Introduction:

: Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deathsrninequality in access to care and quality care have been identified as current barriers. Contributing to these barriersrnare the bypassing behaviour and geographical access which leads to delay in seeking newborn care.

Objectives:

This study irnmeasured geographical accessibility of inpatient newborn care and ii characterized bypassing behaviour usingrnthe geographical accessibility of the inpatient newborn care seekers.

Methodology:

Geographical accessibility to the inpatient newborn units was modelled based on travel time to the unitsrnacross Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whosernnewborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced andrnwere used against the modelled travel time to define bypassing behaviour.

Findings:

Results:

: Approximately 90 of the sick newborn population have access to nearest newborn units 2 h.rnHowever 36 of the mothers bypassed their nearest inpatient newborn facility with lack of diagnostic servicesrn28 and distrust of health personnel 37 being the major determinants for bypassing. Approximately 75 ofrnthe care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison tornsub-county facilities which mostly were bypassed and remained underutilised.

Conclusion:

Understanding bypassing behaviour is critical in assessing the utilization of different levels of health facilitiesrnby care seekers as expected. Our study shows that despite high geographical accessibility of reaching inpatientrnnewborn units with the recommended 2 h bypassing behaviour is high across the sub-county level facilities. Thisrnbehaviour is seen as a strategy by care seekers to seekrnquality care in the higher tier facilities while underutilizing sub-county level facilities which are characterizedrnwith deficiencies in their health infrastructure.

Author(s):

Focus County(s):

Bungoma County

Programme Area(s):

Sexual, Reproductive, Adolescent & Child Health

Research Priority Area(s):

Disease Domain(s):

maternal and neonatal health

Publication Date: 12.May.2020

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