FACTORS AFFECTING UTILIZATION OF SKILLED DELIVERY

AMONG MOTHERS (15-49) YEARS ATTENDING

YOUNG CHILD CLINIC IN KIKUUBE HCIV

KIZIRAFUMBI SUB-COUNTY,

HOIMA DISTRICT.

A RESEARCH REPORT SUBMITTED TO

UGANDA NURSES AND MIDWIVES EXAMINATION BOARD

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE AWARD OF THE DIPLOMA

IN NURSING SCIENCE.

BY,

NYAKATO IMMACULATE

RESEARCH STUDENT

NOVEMBER, 2018.
FACTORS AFFECTING UTILIATION OF SKILLED DELIVERY

AMONG MOTHERS (15-49) YEARS ATTENDING

YOUNG CHILD CLINIC IN KIKUUBE HCIV

KIZIRAFUMBI SUB-COUNTY,

HOIMA DISTRICT.

A RESEARCH REPORT SUBMITTED TO

UGANDA NURSES AND MIDWIVES EXAMINATION BOARD

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE AWARD OF THE DIPLOMA

IN NURSING SCIENCE.

BY

NYAKATO IMMACULATE

NSIN: N15/U011/DND/008

NOVEMBER, 2018

i
 ABSTRACT

Use of skilled birth assistance is still a big problem in developing nations with 26% of

women using unskilled delivery services and 26.4% of the deliveries being outside

the health care system.

The purpose of the study was to assess factors affecting utilization of skilled delivery
among mothers (15-49) years attending Young Child Clinic in Kikuube HCIV
Kizirafumbi sub-county, Hoima district.

The study was based on cross sectional descriptive research design with quantitative
method, simple random sampling procedure was used to obtain the sample size of 43
respondents who meant the study criteria and a questionnaire tool was used for data
collection, finally the collected data was then summarized and tabulated using
Microsoft Excel Vision 7 and presented in frequency and percentages on to tables and
figures.

The from the study results shown that, in socio-economic findings majority
16(37.2%) of the respondents attended secondary level and most 15(35%) had house-
hold-income of sh.50, 000-sh.100, 000 per season, most 23(53%) were peasants and
25(58%) used to seek permission before going for delivery. Furthermore, about a half
20(46.5%) of the respondents were between the age of 15-25 years as one of the
barriers influencing the use of delivery services, with 30(70%) attending ANC and
23(77%) had to seek permission before going to ANC while 18(60%) of mothers used
motorcycles to travel to hospital.

In conclusion, mothers with out or with low education status, parents with low house-
hold-income per season and those mothers who are un employed utilize delivery
services poorly while young mothers with a low parity and complete ANC visits and
also travel short distances to hospital are likely to fully utilize delivery services.

i
 COPYRIGHT

I NYAKATO IMMACULATE declare that this publication is my own effort and it

has never been submitted for academic award in any institution, college or university

before.

Signature ……………………………………………….

Copyright © (2018) by Nyakato Immaculate.

ii
 AUTHORISATION.

Un published research reports submitted to Kampala International University Western

Campus of Nursing sciences (KIU-WC SONS) and deposited in library, are open for

inspection, but are to be used with due regard to the rights of the author. The author

and KIU-WC SONS shall grant privilege of loan or purchase of microfilm or

photocopy to the accredited borrowers provided credit is given in subsequent written

or published work.

Author; NYAKATO IMMACULATE.

Address; Nyakato180@gmail.com

Signature………………………………………….Date…………………………

Supervisor; MR. BALUKU YOSIAH.

Address; balyos766@gmail.com

Signature…………………………………………Date……………………………

Dean; MS. KABANYORO ANNET.

Signature…………………………………………Date…………………………

iii
 DEDICATION

I dedicate my research Proposal to my dear parents’ Mr. Mugisa Jowas Sylvester and

Mrs. Mugisa Margret of Hoima district with the entire family. Thanks for their entire

less support they have given me throughout my life time and education they have

provided me, may the almighty God reward them abundantly.

iv
 ACKNOWLEDGMENT

Special and heartfelt gratitude goes to my research committee and my supervisor MR.

Baluku Yosiah for advice, critical and tireless review of my drafts; you have been a

great source of encouragement, support and inspiration through this grueling process.

Sincere thanks to my friends Agan Adams, Matins Erick, and my Parents Mr. Mugisa

Jowas Sylvester and Mrs. Mugisa Margret of Hoima district with the entire family for

their support during my studies.

I wish to recognize and acknowledge all brethrens and friends in Ishaka, Mbarara

and Hoima for the ceaseless prayers ever since I started my course really the Lord has

been merciful to me because of the combined effort of prayers wherever you are may

his name be praised. Sincere thanks to my brothers and sisters Wamani Wadson,

Tumusiime Steven and beloved elder sister Kyalisiima Doreen for their immense

support. Finally special thanks to Kampala International University for the good, well

equipped and well organization Library it has been of great value to my research.

v
 TABLE OF CONTENTS:

ABSTRACT ..................................................................................................................................... i

COPYRIGHT .................................................................................................................................. ii

AUTHORISATION. ...................................................................................................................... iii

DEDICATION ............................................................................................................................... iv

ACKNOWLEDGMENT................................................................................................................. v

LIST OF FIGURES: ....................................................................................................................... x

LIST OF TABLES: ........................................................................................................................ xi

LIST OF ABBREVIATIONS/ ACRONYM: ............................................................................... xii

DEFINITION OF TERMS .......................................................................................................... xiv

CHAPTER ONE: ............................................................................................................................ 1

1.0 Introduction. .............................................................................................................................. 1

1.1 Background. .............................................................................................................................. 1

1.2 Problem Statement. ................................................................................................................... 3

1.4 Objectives of the study.............................................................................................................. 4

1.5 Research questions .................................................................................................................... 4

CHAPTER TWO: LITERATURE REVIEW ................................................................................. 6

2.0 Introduction: .............................................................................................................................. 6

2.1 Socio-economic characteristics affecting utilization ................................................................ 6

vi
2.1.1 Maternal education................................................................................................................. 6

2.1.2. Income................................................................................................................................... 6

2.1.4 Religion. ................................................................................................................................. 7

2.1.5 Decision Making. ................................................................................................................... 7

2.2 Barriers hindering utilization of skilled delivery. ..................................................................... 8

2.2.1 Age. ........................................................................................................................................ 8

2.2.3 Women's autonomy. ............................................................................................................... 8

2.2.4 Place of residency. ................................................................................................................. 9

2.2.5 Marital Status. ........................................................................................................................ 9

CHAPTER THREE; METHODOLOGY: .................................................................................... 11

3.1. Introduction ............................................................................................................................ 11

