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East Afr Med J. 2005 Nov;82(11):547-53.

Quality of health care and its effects in the utilisation of maternal and child health services in Kenya.

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Department of Community Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya.



To assess the quality of care provided by the Kisumu Municipal health facilities, with special reference to Maternal and Child health services (MCH).


A descriptive cross-sectional survey.


Kisumu Municipal Health facilities.


Four hundred and eighty two mothers were interviewed in a household survey.


A total of 482 mothers were interviewed in the household survey. Out of these, only 40.4%, 53.7% and 45.7% had respectively used Municipal facilities for antenatal services (ANC), immunisation and treatment of their children the last time they required such a service. This translates to by-pass rates for Municipal health facilities of 59.5%, 46.3% and 54.3% respectively for the three services. By-pass was higher for the more central urban catchment areas than the more peripheral ones, a finding that was associated with the socio-economic status of the respondents and the relative location of the municipal facilities vis-a-vis competing facilities, mainly the District and Provincial hospitals. The main reasons cited for by-pass were poor care (21%), lack of drugs and supplies (17%) and lack of/poor laboratory services (12%). From the facility audit, most of the clinics had a reasonable capacity to offer basic health care with only three scoring less than 50% in the scale used. The worst areas were in availability of drugs, equipment and management issues. There was a strong relationship between the perceived quality of care and utilisation of MCH services as well as by-pass. The capacity of the facilities to offer care was however not associated with utilisation of MCH services or by-pass.


There is under-utilisation of Municipal health facilities for MCH services. This is related to the perceived poor quality of care in the facilities. Perception of quality is influenced by a person's socio-economic status especially education.

[Indexed for MEDLINE]

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