Prevalence and individual factors associated with first maternal delay in Nakuru County, Kenya

Grace Jepchumba Kibet; Damaris Ochanda; Tecla Sum

doi:10.51867/ajernet.6.4.115

Authors

Grace Jepchumba Kibet Moi University, Kenya https://orcid.org/0009-0004-5363-6843
Damaris Ochanda Masinde Muliro University of Science and Technology, Kenya https://orcid.org/0000-0002-0363-8662
Tecla Sum Masinde Muliro University of Science and Technology, Kenya https://orcid.org/0000-0001-7345-4714

DOI:

https://doi.org/10.51867/ajernet.6.4.115

Keywords:

First Maternal Delay, Individual Factors, Kenya, Nakuru County, Prevalence

Abstract

Globally, about 700 mothers die daily during pregnancy, labor, or childbirth, a steadily increasing trend, where 40% of the cases were linked to first maternal delay. Mothers who are experiencing a first delay are at risk of facing a number of health problems, accelerating other forms of maternal delays. The research seeks to determine the prevalence and the associated individual factors of first maternal delay in Nakuru County, Kenya. This will help to formulate strategies for reducing cases of preventable maternal mortality. A cross-sectional study design was employed. The research employed 211 antenatal mothers located in eight level 3 health center facilities in Nakuru County. Conveniently, study participants were selected based on inclusion criteria and data collected using a structured questionnaire. Data analysis was conducted through descriptive statistics and chi-square tests while maintaining a significance threshold at p < 0.05. Results: 82.5% of the mothers experienced first maternal delay, while some were exposed to either second (35.6%) or third (29.4%) maternal delay, implying that the 3 types of maternal delays are interconnected and dependent on each other. It further established that it was not only necessary for one to have experienced any form of complication to be linked to first maternal delay. The statistically identified individual factors included attendance of antenatal clinic (ANC) (aOR 4.1, 95% CI = (1.03-17.05), p < 0.010); past negative experience (aOR 0.15, 95% CI = (0.03-0.64), p < 0.010); and prolonged time taken to make the decision to seek care (after 1 hour, aOR 3.26, CI = (1.32-8.02), p < 0.010). Contrary: personal decision-making of when to seek care during an emergency (aOR 0.34, 95% CI=(0.12-0.97)); time taken to decide to seek care after realizing a health issue (immediately, aOR 0.03, 95% CI=(0.01-0.21) & after 30 minutes, aOR 0.07, 95% CI=(0.01-0.66)); and knowledge of maternal delay to be a protective individual factor for not experiencing first maternal delay. Conclusion: The study confirmed that several individual factors were significantly associated with first maternal delay. Recommendation: The health authorities need to develop policies supporting mothers’ autonomy and empowerment to enhance and promote their own care-seeking decision-making and to inject more resources targeting ANC mothers to ensure timely utilization of ANC and delivery services and improve ANC uptake to reduce maternal mortality related to first maternal delay. This initiative will aid in achieving the set WHO target by 2030 and improve maternal outcomes and increase the quality of life for both the mother and that of the infant(s).

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References

Actis Danna, V., Bedwell, C., Wakasiaka, S., & Lavender, T. (2020). Utility of the three-delay model and its potential for supporting a solution-based approach to accessing intra-partum care in low- and middle-income countries: A qualitative evidence synthesis. Global Health Action, 13(1), 1-6. https://doi.org/10.1080/16549716.2020.1819052

Alobo, G., Reverzani, C., Sarno, L., Giordani, B., & Greco, L. (2022). Estimating the risk of maternal death at admission: A predictive model from a 5-year case reference study in Northern Uganda. Obstetrics and Gynecology International, 2022, 4419722. https://doi.org/10.1155/2022/4419722

Alyafei, A., & Easton-Carr, R. (2024). The Health Belief Model of behavior change. In StatPearls. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK606120/

Amani, M. T. (2020). Fulfilling the right to maternal healthcare in Kenya. D-Space Journal, 6(1), 2. http://hdl.handle.net/11071/12348

Amante, T. G., Feyissa, G. T., Desalegn, M., Merdassa, M., & Dereje, M. (2025). Maternal delays and associated factors in utilizing institutional delivery in East Wallaga Zone, Oromia, Ethiopia. medRxiv, 1-39. https://www.medrxiv.org/

https://doi.org/10.1101/2025.02.04.25321654

Bisht, D. R. (2024). What is purposive sampling? Methods, techniques, and examples. Researcher.Life. https://researcher.life/blog/article/what-is-purposive-sampling-methods-techniques-and-examples/

Błachnio, A., & Kuryś-Szyncel, K. (2022). I am a mother because I wanted to-I am a grandmother because others see me that way-Motherhood as a critical life event for ageing women. International Journal of Environmental Research and Public Health, 19(24), 16381. https://doi.org/10.3390/ijerph192416381

Boka, A., Alemu, M., & Gela, D. (2023). Delayed antenatal care and associated factors among pregnant women attending health facilities in Addis Ababa, Ethiopia. African Journal of Midwifery and Women's Health, 17(3), 1-11.