3.2. Study design and rationale ..................................................................................................... 11

3.3. Study Setting and rationale .................................................................................................... 11

3.4 Study population ..................................................................................................................... 12

3.4. Sample Size determination. ................................................................................................... 13

3.4.2 Sampling Procedure. ............................................................................................................ 13

3.4.3 Inclusion Criteria ................................................................................................................. 14

3.4.4 Exclusion Criteria ................................................................................................................ 14

3.5. Definition of Variables .......................................................................................................... 14

vii
Dependent variable: ...................................................................................................................... 14

3.6. Research Instruments ............................................................................................................. 15

3.7. Data Collection Procedure ..................................................................................................... 15

3.8. Data management................................................................................................................... 16

3.9 Data analysis ........................................................................................................................... 17

3.11. Ethical consideration ............................................................................................................ 17

3.12. Limitations of the study. ...................................................................................................... 18

3.12.1 Limited time period: .......................................................................................................... 18

3.12.2 Limited funds ..................................................................................................................... 18

3.12.3 Bad weather ....................................................................................................................... 18

3.13. Dissemination of results....................................................................................................... 18

CHAPTER FOUR: RESULTS ..................................................................................................... 19

DATA ANALYSIS, INTERPRETATION AND PRESENTATION .......................................... 19

4.0 Introduction ............................................................................................................................. 19

4.1 socio-economic characteristics affecting utilization of skilled delivery among

mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-county,

Hoima district................................................................................................................................ 19

4.2 Barriers influencing utilization of skilled delivery among mothers (15-49) years

attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima district. ............................... 24

viii
CHAPTER FIVE: ......................................................................................................................... 29

DISCUSSION, CONCLUSIONAND RECOMMENDATIONS OF THE

STUDYFINDINGS....................................................................................................................... 29

5.0 Introduction. ............................................................................................................................ 29

5.1 Discussion of findings............................................................................................................. 29

5.3 Conclusion. ............................................................................................................................. 36

5.4 Recommendation. .............................................................................................................. 36

5.5 Implications............................................................................................................................. 37

REFERENCES. ............................................................................................................................ 38

APPENDIX I1: INTERVIEW GUIDE. ........................................................................................ 44

APPENDIX III: A MAP OF UGANDA SHOWING LOCATION OF HOIMA

DISTRICT..................................................................................................................................... 48

APPENDIX VI: A MAP OF HOIMA SHOWING THE STUDY AREA. .................................. 49

APPENDIX VII : THE INTRODUCTORY LETTER …………...............................50

ix
 LIST OF FIGURES:

Figure 1: Showing whether mothers had to seek permission when going for

delivery……………………………………………………………………………22

Figure 2: Showing reasons why mothers seek permission when going for

delivery…………………………………………………………………………….23

Figure 3: Showing mothers who had attended

ANC………………………………………………………………………………..25

x
 LIST OF TABLES:

Table 1: Showing socio-economic characteristics affecting utilization of skilled

delivery………………………………………………………………………..20

Table 2: Showing age of mothers utilizing the delivery services……………..24

Table 3: Showing response of mothers towards ANC attendance……………26

Table 4: Showing where mothers who seek permission when going for

ANC……………………………………………………………………………27

Table 5: Showing marital status, tribe and number of delivered

children…………………………………………………………………………28

xi
 LIST OF ABBREVIATIONS/ ACRONYM:

ANC Antenatal Care

CBOs Community Based Organizations

CHPS Community based Health and Planning Services

DHS District Health Survey

DNS Diploma in Nursing Science

GHS Ghana Health Service

GSS Ghana Statistical Services

HCIV Health Center IV

KDHS Kenya Demographic Health Survey

KIU-SONS Kampala International University School Of Nursing Sciences

MDGs Millennium Development Goals

MoH Ministry of Health

SBA Skilled Birth Attendance

TBA Traditional Birth Attendant

UDHS Uganda Demographic Health Survey

xii
UN United Nations

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WHO World Health Organization

YCC Young Child Clinic

xiii
 DEFINITION OF TERMS

Antenatal: The routine health control of presumed healthy pregnant

women without symptoms (screening) in order to

discuss diseases or complicating obstetric conditions

without symptoms and to provide information about

lifestyle, pregnancy and delivery.

Maternal mortality: The death of a woman while pregnant or within 42 days

of termination of pregnancy, irrespective of the duration

and site of the pregnancy, from any cause related to or

aggravated by the pregnancy or its management but not

from accidental or incidental causes.

Skilled care: Type of intermediate care in which the patient or resident

needs more assistance than usual, generally from licensed

nursing personnel and certified nursing assistants.

Skilled birth attendant: A midwife, physician, obstetrician, nurse, or other health

care professional who provides basic and emergency

health care services to women and their newborns during

pregnancy, childbirth and the postpartum period.

xiv
 CHAPTER ONE:

1.0 Introduction.

This chapter presents the introduction, problem statement, purpose of the study,

specific objectives, research questions and justification of the study.

1.1 Background.

Globally, World Health Organization (WHO) estimates that only 43% of women have

access to skilled care during deliveries with the rest exposed to unskilled delivery

(WHO, 2008). Furthermore WHO revealed out that 80% of live births occurred with

the assistance of skilled health personnel in the latest period 2012-2017 from 62% in

2000-2005 periods with largest progress occurring in last 10 years (WHO, 2017).

According to WHO, (2017) estimates that the rate of progress of skilled birth

delivery is varied across regions of central and southern Asia with a greatest rate of

progress from 40% in 2000-2005 up to 77% from 2012-2017. In addition Sub-

Saharan Africa has also shown progress over the same period and 2012-2017 over

50% of births was attended by skilled personnel (WHO, 2017).

Globally according to WHO recommendations of encouraging all women to seek

facility-based delivery, numerous barriers like age, health workers attitude, women

autonomy and distance to the health facility have been documented that prevent

women in Africa from delivering in health facilities (WHO, 2008). Another study

conducted in Ghana it is estimated that only about 49.5% of deliveries are attended by

a skilled personnel in 2010 (GHS, 2011). In addition, various interventions done by

1
the Ghana government like free delivery services, establishment of a CHPS

compounds and health education on the benefits of utilization of delivery services

have been put in place to expand and improve access to skilled delivery, still 50.5%

of women are attended to by unskilled birth assistance.(GHS, 2009, 2011 & GSS,

2008).

According to Kenya Demographic Health Survey (KDH) 56% of birth in Kenya are

delivered at home due to cost of service, the distance to the health facility and quality

of care despite the various strategies like provision of free delivery services being put

in place (KDHS, 2008, 2009). Thus, this calls for skilled attendance at all births

which is the most critical intervention for ensuring safe motherhood (Adanu, 2010).

