The identification of maternal health as one of the eight MDGs firmly situates it as central to poverty reduction and overall development efforts. Its inclusion has resulted in increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries as a key indicator for measuring progress for Goal 5 [1].

Current estimates of maternal mortality ratios vary from more than 1000 per 100,000 live births in most African countries, to around 500 in some Asian countries, to between 200-400 in South America and fewer than 10 in developed countries.

In developing countries, specifically in sub Saharan countries, many women don't have the good fortune to be attended by skilled personnel during child birth, most childbirth occurs at home and is not assisted by skilled attendants, this lack of skilled attendance could be considered as one of the major factors in maternal and infantile mortality [2].

The Cairo International Conference on Population and Development [3] placed a lot of emphasis on reproductive health of which safe motherhood is a component. Kenya adopted the plan of action on /reproductive health.

The government recognized the right of access to appropriate health care services that will enable women to safely go through pregnancy and child birth and provide couples with best chance of having healthy infants. It is every woman’s right to access high quality maternal health services that in turn must be accessible, affordable, effective, appropriate and acceptable to them in order to avoid preventable morbidity and mortality [4].

Many complications of pregnancy and child birth that lead to mortality can be prevented by providing quality care that involves early detection of problems and appropriate timely interventions [5]. Skilled attendants may perform deliveries either at home, in health centres or in hospitals, but it is argued that the most efficient strategy is to place them in health centres with referral capacity [5].

In Kenya, 44 percent of births are delivered under the supervision of a health professional, mainly a nurse or midwife. Traditional birth attendants continue to play a vital role in delivery, assisting with 28 percent of births.

The challenge has therefore remained the provision of Maternal Child Health/Family Planning services to cater for the health needs of the expanding number of women of reproductive age. Nevertheless, in Kajiado county, different aspects of provision of reproductive health services are still found to want [7].

The county has 3 county Hospitals, 19 health centers, 40 dispensaries, 26 private health institutions and the average distance to a health facility is 10 Kilometres. The most prevalent diseases are malaria, respiratory infections, diarrhoea, skin diseases and eye infections. The doctor/patient ratio is 1:66,412.

Life expectancy level in the District is 43 years, which is below the national average of 53 years. The county has experienced difficulties in providing efficient health services for the fast-growing population because it needs heavy investments to upgrade, modernize and construct new health facilities [7].

The prevalence of home deliveries in some parts of Kajiado County is as high as 77.8% [8]. The proportion of mothers assisted by traditional birth attendants during delivery is equally high at 56.7%. This poses a high risk to both the mother and new born [8].

Despite Kajiado District having 145 health facilities, several problems affecting skilled delivery utilization exists. The county is predominantly Maasai pronounce for their strong culture and traditions including female genital mutilation which can pose grave danger to the women during childbirth and especially if unattended by a skilled attendant.

It is noted that Maasai’s have unique economic, social, cultural and environmental characteristics which could play a role in that respect as well as the level of knowledge, attitude, practice and their perception towards modern health facilities.

No substantive study has related these to utilization in delivery services in Kajiado North [7]. The numbers of home deliveries at the National level are of 56% compared to 77.8% within the county despite the existence of public health facilities.

This study therefore aimed to analyse the role of health seeking behaviour on utilization of skilled delivery services by Maasai women in Kiekonyokie sub location of Kajiado County.

interview guide were pre-tested in a neighbouring sub-location. Prior the actual data collection, the questionnaires were pre-tested in Kiekonyokie south location area (outside the cluster areas under study) and each enumerator had a chance to interview at least one woman who has had a child in the last 5 years.

Pre-testing was done to check on the validity, consistency, time taken, and completeness of the tool by comparing the data obtained by principal investigator versus the enumerators data and also to have enumerators familiarize themselves with the tool and also to check the ability of the interviewers and the quality of the tools. Based on the result corrections were done and harmonized.

Data collection: Quantitative data was collected using semi-structured questionnaires administered by a team of trained enumerators and supervisors. The questionnaire was segmented into sections to capture information on the specific target objectives. Questionnaires for each cluster were coded differently for easy monitoring during data collection and the enumerators were required to write their names for follow-up in case of need for a clarification.

Qualitative data was collected using focus group discussions and key informant interviews. 3 FGDs were held i.e. one in each of the cluster areas through barazas forum. The FGD participants were selected using similar criteria to the one for quantitative data collection. In each FGD there were 6 to 9 discussants who were women aged between 15 and 49 years.

The invitations were conducted through the village elders who had acted as community guides during quantitative data collection. There were 2 note-takers during the discussion. One co-moderator was engaged to take note of any non-verbal expressions that can be propped at the end of the discussion.

Data Analysis: Quantitative Data was entered into Statistical Package for Social Sciences (SPSS) software version 17.0 and further analysed using descriptive statistics including narration. Data was then presented using frequencies, graphical techniques, ratios, rates and percentages Bivariate and Univariate analysis was used to describe the correlations.

Qualitative data were analysed through content and thematic analysis.

The traditional rite of passage practices had no

From an FGD session the women had the following response on skilled delivery,

“…….ore eishoi tesipitali naasidai kake meepooki ng’ai nayeu….”

(“…….delivering at the hospital is good but not everybody wants…” )

The table 3 below shows 56.1%, of the women had delivered at home while 11.4% were assisted by health personnel at the facility.

Table-3: Assistance during delivery

The supposed correct danger signs were bleeding from the birth canal, severe head-ache, reduced foetal movements. and severe abdominal pain.

The following sentiments were captured in both FGDs and KII sessions on knowledge of danger signs,

“ …….kiyolo aajo keloentua sipitali peetum embaata sidai tenotai…”

(“We know that a pregnant woman should go to hospital to get good treatment during pregnancy.”)

“……..ekeiteng’eni itomonok te sipitali anaapukunot naishaakinore teneeku esaisai kake Engai ooshi naatapooki naapuo sipitali o naisho tiaang…”

(“…….women are enlightened at the hospital on labour but God takes care of at the hospital and those who delivers at home.”)

homes or with Traditional Birth Attendants , they all seemed to acknowledge the benefits associated with health facility based deliveries [10].

Another finding that was in line with the Kajiado study was that done in Burkina Faso asserted that women are often surprised by the sudden onset of labour and are obliged to be attended by the traditional birth attendant or a member of the family, for some others it was not possible to know at what time the baby will come [2].

A cross sectional study on the use pattern of maternal health services and determinants of skilled care during delivery in Tanzania found out that the proportion of women with skilled attendants at delvery decreased with increasing distance to the health facility which provide delivery care from 50.1% among women residing within 5 km of a health facility to only 20.2% among those residing more than 5 km from a health facility (OR 3.84 (95%CI 2.61–5.65) [9].

A qualitative study on women’s perception of Ante Natal Care and delivery care services reveals that the costs involved in meeting hospital requirements and paying user fees and informal fees as well as meeting personal requirements, was too high, the cost of transportation, the attitude and conduct of service providers (rude and disrespectful to their clients), also deterred service utilization [10].

In conclusion this study on health seeking behaviour shows 57.2% went to the health facility in case of illnesses, while 7.6% consulted their mother in law, preparation of the expectant mother for delivery did not have a statistical significant p-0.046. The traditional rite of passage practices had no statistical significance p-0.190.

72% who could at least mention one correct danger sign for pregnancy out of the posssible four. 69% of those who delivered in the hospital paid > 500 shillings compared to 8% of those who paid < 500 shillings. The amount paid for skilled delivery had a statistical significance, (p<0.001).

97.7% of the Maasai women in the Kajiado North study takes more than 1hour to reach to the nearest health facility while less than1% of them in this study takes less than 30minutes to reach to the health facility. 56.1%, of the women had delivered at home while 11.4% were assisted by health