https://doi.org/10.12968/ajmw.2022.0036

Chauke, L. (2025). Improving access to emergency obstetric care in low- and middle-income countries. Best Practice & Research: Clinical Obstetrics & Gynaecology, 98, 1-10. https://doi.org/10.1016/j.bpobgyn.2024.102572

Collins. (2025). All related terms of delay: Delay definition and meaning. Collins English Dictionary. https://www.collinsdictionary.com/dictionary/english/delay

County Government of Nakuru. (2024). Draft health sector report (pp. 1-187). Department of Health Services, Nakuru. https://nakuru.go.ke/wp-content/uploads/2025/01/HEALTH-SECTOR-REPORT-2024.pdf

Debela, D. E., Aschalew, Z., Bante, A., Yihune, M., Gomora, D., Hussein, F., Sahile, A., & Mersha, A. (2024). Maternal delay for institutional delivery and associated factors among postnatal mothers at southeastern Ethiopia: A cross-sectional study. BMC Pregnancy and Childbirth, 24(1), 1-7. https://doi.org/10.1186/s12884-024-06416-z

Erega, B. B., Zeru, A. A., Mekuriaw, B. Y., Arage, R. B., Goshu, Y. A., Ferede, W. Y., Ayele, M., Yilak, G., Tilahun, B. D., Alemayehu, H. D., & Lake, E. S. (2024). Women living in the region under an emergency command post are experiencing delays in reaching health facilities: A multi-center cross-sectional study. BMC Health Services Research, 24(1), 56-67. https://doi.org/10.1186/s12913-024-11799-y

Ersboll, C., & Pal, K. (2025). Action and innovation in maternal health must be accelerated. World Economic Forum, 1-5. https://www.weforum.org/stories/2025/04/

Eshetu, D., Aschalew, Z., Bante, A., Negesa, B., Gomora, D., Ejigu, N., Geta, G., & Mersha, A. (2024). Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale zones, Ethiopia: A cross-sectional study. PLOS Global Public Health, 4(2), 1-11. https://doi.org/10.1371/journal.pgph.0002964

Fernandes, E. (2020). An American crisis: An analysis of maternal mortality across the U.S. Digital Commons @ Assumption University, 1-40. https://digitalcommons.assumption.edu/honorstheses/68

Gelaw, K. A., Atalay, Y. A., Zerefu, F., & Gebeyehu, N. A. (2023). Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia. Frontiers in Global Women's Health, 4, 1-10. https://doi.org/10.3389/fgwh.2023.1236242

Geremew, A. B., Roberts, C. T., Kassa, B. G., Ullah, S., & Stephens, J. H. (2025). Exploring evidence of healthcare-seeking pathways for maternal complications in Sub-Saharan Africa: A scoping review. BMC Pregnancy and Childbirth, 25(1), 1-26.

https://doi.org/10.1186/s12884-025-07745-3

Ghazi, H. F. (2020). Sample size made easy. ResearchGate, 1-5. https://doi.org/10.13140/RG.2.2.28801.89442

Guides, H. H. (2024). Good care during pregnancy. Health Action for Women, 212-245. en_haw_2015_08.pdf

Hadaro, T. S., Shewangizaw, M., Geltore, T. E., Bekel, M., Zewude, L. D., Abebe, M., Chisha, Y., Mare, K. U., & Leyto, S. M. (2025). Delays in the decision to seek care and associated factors among women in Ethiopia: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 25, 831. https://doi.org/10.1186/s12884-025-07968-4

Haile, A., Lonsako, A. A., Kebede, F. A., Adisu, A., Elias, A., & Kasse, T. (2024). Women autonomy in health care decision making and associated factors among postpartum women in Southern Ethiopia: A cross-sectional study. Health Science Reports, 7(12), 1-9. https://doi.org/10.1002/hsr2.70245

Institute of Public Finance. (2023). Nakuru County: Kenya County fact sheets (3rd ed.). Commission on Revenue Allocation (CRA). https://new.ipfglobal.or.ke/wp-content/uploads/2023/10/Nakuru-County-Kenya-County-Fact-Sheets-3rd-Edition-by-CRA.pdf

Ishimwe. (2025). Predictors for delayed first antenatal care visit in rural area of Rwanda: Analysis of secondary data using Rwanda Demographic Health Survey 2019-2020. Authorea, 1, 1-11. https://doi.org/10.22541/au.173194213.32128464/v1

Kassa, B. G., Tiruneh, G. A., & Solomon, A. A. (2023). Delay in reaching health facilities and its associated factors among mothers giving birth in South Gondar zone hospitals, Northwest Ethiopia, 2020: A facility-based cross-sectional study. Frontiers in Global Women's Health, 4, 1-7.

https://doi.org/10.3389/fgwh.2023.916978

Kenya Demographic Health Information System. (2022). Demographic and health survey. County Government of Nakuru, Kenya Bureau of Statistics. https://dhsprogram.com/pubs/pdf/PR143/PR143.pdf