In Uganda it was found out that 74% of live births in the 5 years preceding the survey

of 2016 were delivered by a skilled provider and almost the same proportion of (73

%) were delivered in a health facility and the remaining were neither delivered in the

health facility nor by skilled providers (UDH, 2016). In western Uganda mostly in

Bunyoro land were the study will be conducted from, it’s found out that about 24.1%

delivered outside health facility, which has led to the high incidence of avoidable

deaths of pregnant women (Evans, 2013). This therefore addresses the issue of

maternal health which should not be left out side of the ministry of health and that it

will take a concerted effort of government, nongovernmental agencies and

intersectoral collaboration (Reuben K, Margaret S, 2013). Hence this study aims at

finding out factors that affect utilization of delivering services.

2
1.2 Problem Statement.

Access to skilled delivery is crucial for reducing maternal mortality (Hounton,

Chapman, Menten, Brouwere & Ensor, 2008). Globally, World Health Organization

(WHO) estimates that only 43% of women have access to skilled care during

deliveries with the rest exposed to unskilled delivery (WHO, 2008). Furthermore

WHO revealed out that 20% of live births occurred with the assistance of unskilled

health personnel in the latest period 2012-2017 from 38% in 2000-2005 periods with

largest progress occurring in last 10 years (WHO, 2017).

In Uganda, according to UDHS, (2016) estimated 26% of women are not delivered

by skilled personnel and in Bunyoro where the study will be conducted, a number of

deliveries not attended to by the skilled personnel are as low as 24.1%, 26.4% of

deliveries are outside the health facility and 92.3% of mothers attend ANC. The

government and nongovernmental organizations (UNICEF & UNFPA) have put

different interventions like provision free delivery and ANC services, provision of

delivery kits and community ambulances but still the intended percentage of skilled

delivery is not achieved. Construction of roads to health centers, improving on the

standards of the health centers by constructing more wards and adding more beds

with more health workers mostly midwives and putting strict laws on health workers

who are always absent and have poor attitude to mothers are the most urgent

interventions to improve on skilled delivery because failure to do so there will be

increased maternal mortality and morbidity rate, prenatal death, and sepsis due to

unsafe delivery.

3
1.3 Purpose of the study.

To asses factors affecting utilization of skilled delivery among mothers (15-49) years

attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima district.

1.4 Objectives of the study

1. To assess the socio-economic characteristics affecting utilization of skilled delivery

among mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-

county, Hoima district.

2. To identify the barriers hindering utilization of skilled delivery among mothers

(15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima

district.

1.5 Research questions

1. How does a socio-economic characteristic affect utilization of skilled delivery

among mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi

sub-county, Hoima district?

2. What are barriers hindering utilization of skilled delivery among mothers (15-

49) years attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima

district?

4
1.6 Justification of the study.

Ministry Of Health

The study was expected to guide the Ministry of Health in policy formulation taking

into account the factors affecting utilization of skilled delivery.

Nursing practice

The results of the study were to contribute to a body of knowledge on the public’s

utilization of skilled delivery.

Nursing education

It was expected to act as a reference to other students and future researchers.

Community

The study was also meant to clear superstition and negative belief held by people on

utilization of skilled delivery.

5
 CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction:

This chapter focused on establishing what had already been done and found out in the

area of skilled delivery services in both developed and developing countries by other

scholars or authors. Areas highlighted included: socio-economic characteristics and

barriers to skilled deliveries.

2.1 Socio-economic characteristics affecting utilization of skilled delivery.

2.1.1 Maternal education.

According to the study done by Jat & San Sebastian, (2011) results revealed out that

parental education, especially mother’s education plays an important role in the use of

skilled assistance at delivery. In addition to a study conducted in Ghana results

showed that improving education for the girl child can increase skilled delivery

attendance, since most of those who used unskilled delivery, their educational status

were either low or none (Esena & Sappor, 2013).

2.1.2. Income.

The studies conducted in Nigeria and Indian points out significant association

between household socio-economic status and the use of skilled assistance at delivery

which affirms that the use of skilled assistance at delivery is more than four times

higher among women from rich and very rich households compared to the women

from very poor households (Babalola and Fatusi, 2009, Onta, et al., 2015, Doctor

&Dahiru, 2010).

6
2.1.3 Occupation.

According to a study done by GSS (2008), results revealed that occupation of the

woman or husband plays an important role in the use of maternal health care services

by pregnant women whereas the study conducted out in Ghana by GSS (2008) results

shown that employed professionals utilize skilled delivery services 100% compared

to nonprofessional and unemployed mothers.

2.1.4 Religion.

A study conducted from Bangladesh which reveals that the use of skilled attendants at

birth is higher among women from Hindu religion compared to women from Muslim

religion (Baral, Lyons, Skinner & Van Teijlingen, 2010). On the other hand, studies

in India claim that Muslim women are more likely to deliver with skilled assistance

compared to women from Hindu religion (Nair, Ariana & Webster, 2012).

2.1.5 Decision Making.

In most African settings, men’s decision-making authority over women hinders their

use of reproductive health-care services & this is evidenced by a study conducted on

women in Kano state (2008), fail to utilize delivery care services because of spousal

inhibition and access to experienced traditional birth(Jibo,2008). Joint decision-

making was further strengthened by high education and high household assets

ownership (Kabakyenga, Östergren, Turyakira, &Pettersson, 2012).

7
2.2 Barriers hindering utilization of skilled delivery.

2.2.1 Age.

A study done in developed countries revealed, women of age group of 35-44 years

did not deliver at the health facility because there are more likely to be confident in

their ability to have a successful home delivery due to accumulated experience in

birthing and might also be more traditionally inclined (Doctor et al., 2012).

2.2.2 Use of ANC.

A study conducted from rural Bangladesh revealed that expectant women who might

have made less visits to the ANC as is required were most likely to use unskilled

delivery (Chowdhury & Hasan, et al., 2013). A similar study done in Ethiopia

established that women making their first ANC visit after the first trimester has past

were likely to deliver at home (Mengesha & Koye, et al., 2013).Another study done

from urban slums of Nairobi evidenced that women who were informed that their

pregnancy is progressing well, might not see the need to visit the health facilities

manned by skilled care since they do not foresee any complication (Lzugbara, Kibiru

& Zulu, 2009).

