研究背景與目的:
全球預估99%的孕產婦死亡發生在發展中國家，其中半數在撒哈拉沙漠以南，然而其中有75%的孕產婦死亡是可以透過專業的分娩照護來預防。肯亞政府正積極地推廣專業分娩，但其使用率仍然很低。為了改善肯亞的婦幼衛生，本研究的目的：是探討影響肯亞當地婦女使用產科照護的影響因子。

研究工具與方法：
本篇研究是採橫斷性研究。研究族群是肯亞大湖大學2010年Rachuonyo District資料庫中，在Kakelo Dudi 和Kakelo Kamroth這兩個地區，過去一年內有分娩的婦女。研究者設計一份結構式問卷收集分娩相關訊息以進行量性研究；而質性研究則是隨機選樣研究婦女中的10%、加上社區衛生志工和傳統接生婆來進行焦點團體討論，並深度訪談研究地區在衛生所提供服務的健康照護者。

研究結果：
在323名受訪婦女中，96.6%的婦女在懷孕期間曾前往醫療院所進行產前檢查，但只有45.5%的婦女選擇到醫療院所進行分娩。從多變項模式分析發現居住在Kakelo Dudi地區、曾有醫療院所分娩經驗、有預備金錢來生產、及在產前檢查期間有接收到懷孕與分娩相關訊息的婦女比較會選擇到醫療院所進行分娩。

研究結論：
雖然肯亞政府在各個衛生所提供免費的分娩服務，但還是有一半以上的婦女在非醫療院所進行分娩。本研究認為鼓勵健康照護者在婦女產前檢查期間提供衛教宣導、教育婦女提前預備生產所需經費和提升醫療的可近性，可能有助於提高專業產科照護的使用率。

Objective: Estimated 99% of the maternal deaths in the world occur in developing countries, and half of them happen in sub-Saharan Africa. However, 75% of these maternal deaths could be prevented by timely access to skilled delivery service. Kenyan government wants to promote the use of skilled birth attendants at health facilities but the utilization is very low. Thus, this research would like to investigate the determinants of utilization of skilled obstetric care.

Methods: This was a cross-sectional study. The study population was women who had delivered in last one year in Kakelo Dudi or Kakelo Kamroth, selected from 2010 database of Rachuonyo District setup by Great Lakes University of Kisumu. A structured questionnaire was used to collect the quantitative data and Focus Group Discussion for 10% of targeted women, community health workers and traditional birth attendants as well as staff at the health station was performed to collect qualitative data.

Result: Of 323 interviewed women, 96.6% had at least one antenatal care visit, while only 44.5% delivered babies at the health facility. In multivariate regression analysis, women were more likely to deliver babies at the health facility if they resided in Kakelo Dudi, had health facility delivery experience before, had money preparedness for delivery and had received more information related to pregnancy and delivery during antenatal care visit.

Conclusion: Although Kenyan government has provided free delivery services for women, more than half of them still deliver babies at non-health facility. We suggested that encouraging health workers to provide more information for women during antenatal care visit, money preparedness for delivery and improving the accessibility of health services may help increase the utilization of obstetric care.

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