Determinants Of Bypassing County Public Health Facilities Among Women Seeking Childbirth Services At Moi Teaching And Referral Hospital, Eldoret-Kenya

Purpose: This study aimed at determining the individual and health facility factors that inform a woman's decision to bypassing county public health care facilities and seek childbirth services at Moi Teaching and Referral Hospital Methodology: This was a hospital based cross sectional study using quantitative approach. The study was carried out in Moi Teaching and Referral Hospital, Uasin Gishu County. Simple random sampling method was employed to attain the sample size (n=399). Data analysis was done using descriptive statistics, bivariate and multivariate logistic regressions. Strength of association between the dependent variable and independent variables was measured using odd ratio with a p value ≤ 0.05 considered statistically significant at 95% confidence interval. Results: Out of the 399 respondents, 306 (76.7%) bypassed lower level public health facilities while 93 (23.3%) were actual referrals. Among the individual characteristics that influenced bypassing were older age (OR: 2.5; CI: 1.4-4.4; p= 0.001), primiparity (p=0.0001), history of previous pregnancy complications (OR: 3.7; CI: 2.2-6.2; p< 0.0001) and home county (OR: 4.3; CI: 2.7-7.2; p< 0.0001). Health facility characteristics that were significant in this study were availability of ambulance (OR: 0.4; CI: 0.2-0.9; p= 0.03) and a functional theatre and doctor to handle emergency cesarean sections (OR: 0.4; CI: 0.2-0.9; p= 0.01). Unique contribution to theory, practice and policy: The research brings in a wealth of knowledge that the expectation of quality maternal care plays a key role in the selection of childbirth facilities by women irrespective of their individual characteristics.