2.2.3 Women's autonomy.

According to Baral, et al., (2010), in their study they revealed out various dimensions

of autonomy, such as position in the household, financial independence, mobility and

decision-making power regarding one's own healthcare, may all impact on health

facility use. In many countries, women cannot decide on their own to seek care,

8
without asking for permission from a husband or mother-in-law, this has led to lack

of control over material resources needed to pay for expenses, their mobility may be

restricted to access to transportation such as vehicles or even bicycles or donkeys

(Shimazaki, Honda, Dulnuan, Chunanon, & Matsuyama, 2013).

2.2.4 Place of residency.

Studies in developing countries have demonstrated that hospital delivery service

utilization is influenced by place of residence (Baral, et al., 2010). Living in urban

areas increases the probability of pregnant women using skilled assistance at delivery

(Mayhew, Hansen, Peters & Edward, et al., 2008, Tarekegn, et al., 2014).

2.2.5 Marital Status.

A study carried out on maternal health in Zambia had an important impact on access

to healthcare services during pregnancy, with those who were married more likely to

receive health care access during pregnancy than unmarried women (Breen,

2011).More so many studies have confirmed that, polygamous relationships have a

negative effect on a mother’s receipt of adequate care during pregnancy and

childbirth (Mengesha, et al., 2013, Breen, 2011).

2.2.5 Ethnic group.

A study done by Palamuleni, (2011) revealed out that different regions in countries

have been found to have disparities as far as the type of service sought during

delivery is concerned. Another study done in Turkey revealed out that ethnic

minorities who largely occupy specific regions are more likely to be attended by

9
unskilled birth attendants at delivery due to marginalization by their government

(Gabrysch, Sabine & Campbell, 2009).

2.2.6 Birth order.

Study done in rural Pakistan about delivery assisted by non-skilled attendants varied

with the birth order revealed out that most women had their first child birth assisted

by skilled birth attendants, with subsequent birth occurring at home under the care of

non-skilled attendants (Agha & Carton, 2011). A similar study done in India revealed

out those women of higher birth order did not find it important to receive professional

delivery if previous births did not have complications (Gabrysch, et al., 2009).In

Rakai district of Uganda, birth order was not found to be significant same as in North

Nigeria(Kagunaa A & Nuwaha F, 2008).

2.2.8 Distance and transport means to health facility.

Distance to health services affect health care seeking behavior in that, it discourages

women from making a decision to seek skilled care in the first place (Story W &

Burgard S, 2012). The lack of access roads may increase time in accessing skilled

delivery services due to lack of vehicle or inability to afford the cost of transportation

(Nair, et al., 2012). Easily accessible roads attracts more vehicles and reduces cost of

transportation hence, enable clients to access health facilities in time of need such as

during labor (Saxena, Vangani & Thomsen, 2013).

10
 CHAPTER THREE; METHODOLOGY:

3.1. Introduction

This chapter explains the various methods and procedures that would be used and

followed while conducting the study. It includes the study design, study setting, study

population, sample size determination, sampling procedure, inclusion criteria,

definition of variables, research instruments, data collection procedure, data

management, data analysis, ethical considerations, study limitations and

dissemination of results.

3.2. Study design and rationale

The study was based on cross sectional descriptive in nature and quantitative method.

Across sectional study was chosen because of the poor turn up of mothers on the

YCC thus it helped me to collect data at one point for two different days.

3.3. Study Setting and rationale

The study was conducted at Kikuube HCIV in Kizirafumbi sub-county Hoima

district, Kikuube HCIV is found on Fortpotal road 15 km away from Hoima

municipal town, Kikuube HCIV is found on the left hand side opposite Kikuube

primary school which is on its right hand side. Hoima district is located 200.2 km

away from Kampala city and it 3 hours 37 minutes drive, it’s found on the western

border of the country with the Democratic Republic of Congo. Hoima district is

bordered by Masindi district, Kibonga district and Kibaale districts, and has a border

on Lake Albert. The district has a predominantly rural settlement, typical of much of

11
the nation. The district population size is approximately 401,000 according to UDHS,

(2008/ 2009) and it depends mostly on agriculture, with tea, tobacco and sugarcanes

as the main crops for income since it’s near Lake Albert, fishing is also economic

activity carried out. The health care system in Hoima district consists of a Regional

Referral Hospital in the town and other small health centers which includes Kikuube

HCIV consisting of a medium size hospital of 45 beds with capacity for emergency

obstetric care. In addition the health center provides services for uncomplicated

delivery, antenatal care, family planning and essential clinical care services. The

district has a hilly geographic terrain and a precarious road infrastructure, especially

during wet weather. Hoima district is historically the center of the Bunyoro Kitara

Kingdom and their towns still serves as the seat of the cultural king of the Banyoro

people, who form the majority of Hoima, Kibaale, Kibonga and Masindi districts.

However, there are a number of other ethnic groups in district, including members of

the Butoro, Bukiga, Alur and Bugungu groups. Kikuube HCIV was chosen because it

receives mothers from a big population mostly five sub-counties mainly Kizirafumbi

where it is situated, Buhaguzi, Bugambe, Kyabatalya and Kinogozi sub-counties.

3.4 Study population

The study was conducted among women of reproductive age group (15- 49 years)

who had delivered in less than a year prior to the study attending YCC in Kikuube

HCIV Kizirafumbi sub-county, Hoima district whether by the help of skilled or

unskilled assistance.

12
3.4. Sample Size determination.

The sample size was calculated and determined using the formula below

( )
(LoBiondo and Heber, 2014).

Where n=Sample size, N=Population (target) is 48 female. e=Standard error or of

margin. –e is 5% expected frequency. The confidence interval will be taken as 95%

(LoBiondo and Heber, 2014). ( )

= ( )

= = 42.85

Therefore 43 females of reproductive age(15-49)years attending YCC and delivered

in less than one year prior to the study in Kikuube HCIV Kizirafumbi sub-county,

Hoima district, whether by skilled or unskilled attendants.

3.4.2 Sampling Procedure.

The researcher utilized simple random sampling procedure to obtain the sample size

for the study. The researcher gave all potential respondents who meet the study

criteria and majorly those who attended Young Child Clinic on the two different days

of data collection were allowed to participate in the study by picking papers from an

enclosed box and any respondent who picks a paper with a word YES written on it

13
was requested to participate in the study. This continued until the total of 43

respondents was achieved.

3.4.3 Inclusion Criteria

Women who had come at YCC with children before one year of age and were

residents of Hoima district for at least one year were eligible for inclusion in the

study. Mothers who delivered from any health center and those who did not go to any

other health facility at the time of delivery were included.

3.4.4 Exclusion Criteria

Women who were visiting the households in the study area at the time of data

collection were excluded. All non-consenting mothers with children less than one

year of age were also excluded from the study. The females below15 and above 49

years and those who would be present at the time of the study were also excluded.

