%置信区间[CI]：2.73 - 6.23，p < 0.001）；以及工作人员态度积极（调整后的AOR为4.68，95% CI：2.06 - 10.60，p < 0.001）。在不同设施分娩的两个显著预测因素是“在孕期/产前被告知/建议在那里分娩”（调整后的AOR为0.23，95% CI：0.15 - 0.35，p < 0.001）和家庭财富状况较高（四分位数AOR为0.29，95% CI：0.09 - 0.91，p = 0.034；五分位数AOR为0.23，95% CI：0.07 - 0.72，p = 0.011）。干预暴露不显著。
大多数参与G-ANC的女性选择在其他设施分娩。分娩设施的选择受干预以外的因素影响最大，如距离、工作人员积极态度、健康建议和家庭财富状况。
