As maternal child health (MCH) programs expand in the setting of HIV, health systems are challenged to reach those most vulnerable and at the greatest need. Cross-sectional surveys of MCH clinics and recent mothers in the Siaya Health Demographic Surveillance System were conducted to assess correlates of accessing antenatal care and facility delivery. Of 376 recent mothers, 93.4% accessed antenatal care and 41.2% accessed facility delivery. Per-kilometer distance between maternal residence and the nearest facility offering delivery services was associated with 7% decreased probability of uptake of facility delivery. Compared with a reference of less than 1 km between home and clinic, a distance of more than 3 km to the nearest facility was associated with 25% decreased probability of uptake of facility delivery. Distance to care was a factor in accessing facility delivery services. Decentralization or transportation considerations may be useful to optimize MCH and HIV service impact in high-prevalence regions.
Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Departments of Global Health and Psychosocial & Community Health, University of Washington, Seattle, Washington, USA. Adam Akullian, PhD, is an Affiliate Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. John Okanda, BSc, is Research Officer, KEMRI & CDC Research and Public Health Collaboration, Kisumu, Kenya. George Otieno, MSc, is Senior Data Analyst, KEMRI & CDC Research and Public Health Collaboration, Kisumu, Kenya. John Kinuthia, MBChB, MMed, MPH, is Head of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. Joachim Voss, PhD, RN, FAAN, is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Brenda Zierler, PhD, RN, FAAN, is Professor, Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA. Grace John-Stewart, MD, PhD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA.
Corresponding author: Pamela Kohler, e-mail: email@example.com
Sponsorships or competing interests that may be relevant to content are disclosed at the end of the article.