3.5. Definition of Variables

Dependent variable:

Utilization of skilled delivery services.

Independent variables:

Socio-economic characteristics affecting utilization of skilled delivery such as

maternal education, income, occupation, religion and decision making among

mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-county,

Hoima district.

14
Barrier hindering utilization of skilled delivery in Kikuube HCIV, Kizirafumbi sub-

county included; age, use of ANC, women’s autonomy, place of residency, marital

status, Ethnic group, birth order, distance and means of transport to the health facility

3.6. Research Instruments

A pre-tested questionnaire with both open and close ended questions was designed

and administered to the selected respondents who had consented to participate in the

study. A pre-test questionnaire was conducted at KIU-teaching hospital in maternity

ward in Ishaka district among post-partum mothers. When collecting data, the

researcher conducted a face-face interview with the selected respondents where he or

she was requested to fill in their responses by themselves and most “important” of

all, was to allow them “feel free” while responding to the questions since some of

them would shy away from airing out there responses. The researcher also opted for

this method because most youths need a lot of privacy and comfort in case they are to

provide fact and detailed information about themselves and more so concerning

reproductive health issues.

3.7. Data Collection Procedure

The questionnaire had sections on socio-economic characteristics and barriers

influencing utilization of skilled delivery services. The questionnaire was developed

basing on standard DHS questionnaires. Standardized questionnaire was administered

by trained interviewers (Professional Nurses). Administration of questionnaires was

face-to-face interview. In order to maintain the quality of data collected, interviewers

15
were first trained, frequent supervision was performed during data collection and

interviews were done using local languages (Runyoro). Administered questionnaire

were checked for completeness and accuracy.

The researcher introduced herself to the prospective participates and read to the

individual participant the consent form that had details of the title and purpose of the

study as well as the rights of the participant. Whenever the participant agreed to be

interviewed he or she would be asked to provide written consent by signing or

fingerprinting. If they would refuse to participate, the interview would not proceed.

After obtaining the written consent, the researcher entered the questionnaire serial

number and date of interview and then would proceed from the first up to the last

question using any language understood by the participant. The investigator entered

responses given by participants by circling and writing the appropriate response and

entered the same number in to the coding box. This was done to ensure data quality as

the response number ticked was supposed to be the same as the one entered in coding

box. If the number was different it would not availed response.

3.8. Data management

The filled questionnaires were checked for validity before leaving the data collection

site. Data was encoded and coded manually and it was entered correctly in the

computer. The questionnaires were kept properly in a lock and key to avoid access by

those not authorized and losses. Data was also to be kept for at least six months

before being discarded.

16
3.9 Data analysis

The collected data was summarised and tabulated using Microsoft Excel vision 7 and

presented in frequency and percentages on to tables, pie charts and graphs.

3.10 Quality control.

For reliability and validity, the questionnaire was pretested with tenth of the sample

size outside study area. The questionnaire was checked, for completeness, clarity,

consistency and uniformity by the researcher.

3.11. Ethical consideration

The Study was approved by Kampala International University School of Nursing

Sciences [KIU-SONS] ethics committee. An introductory letter was obtained from

the chairperson of the research committee KIU-SONS and was used to request

permission and introduce the researcher to different administrators in Kikuube

Hospital on the research day. The researcher explained to the participants the purpose

of the study and its objectives and they were requested to respond. Consent from was

signed by the participants and they were informed of the right to withdraw from the

study at any time without any penalty. The researcher also informed the respondents

that no hidden intention behind participating in the study and they were assured of

maximum confidentiality and that the results should only be used for the purpose of

the research.

17
3.12. Limitations of the study.

3.12.1 Limited time period: It was anticipated that the researcher was not be able to

accomplish data collection process in the estimated time. However, the researcher

was guided by a work plan showing the activity to be done at a given time period.

3.12.2 Limited funds: The researcher seeked assistance from guardians and friends

to provide him with money for research.

3.12.3 Bad weather: It was also expected that the researcher was to face problems of

weather changes, and this was overcome by carrying an umbrella and gumboots in

preparation for the weather changes.

3.13. Dissemination of results

Information obtained was discussed with the study supervisor and then later with the

administration of Kikuube LCI. After approval, the final report was written and

distributed as follows:

 A copy to library (KIU-SONS).

 A copy to Uganda Nurses and midwives Examinations Board.

 A copy for the Researcher.

18
 CHAPTER FOUR: RESULTS

DATA ANALYSIS, INTERPRETATION AND PRESENTATION

4.0 Introduction

This chapter presents the results that were obtained after data collection. Data was

collected from 43 participants using questionnaires for a study whose aim was to

identify the factors affecting utilization of skilled delivery among mothers (15-49)

years attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima district. Out

of 43 respondents interviewed, 43 questionnaires were completely filled thus giving

response rate of 100%.

4.1 socio-economic characteristics affecting utilization of skilled delivery among

mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-

county, Hoima district.

19
Table 1: Showing socio-economic characteristics affecting utilization of skilled

delivery.

N=43

Parameters Variables Frequency(n) Percentages (%)

Level of education Primary level 13 30.2

Secondary level 16 37.2

Tertiary level 10 23.3

Never attended school 4 9.3

House- hold-income <shs50,000/= 13 30.2

Shs50,000shs100,000 15 35.0

shs110,000-shs200,000 3 7.0

>shs210,000 12 28.0

Mothers occupation Peasants 23 53.0

House wife 9 21.0

Trader 8 19

Public servant 3 7

Religion Anglicans 11 26.0

Catholics 21 49.0

Muslims 7 16.3

Others like seventh day 4 9.3

Adventists

20
From table 1 above, research finding shows, that majority 16(37.2%) of the

respondents had ever attended secondary level of education compared to the 4 (9.3%)

who had never gone to school.

Most 15 (35.0%) of the respondents report their house hold average income to be

between shs50, 000 to shs100, 000 compared to 3(7.0%) who said their income to be

ranging from shs110, 000 to shs200, 000.

More than a half 23 (53.0%) of the respondents said their occupation was farming

compared to 3 (7.0%) who said to be public servants, more so majority 21 (49.0%) of

the respondents said to be of Catholic religion compared to 4 (9.3%) who said to be

belonging to other religions like the seventh day Adventist.

21
 N=43

42%
58% YES
NO

Figure 1: Showing whether mothers had to seek permission when going for

delivery.

Results in figure 1 above shows that majority 25 (58%) of the respondents did not

seek permission when going to the hospital for delivery compared to 18 (42%) who to

seek permission from different people like their husbands, their mothers and mother-

in-laws before going for delivery.

22
 N=18

28% 28%

lovefor the family

need for support
create awareness
44%

Figure 2: Showing reasons why mothers seek permission when going for

delivery.

According to the research findings, results show that most 8(44%) of the respondents

seek permission because they needed support when going to hospital compared to an

equal 5 (28%) of the respondent who seek permission before going to the hospital for

delivery due to the love they had for their family and to create awareness

respectively.

23
4.2 Barriers influencing utilization of skilled delivery among mothers (15-49)

years attending YCC in Kikuube HCIV Kizirafumbi sub-county, Hoima district.

Table 2: Showing age of mothers utilizing delivery services at Kikuube HCIV.

N=43

Parameters Variables Frequency(n) Percentages (%)

Age 15-25 years 20 46.5

26-35 years 14 32.6

36-45 years 9 20.9

Total 43 100

According to the research findings in the table 2 above, results show that about a half

20 (46.5%) of the respondents who utilize the delivering services at Kikuube HCIV

said they are in the age group ranging from 15years to 25 years compared to 9

(20.9%) of respondents who range between 36- 45 years.

24
 N=43

30%

YES
70% NO

Figure 3: Showing mother who had attended ANC.

According to the research findings in figure 3 above, results show the majority 30

(70%) of the respondents said they attended ANC when they were pregnant

regardless on the number of times attended compared to 13 (30%) who said they did

not attend ANC at all.

25
Table 3: Showing response of mothers towards ANC attendance.

N=30

Parameters Variables Frequency(n) Percentages (%)

Transport means Walking 10 33

being used Bicycles 2 7

Motorcycles 18 60

Time taken to <30 minutes 8 27

reach the HCIV 1 hour 10 33

2 hours 2 7

>2 hours 10 33

Number of ANC One time 9 30

attendance. Two times 4 13

<3 times 17 57

Whether any Yes 23 77

seeked permission No 7 23

According to the research findings, results show that most 18 (60%) of the

respondents used motorcycles to travel to the hospital when going for ANC compared

to 2 (7%) of respondents who used bicycles when going for ANC.

Results also shows majority 10 (33%) of the respondents who said they used to reach

the health center within one hour and more than two hours depending on the distances

26
being travelled when going to the health center respectively compared to 2 (7%) who

said used to take 2 hours when travelling to the health center.

Also results show that the majority 17(57%) of the respondents attended ANC more

than three times compared to 4(13%) who attended twice and majority 23 (77%) of

the respondent used to seek permission before going for ANC compared to 7 (23%)

who never seek permission when going for ANC.

Table 4: Showing where mothers seek permission when going for ANC.

N=23

Parameters Variables Frequency(n) Percentages (%)

Where they seek Mother 3 13

permission. Father 6 26

Mother-in-law 9 39

Husband 5 22

Total 23 100

According to the research findings in table 4 above, majority 9(39%) of the

respondents seek permission from their mother-in laws compared to 3(13%) who seek

permission from their mothers.

27
Table 5: Showing marital status, tribe and number of delivered children.

N=43.

Parameters Variables Frequency (n) Percentages (%)

Marital status Married 15 35
Widowed 8 18
Never married 20 47
Tribe Munyoro 13 30
Mukiga 20 47
Mutooro 5 12
Others (Aluru) 5 12
Number of 1-2 10 23
delivered children. 3-4 8 19
>5 25 58

According to the research finding, results show about a half 20 (47%) of respondents

said they have never got married compared to 8 (18%) who said they are widows and

most20 (47%) of the respondents said are Bakiga compared to 5 (12%) who said they

were both Batooro and Alurus respectively.

More than a half 25 (58%) of the respondents have ever delivered more than five

children either by the help of skilled or unskilled birth assistance compared to 8

(19%) who have ever delivered three to four children by the help of either the skilled

or unskilled assistance.

28
 CHAPTER FIVE:

DISCUSSION, CONCLUSIONAND RECOMMENDATIONS OF THE STUDY

FINDINGS.

5.0 Introduction.

This chapter deals with discussion of the findings objectively in relation to the

literature review to answer research questions, conclusion and recommendations are

made in relation to; socio-economic and barriers influencing utilization of skilled

delivery among mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi

sub-county, Hoima district. Out of 43 respondents interviewed in the study, 43

questionnaires were returned completely filled thus giving response rate of 100%.

5.1 Discussion of findings.

According to the research findings, results revealed that majority16 (37.21%) of the

respondents attended school up to secondary level. This could be due to the fact that

having done the research in the village and most people especially mothers who stay

there have a lower education level are thus likely to underutilize the delivery services

at health centers, these findings are in agreement with the study done by Jat, et al.,

(2011) in their study done in developed country in Indonesia revealed out that

parental education, especially mother’s education, plays an important role in the use

of skilled assistance at delivery. However a study conducted in Ghana by Esena &

Sappor, (2013) reveled out that improving education for the girl child can increase

skilled delivery attendance, since most of those who used unskilled delivery, their

educational status were either low or none.

29
The findings of the study revealed majority 15 (35%) of the mothers with house-

hold- income between sh.50, 000 to sh.100, 000per season are likely not to go to

health facility for childbirth due to money not being at hand at the time of delivery

since transport costs are high to reach the health center and the same amount of

money will be needed for travelling back home after deliver. These study finding are

in line with Babalola and Fatusi, (2009), Onta, et al.,(2015), Doctor & Dahiru,(2010)

their study was conducted in Nigeria and Indian and revealed out significant

association between household socio-economic status and the use of skilled assistance

at delivery which affirms that the use of skilled assistance at delivery is more than

four times higher among women from rich and very rich households compared to the

women from very poor households.

According to the research findings, results show that more than a half 23(53%) of the

respondents were peasants, this is thus not surprising since the study was carried out

in the village and it was planting season, mothers are likely not to utilize delivery

services due to the busy schedule, these findings are in agreement with GSS, (2008)

results revealed that occupation of the woman or husband plays an important role in

the use of maternal health care services by pregnant women and another similar

study conducted in Ghana by GSS (2008) results shown that employed professionals

utilizes skilled delivery services 100% compared to nonprofessional and unemployed

mothers.

30
Majority 21 (49.0%) of the respondents were Catholics, this could be due to the fact

that catholic religion is the most dominant in the village and they help to pass health

education messages about utilization of delivering services among mothers through

churches and community based health programs. These study findings are in line with

Baral, et al., (2010) their study was conducted from Bangladesh and revealed that the

use of skilled attendants at birth is higher among women from Hindu religion

compared to women from Muslim religion.

More than a half 25(58%) of the mothers did not seek permission when going for

delivery, this could be due to the fact that the people they were to seek permission

from like their husbands were already aware of their wives being pregnant and had

already made a plan for delivery. The findings are in line with Jibo, (2008) whose

study was done on most African settings in Kano state (2008) on women,were men’s

decision-making authority over women hinders their use of reproductive health

services which further revealed reasons for non-utilization of delivery care services

amongst the women because of spousal inhibition and access to experienced

traditional birth.

According to the research findings from the study results show most 20 (46.5%) of

the mothers are in age group ranging 15 and 25 years. Although not always the case

majority of the young mothers go for health services like antenatal services and

delivery services because of fear of complications during pregnancy since they are

not exposed to delivery and they lack confidence in giving birth. These study findings

31
are in agreement with Doctor et al., (2012) whose study revealed out that women

within the age group of 35-44 years did not deliver at the health facility because there

are more likely to be confident in their ability to have a successful home delivery due

to accumulated experience in birthing and might also be more traditionally inclined.

Results shown majority 30(70%) of the mothers attended ANC because they wanted

to rule out abnormalities and also know the progress of their pregnancy, there is likely

hood of these mothers not delivering from hospital once they know their pregnancy is

progressing well. The study findings are in line with Lzugbara, et al., (2009) their

study that was done from urban slums of Nairobi which revealed out that woman who

were informed that their pregnancy is progressing well, might not see the need to visit

the health facilities manned by skilled care since they do not foresee any

complication.

More than a half17 (57%) of the mothers attended ANC more than three times,

mothers who fully complete their ANC visits are more likely to deliver from the

hospital because they are confident and aware of their expected dates of delivery

hence fearing health providers who may be harsh on them for having not completed

the ANC visits. These study findings are in line with a study conducted from rural

Bangladesh by Chowdhury, et al., (2013) their study revealed that expectant women

who might have made less visits to the ANC as is required were most likely to use

unskilled delivery.

32
Majority 23(77%) of mothers had to seek permission when going for ANC, this could

be due to the need to create awareness of their pregnancy for proper planning in

future. These study findings are in agreement with Baral, et al.,(2010) whose study

revealed out various dimensions of autonomy, such as position in the household,

financial independence, mobility and decision-making power regarding one's own

healthcare, may all impact on health facility use.

Less than a half 9(39%) of the women could seek permission from mother- in- laws,

this could be due to the study having been carried out in the village and majority of

the males can marry and stay with their wives in the village near their parents, there is

a high possibility of the mother- in-laws to make decision for their sons and daughter-

in- laws. These study findings are in line with Shimazaki, et al., (2013) whose studies

were done from many countries and revealed out that women cannot decide on their

own to seek care, without asking for permission from a husband or mother-in-law,

this has led to lack of control over material resources needed to pay for expenses,

their mobility may be restricted to access to transportation such as vehicles or even

bicycles or donkeys.

Majority 18(60%) of the mothers used motorcycles to travel to the hospital this could

be due to inaccessible roads increasing transport costs of cars and ambulances,

majority of mothers resort to using motorcycles since the costs are relatively

affordable for them and at least they are easily accessible in the village. These study

finding are in line with Nair, et al., (2012) whose study revealed out that lack of

33
access roads may increase time in accessing skilled delivery services due to lack of

vehicle or inability to afford the cost of transportation. These findings further agrees

with Saxena, et al., (2013) which revealed out that easily accessible roads attracts

more vehicles and reduces cost of transportation hence, enable clients to access health

facilities in time of need such as during labor.

Less than a half 10 (33%) of the respondents could take 1 hour and more than 2 hours

respectively. The time taken to travel the distance to the hospital could influence

mother’s health care seeking behaviors, time taken to travel to the hospital could

discourage mothers to utilize the delivery services due to long distances being

travelled. These study findings are in agreement with Story et al., (2012) whose study

revealed out that distance to health services affect health care seeking behavior in

that, it discourages women from making a decision to seek skilled care in the first

place.

According to the results of the study findings most 20 (47%) of the mothers had

married, since unmarried women may lack appropriate support from their husbands

hence make their own decision regarding the place for delivery there is a high

possibility of these mothers to deliver from unskilled birth attendants. These study

findings are in line with the findings of Breen, (2011) whose study was done from

Zambia and shown that married women are more likely to receive health care access

during pregnancy than unmarried women.

34
Most 20(47%) of the respondents said are Bakiga, although this study was not meant

to compare among tribes of the respondents and utilization of delivery services

among mothers, it’s worth to note that Bakiga who settled in the parts of Bunyoro

mostly in Kizirafumbi sub-county are more likely not to utilize the delivery services

because of luck of privacy during check up and at time of delivery since most of them

are used to their cultural beliefs being performed at birth which will not be the case

when they deliver from the health facility. These study findings are in agreement with

the study done by Palamuleni, (2011) which revealed out that different regions in

countries have been found to have disparities as far as the type of service sought

during delivery is concerned. More so the findings from the study further agrees with

a study done by Gabrysch and Campbell,(2009) carried in Turkey and revealed out

that ethnic minorities who largely occupy specific regions are more likely to be

attended by unskilled birth attendants at delivery due to marginalization by their

government.

Results also show more than a half 25(58%) of the respondents said to be having

more than five children, mothers with a high birth order are more likely not to deliver

from the hospital because of increased experience in birthing and some can predict to

have normal delivery since has been delivering normally. These study findings are in

line with Gabrysch & Campbell, (2009) whose study was done in India which

revealed out that women of higher birth order did not find it important to receive

professional delivery if previous births did not have complications however, the study

findings disagrees with Doctor, Kagunaa & Dahiru, (2010) whose study was done

35
from Rakai district of Uganda, which revealed out that birth order was not found to be

significant same as in North Nigeria.

5.3 Conclusion.

From the study findings the following conclusion are made;

Poor utilization of delivering services among mothers (15-49) years is common

among mothers with out or with low education status mostly the primary and

secondary drop outs, parents with low house hold income per season, parents who are

unemployed or self-employed and non-religious mothers,

Factors leading to utilization of delivering services include; young mothers,

completing ANC visits, short distances to the health facility, good transport system,

married mothers and mothers with low parity.

5.4 Recommendation.

1. There is need for intense awareness generation by the health workers and the

government through a multimedia approach, stressing on female literacy,

improving the overall socioeconomic conditions through various income

generation schemes, along with counseling the local people of eminence and

head of the families on the benefits of timely and appropriate healthcare-

seeking behaviors both pregnancy and delivery time.

2. Government should consider putting up health units closer to people

preferably at parish levels and local council one basing on geographical and

morphological challenges of Hoima district to improve accessibility and

reduce costs on transport and use of unskilled birth attendants.

36
3. Government should consider collaboration with other stalk holders like NGOs and

private sector clinics to offer subsidized services to poor citizens.

5.5 Implications.

I. The parents should ensure and continue putting effort to girl child education;

at least they should attain secondary level of education. In line with the

ministry of education to ensure full compliance with the return to school

policy for those girls who give birth mid-way of their either primary or

secondary schooling.

II. All sub-county governments should fully implement the community health

strategy mostly at local level by ensuring the community health volunteers in

some sub-counties to ensure cross referrals between community members and

the health facilities for a wide range of services including ANC, delivery and

postnatal services.

III. Nursing students and professional should ensure ethical considerations mostly

keeping privacy and not to charge money on the services provided at the

health centers, this will increase on the demand for utilization of delivery

services once they have good morals.

37
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Agha, Sohail and Carton, T.W (2011).Determinants of institutional delivery in rural

Jhang, Pakistan, international journal for equity in health, 10(31),

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Babalola & Fatusi, (2009).Determinants of use of maternal health services in Nigeria

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Childbirth, 9(1), 43.

Baral, Lyons, Skinner & Van Teijlingen (2010).Determinants of skilled birth

attendants for delivery in Nepal.Kathmandu University Medical Journal.

Breen, (2011).Financial implications of skilled attendance at delivery in Nepal.

Tropical Medicine and International Health, 11(2), 228–237.

Choulagai, Onta, &Shrestha,(2015). Barriers to using skilled birth attendants’

services in mid- and far-western Nepal : a cross-sectional study.

Chowdhury, A.H, Hasan, Ahmed, Darwin, &Haque, (2013).Socio-demographic

factors associated with home delivery assisted by untrained traditional

birth attendant in rural Bangladesh; American journal of public health

research, 1(8), pp. 226-230.

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Doctor, H.V. and Dahiru, T,(2010). Utilization of unskilled birth attendants in

Northern Nigeria: A Rough Terrain to the Health-Related MDG’s.,

African journal of Reproductive Health, 14(2), pp.37-45.

Doctor, et al., (2012).Using community-based research to shape the design and

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Health Matters, 20(39), 104–112.

Doctor, & Dahiru, (2010). Utilization of Non-Skilled Birth Attendants in Northern

Nigeria : A Rough Terrain to the Health-Related MDGs, 14(2), 36–45.

Esena, Reuben K & Mary-Margaret Sappor, (2013). Factors Associated With The

Utilization Of Skilled Delivery Services In The Ga East Municipality Of

Ghana Part 2 : Barriers To Skilled Delivery, 2(8), 195–207.

Evans, (2013).A review of cultural influence on maternal mortality in the developing

world. Midwifery, 29(5), 490–496.

Gabrysch, Sabine & Campbell, O.M.M, (2009).literature review of the determinants

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9(34),http://biomedicalcentral.com/1471-2393/9/34.

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attended by skilled personnel.

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GSS, (2010, 2008). Population and Housing Census Final Results Ghana Statistical

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POPULATION_AND_HOUSING_CENSUS_FINAL_RESULTS.Pdf.

Hounton, Chapman, Menten, Brouwere, Ensor &Sambie (2008).Accessibility and

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Saxena, Vangani, Mavalankar& Thomsen, (2013). Inequity in maternal health care

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42
APPENDIX 1: CONSENT FORM.

Good morning/ afternoon/ evening,

My name is Nyakato Immaculate, a student of KIU, Western Campus. I am carrying

out a study to identify the factors affecting utilization of skilled delivery among

mothers (15-49) years attending YCC in Kikuube HCIV Kizirafumbi sub-county,

Hoima District. You have voluntarily consented to participate in the study and all the

information you give will be kept confidential. You are under no obligation to

participate in the study, and refusal to participate will not block your access to any

services in the sub-county.

I have explained the study the purpose and objectives of the study to the participant,

and they have understood and voluntarily consented to participate in the study.

Researcher’s

Signature………………………………….Date………………………………….

The topic and its objectives have been fully explained to me, and I have understood

and voluntarily agreed and consented to participate in the study.

Respondents

Signature…………………………………or thumb print…………………………

Date……………………………………

43
 APPENDIX I1: INTERVIEW GUIDE.

My name is NYAKATO IMMACULATE, a student of KIU, Western Campus. I am

carrying out a study to identify the factors affecting utilization of skilled delivery

among mothers (15- 49) years attending YCC in Kikuube HCIV, Kizirafumbi sub-

county, Hoima District. You have voluntarily consented to participate in the study

and all the information you give will be kept confidential.

Instructions

Please respond to all questions asked.

Please answer as accurately as possible to enhance data quality.

Please circle or write where appropriate.

Questions;

SECTION A: SOCIO-ECONOMIC CHARACTERISTICS.

1. What is your level of education?

A. Primary C. Tertiary

B. Secondary D. NONE

2. What is your house hold income per season?

A. Less than 50,000shs B. 50,000shs – 100,000shs

C. 110, 000shs – 200,000shs D. More than 210,000shs

44
3. What is your occupation?

A. Peasant C. House wife

B. Trader D. Public servant

E. none (specify)…………………………………………………………

6. What is your religion?

A. Anglican D. Muslim

B. Catholic E. others (specify)………

7. Did you seek permission when going for delivery?

A. Yes

B. No

8. If Yes, from whom did you seek permission from?............................................

45
SECTION B: BARRIERS HINDERING UTILIZATION OF SKILLED

DERVIERY.

9. What is your age?

A .15-25 B. 26-35

C. 36-45 D.46 and above

10. Did you attend ANC?

A. Yes

B. No

11. If yes how many times?.......................................................................................

12. Do you seek permission before going for ANC?

A.YES

B. NO

13. If yes, where do you seek permission?.....................................................................

14. How long did it take you to reach the health center?

A. 30 minutes B.1hr

C.2hrs D. More than 2hrs

46
15. What transport means do you use?

A. Walking B. bicycle

C. Motorcycle D. Car

16. What is your marital status?

A. Married C. Never married

B. Widowed

17. What is your tribe?

A. Munyoro C. Mutooro

B. Mukiga D. Others (specify)………

18. How many children have you ever delivered?

A.1-2 C.5 and above

B.3-4

THANK YOU FOR YOUR PARTICIPATION.

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APPENDIX III: A MAP OF UGANDA SHOWING LOCATION OF HOIMA

DISTRICT.

KEY: HOIMA DISTRICT

48
 APPENDIX VI: A MAP OF HOIMA SHOWING THE STUDY AREA.

KEY

Lake Albert

Kikuube health centre IV

49
APPENDIX VII THE INTRODUCTORY LELTER

50