No abstract

Chinese Clinical Trial Registry (ChiCTR-IOR-15006433), http://www.chictr.org.cn/enIndex.aspx (retrospectively registered).

PurposeAccess to skilled care and facilities with capacity to provide emergency obstetric and newborn care is critical to reducing maternal mortality. In rural areas of Zambia, 42% of women deliver at home, suggesting persistent challenges for women in seeking, reaching, and receiving quality maternity care. This study assessed the determinants of home delivery among remote women in rural Zambia.MethodsA household survey was administered to a random selection of recently delivered women living 10 km or more from their catchment area health facility in 40 sites. A subset of respondents completed an in-depth interview. Multiple regression and content analysis were used to analyze the data.ResultsThe final sample included 2,381 women, of which 240 also completed an interview. Households were a median of 12.8 km (interquartile range 10.9, 16.2) from their catchment area health facility. Although 1% of respondents intended to deliver at home, 15.3% of respondents actually delivered at home and 3.2% delivered en route to a facility. Respondents cited shorter than expected labor, limited availability and high costs of transport, distance, and costs of required supplies as reasons for not delivering at a health facility. After adjusting for confounders, women with a first pregnancy (adjusted OR [aOR]: 0.1, 95% CI: 0.1, 0.2) and who stayed at a maternity waiting home (MWH) while awaiting delivery were associated with reduced odds of home delivery (aOR 0.1, 95% CI: 0.1, 0.2). Being over 35 (aOR 1.3, 95% CI: 0.9, 1.9), never married (aOR 2.1, 95% CI: 1.2, 3.7), not completing the recommended four or more antenatal visits (aOR 2.0, 95% CI: 1.5, 2.5), and not living in districts exposed to a large-scale maternal health program (aOR 3.2, 95% CI: 2.3, 4.5) were significant predictors of home delivery. After adjusting for confounders, living nearer to the facility (9.5–10 km) was not associated with reduced odds of home delivery, though the CIs suggest a trend toward significance (aOR 0.7, 95% CI: 0.4, 1.1).ConclusionFindings highlight persistent challenges facing women living in remote areas when it comes to realizing their intentions regarding delivery location. Interventions to reduce home deliveries should potentially target not only those residing farthest away, but multigravida women, those who attend fewer antenatal visits, and those who do not utilize MWHs.

BackgroundDespite significant improvements, postpartum family planning uptake remains low for women in sub-Saharan Africa. Transmitting family planning education in a comprehensible way during antenatal care (ANC) has the potential for long-term positive impact on contraceptive use. We followed women for one-year postpartum to examine the uptake and continuation of family planning following enrollment in group versus individual ANC.MethodsA longitudinal, prospective cohort design was used. Two hundred forty women were assigned to group ANC (n = 120) or standard, individual care (n = 120) at their first ANC visit. Principal outcome measures included intent to use family planning immediately postpartum and use of a modern family planning method at one-year postpartum. Additionally, data were collected on intended and actual length of exclusive breastfeeding at one-year postpartum. Pearson chi-square tests were used to test for statistically significant differences between group and individual ANC groups. Odds ratios and adjusted odds ratios were calculated using logistic regression.ResultsWomen who participated in group ANC were more likely to use modern and non-modern contraception than those in individual care (59.1% vs. 19%, p < .001). This relationship improved when controlled for intention, age, religion, gravida, and education (AOR = 6.690, 95% CI: 2.724, 16,420). Women who participated in group ANC had higher odds of using a modern family planning method than those in individual care (AOR = 8.063, p < .001). Those who participated in group ANC were more likely to exclusively breastfeed for more than 6 months than those in individual care (75.5% vs. 50%, p < .001). This relationship remained statistically significant when adjusted for age, religion, gravida, and education (AOR = 3.796, 95% CI: 1.558, 9.247).ConclusionsGroup ANC has the potential to be an effective model for improving the uptake and continuation of post-partum family planning up to one-year. Antenatal care presents a unique opportunity to influence the adoption of postpartum family planning. This is the first study to examine the impact of group ANC on family planning intent and use in a low-resource setting. Group ANC holds the potential to increase postpartum family planning uptake and long-term continuation.Trial registrationNot applicable. No health related outcomes reported.

ObjectiveMaternity waiting homes (MWHs) have been identified as one solution to decrease maternal morbidity and mortality by bringing women living in hard-to-reach areas closer to a hospital or health center that provides emergency obstetric care. The objective of this study was to obtain data on current MWH characteristics and the women who use them as well as women’s perceptions and experiences with MWHs among seven Saving Mothers Giving Life (SMGL) supported districts in Zambia.MethodsA cross-sectional household survey design was used to collect data from 2381 mothers who delivered a child in the past 13 months from catchment areas associated with 40 health care facilities in seven districts. Multi-stage random sampling procedures were employed with probability proportionate to population size randomly selected. Logistic regression models, Chi-square, and independent t-tests were used to analyze the data.ResultsWomen who lived 15–24 km from a health care facility were more likely to use a MWH when compared to women who lived 9.5–9.9 km from the nearest facility (AOR: 1.722, 95% CI: 1.450, 2.045) as were women who lived 25 km or more (AOR: 2.098, 95% CI: 1.176, 3.722.881). Women who were not married had lower odds of utilizing a MWH when compared to married women (AOR: 0.590, 95% CI: 0.369, 0.941). Over half of mothers using a MWH prior to delivery reported problems at the MWH related to boredom (42.4%), management oversight (33.3%), safety (33.4%), and quality (43.7%). While the study employs a robust design, it is limited by its focus in Saving Mothers Giving Life districts.ConclusionMWHs, which currently take many forms in Zambia, are being used by over a third of women delivering at a health facility in our study. Although over half of women using the existing MWHs noted crowdedness and nearly a third reported problems with the physical quality of the building as well as with their interaction with staff, these MWHs appear to be bridging the distance barrier for women who live greater than 9.5 km from a health care facility.