Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis

Abstract

ObjectiveOptimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia.MethodsA cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC).ResultsUtilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas.ConclusionUtilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana

“…In agreement with this research, Mohan et al [23] reported no signi cant association between community-level distance to a health facility and PNC services utilization. Also similar to this study, some researchers reported that the association between use of PNC services and area of residence was not signi cant [25,46]. In addition, a study by Darega et al [47] found no signi cant association between employment status and the use of PNC services.…”

“…For instance, Worku et al [22] found no signi cant area-level effects on the use of PNC services. Some multilevel studies in Tanzania [23], Nigeria [24], Zambia [25], Kenya [26] and India [27,28] reported that a community-level effect strongly predicted PNC services use, after controlling for individual-level predictors. In addition, these previous studies estimated different community-level effects of communities on the utilization of PNC services; for example Mohan et al [23] and Solanke et al [29] reported that 12% and 37.2% unexplained community variance respectively accounted for the variability in PNC services use.…”

Level of completion along continuum of care for maternal and child health services and factors associated with it among women in Arba Minch Zuria Woreda, Gamo Zone, Southern Ethiopia: a community based cross-sectional study

“…Full service was measured as when women's received the seven selected essential antenatal care services (blood pressure measurement, blood sample collection, urine sample collection, tetanus toxoid(TT2+) vaccination, iron foliate(90+) supplementation and health education on danger signs and nutrition). Full services was considered as not received when one of the seven selected elements of antenatal care services was not provided during ANC visit [21,26]. Means of transportation to health facilities was classified as on foot, by bicycles, or by car [18,19].…”

Women’s Perspectives on Influencers to the Utilisation of Skilled Delivery Care: An Explorative Qualitative Study in North West Ethiopia

“…Sociodemographic and economic factors including higher maternal education [9][10][11][12][13][14][15][16][17][18], higher wealth quintile [9,11,15], and employed by occupation [11] were found to have a positive association with health facility childbirth. Antenatal care attendance [9][10][11][12][13][14][15][16][17][18][19], birth order [10,14,15], previous childbirth in health facility [17], closer distance to health facility and access to transport [15], known pregnancy complication [9], planning to give birth in health facility [14], and quality of care [15] were also the factors that influenced women to utilise skilled birth attendance service. Furthermore, a community-based cross-sectional study conducted in North West Ethiopia revealed that fear and occurrence of complications, getting better service, safe and clean delivery, being informed to deliver at health facility during antenatal care, antenatal care attendance, and positive attitude of health workers were the main reasons for choosing skilled delivery service [13].…”