Utilisation of Skilled Birth Attendants among Recently Parturient Women in Rural Communities of Kano State, Nigeria: A Mixed-Methods Study

Abstract

Background: Ensuring access to skilled birth attendants (SBA) during childbirth is critical for maternal and newborn survival, especially in  underserved rural communities of northern Nigeria.

Methods: We assessed the utilisation of SBA in rural communities of Kano state.  Using a cross-sectional study design with a concurrent mixed method of data collection, multi-stage and purposive sampling techniques  were employed to select respondents of the quantitative and qualitative components of the study, respectively. Focus group discussions and key informant interviews were conducted to assess the perception of women, husbands and delivery service providers regarding the  utilisation of SBA.

Results: Of the 194 women, 38(19.6%) were attended to by SBA, 138(71.1%) by unskilled birth attendants and 18(9.3%)  had solitary birth. Furthermore, facility-based delivery was only 14.9% as the majority of the women delivered at home. Previous hospital  delivery (p=0.02, aOR = 4.5; 95% CI=1.4-14.8) and husband’s level of education (p=0.03, OR = 5.9; 95% CI=1.3-27.3) were found to be  independent predictors of utilisation of SBA. Perceptions regarding utilisation of SBA varied, ranging from a general preference for home  delivery with the assistance of a traditional birth attendant to a predisposition towards hospital delivery with the assistance of SBA.  Factors that contributed to adherence to traditional birthing practices included healthcare workers’ negative attitudes, manpower gap,  lack of equipment and supplies and inadequate functioning health facilities.

Conclusion: Utilisation of SBA in rural communities of Kano  state is low. Efforts should be made to increase women’s and men’s awareness, improve health facilities, and ensure improved and  equitable access and availability of skilled delivery care services.