Khalil, A., Samara, A., O'Brien, P., Coutinho, C. M., Quintana, S. M., & Ladhani, S. N. (2023). A call to action: The global failure to effectively tackle maternal mortality rates. The Lancet Global Health, 11(8), e1165-e1167. https://doi.org/10.1016/S2214-109X(23)00247-4

Masaba, B. B., & Mmusi-Phetoe, R. (2023). A strategy for reducing maternal mortality in rural Kenya. International Journal of Women's Health, 15(April), 487-498. https://doi.org/10.2147/IJWH.S396257

Mohammed, M. M., El Gelany, S., Eladwy, A. R., Ali, E. I., Gadelrab, M. T., Ibrahim, E. M., Khalifa, E. M., Abdelhakium, A. K., Fares, H., Yousef, A. M., Hassan, H., Goma, K., Ibrahim, M. H., Gamal, A., Khairy, M., Shaban, A., Amer, S., Abdelraheim, A. R., & Abdallah, A. A. (2020). A ten year analysis of maternal deaths in a tertiary hospital using the three delays model. BMC Pregnancy and Childbirth, 20(1), 1-9. https://doi.org/10.1186/s12884-020-03262-7

Mutowo, J., Yazbek, M., Wath, A. V., & Maree, C. (2021). Barriers to using antenatal care services in a rural district in Zimbabwe. International Journal of Africa Nursing Sciences, 15, 1-9. https://doi.org/10.1016/j.ijans.2021.100319

Ngoma-Hazemba, A., Hamomba, L., Silumbwe, A., Munakampe, M. N., & Soud, F. (2019). Community perspectives of a 3-delays model intervention: A qualitative evaluation of saving mothers, giving life in Zambia. Global Health Science and Practice, 7, S139-S150. https://doi.org/10.9745/GHSP-D-18-00287

Orangi, S., Kairu, A., Ondera, J., Mbuthia, B., Koduah, A., Oyugi, B., Ravishankar, N., & Barasa, E. (2021). Examining the implementation of the Linda Mama free maternity program in Kenya. International Journal of Health Planning and Management, 36(6), 2277-2296. https://doi.org/10.1002/hpm.3298

Orwa, J., Temmerman, M., Nyaga, L., Mulama, K., & Luchters, S. (2023). Health facilities preparedness to deliver maternal and newborn health care in Kilifi and Kisii Counties, Kenya. BMC Health Services Research, 23(1), 1-10. https://doi.org/10.1186/s12913-023-09884-9

Phiri, M., Mwanza, J., Mwiche, A., Lemba, M., & Malungo, J. R. S. (2025). Delay in timing of first antenatal care utilisation among women of reproductive age in sub-Saharan Africa: A multilevel mixed effect analysis. Journal of Health, Population and Nutrition, 44(1), 1-16. https://doi.org/10.1186/s41043-025-00857-8

Riese, S., & Dhakal, R. (2023). Understanding the three delays among postpartum women at health facilities in Nepal: Further analysis of the Nepal Health Facility Survey 2021. DHS Further Analysis Reports No. 144, 1-38.

Saffa, G., Keimbe, C., Bangalie, A., Sheriff, A. A., Jalloh, B., Bah, D., Bangura, F., Tamba, F., Bangura, H., Sesay, I., Kamara, K., Gborie, S., Teka, H., Ikoona, E., Elduma, A. H., & Gebru, G. N. (2024). Factors contributing to delays in accessing health facility-based maternal delivery services in Sierra Leone, 2018: A community-based cluster survey. PLOS ONE, 19(9), 1-16. https://doi.org/10.1371/journal.pone.0307179

Sago. (2023). The significance of validity and reliability in quantitative research. Sago Company Article, 1. https://sago.com/en/resources/blog/the-significance-of-validity-and-reliability-in-quantitative-research/

Saputra, F. (2025). Instrument reliability analysis. Jurnal Indonesia Sosial Sains, 6(3), 791-806. http://jiss.publikasiindonesia.id/

https://doi.org/10.59141/jiss.v6i3.1669

Sumankuuro, J., Mahama, M. Y., Crockett, J., Wang, S., & Young, J. (2019). Narratives on why pregnant women delay seeking maternal health care during delivery and obstetric complications in rural Ghana. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2414-4

The White House. (2022). Addressing the maternal health crisis. The White House. https://bidenwhitehouse.archives.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf

Tiruneh, G. A., Arega, D. T., Kassa, B. G., & Bishaw, K. A. (2022). Delay in making decision to seek care on institutional delivery and associated factors among postpartum mothers in South Gondar zone hospitals, 2020: A cross-sectional study. Heliyon, 8(3), e09056. https://doi.org/10.1016/j.heliyon.2022.e09056

World Health Organization. (2021). Antenatal care coverage: At least four visits. Global Health Obstetrics, 21-24. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/80

World Health Organization. (2023). Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa. Analytical Fact Sheet, March, 1-11. https://aho.afro.who.int/country-profiles/af

World Health Organization. (2025). Maternal mortality. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality