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Introduction: utilization of health facility for delivery could save pregnant women from avoidable maternal deaths. However, use of health facility in deliveries remains inconsistent. The main study objective was to identify factors influencing health facility delivery among women of reproductive age in Lilongwe District., Methods: a cross-sectional study using structured questionnaires administered to 210 women of reproductive age was used. Chi-square (or Fischer Exact Test), where appropriate was used to analyze data., Results: the findings of the study revealed that the level of health facility delivery in Lilongwe District is 73.8%. It revealed that 97.1% of the respondents are aware of health facility delivery and most (89.5%) prefer health worker as the best person to assist pregnant women during delivery. There is a significant association between level of knowledge (p = 0.000), the level of education (p=0.000), employment (94.7%) and religious teachings (p=0.000) with delivery in a health facility. The study further shows that more Muslim´s women (91.7%) delivered at health facility compared to their counterparts from others religions and African traditionalists (20%)., Conclusion: in conclusion, the level of knowledge, age, level of education and marital status, Occupation, monthly income, and the amount spent during the past delivery, and the religious teachings influence health facility delivery. We recommend the sharing of the findings with different stakeholders in order to find the solutions and the need for dialogue with traditional chiefs and religious leaders on advocating for health facility delivery., Competing Interests: The authors declare no competing interests., (Copyright: Samuel Gamah et al.)

Background: Despite the widespread application of the community health strategy (CHS) in Kenya and evidence of its effectiveness in reducing health outcomes at the household level, data from Kakamega County, of which Lurambi sub-county is part of, still showed that skilled birth delivery was at 47% against the national estimateof 62% and a target of 90%. However, there was limited evidence on the level of CHS implementation and its association with the uptake of skilled delivery., Methods: The study employed a cross-sectional analytic design. A structured validated community unit (CU) scorecard and a household questionnaire were used to collect quantitative data from the CUs through Community Health Extension Workers (CHEWs) and at the household level through mothers with children below 1 year. A random sample of 436 mothers from all the 38 Community Units (CUs) was included. CU functionality was assessed using 17 binary indicators (scored as 1 for a positive response, 0 otherwise) and total scores were expressed as percentages. Fully functional CUs scored ≥80% and semi-functional CU scored >50 to <80%. No CU was non-functional (scored ≤50%). Data from the CUs were merged with data at the household level. Association between CU functionality and skilled delivery was assessed using multivariable binary logistic regression controlling for socio-demographic variables. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) are reported., Results: A total of 38 CUs were assessed and of these, 26(68.6%) were fully functional and 12(31.4%) were semi-functional, 18(47.4%) had both household registers (MOH 513) and service delivery logbooks (MOH 514). Overall, 387(80.0%) of mothers had skilled birth deliveries, 263(68%) were from functional CUs and 124(32%) were from semi-functional CUs. Pregnant women were more likely to have skilled deliveries in fully functional CUs than semi-functional CUs (OR=1.3; 95% CI=1.1-2.4; p-value<.001). Other factors significantly associated with uptake of skilled delivery included receiving health education(OR=2.9;95%CI =1.4-6.1, p=.005), being visited at least twice by Community Health Volunteers, CHVs(OR=1.9;95%CI=1.1-3.5, p=.045), attending antenatal care clinics, ANC (OR=3.4;95%CI=1.3-3.5, p=.012), receiving advice where to deliver (OR=4.1;95%CI=1.8-9.4, p=.001)., Conclusion: 2 out of 3 community units were fully functional, and functionality was associated with increased uptake of skilled delivery. In a fully functional CUs, Community Health Volunteers provided health education through regular visits and they were able to provide a referral to health facilities for the pregnant women. To achieve national targets for skilled deliveries and universal health coverage, there is a need to ensure CUs are fully functional., (© The East African Health Research Commission 2020.)