Place of Delivery Associated With Postnatal Care Utilization Among Childbearing Women in Zambia.

Charles Chungu,Mumbi Chola,Mpundu Makasa,Choolwe Nkwemu Jacobs

doi:10.3389/fpubh.2018.00094

Charles Chungu, Mumbi Chola + Show 2 more

Open Access

https://doi.org/10.3389/fpubh.2018.00094

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Abstract

Postnatal care (PNC) utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia. Data from the 2013/14 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported giving birth in the 2 years preceding the survey was used. The data comprised of sociodemographic and other obstetric data, which were cleaned, recoded, and analyzed using STATA version 13 (Stata Corporation, College Station, TX, USA). Multivariate logistic regression was used to examine the association of place of delivery and other background variables. Women who delivered in a health facility were more likely to utilize PNC in the first 48 h compared to those who did not deliver in a health facility: government hospital (AOR 7.24, 95% CI 4.92-11.84), government health center/clinic (AOR 7.15 95% CI 4.79-10.66), other public sector (AOR 23.2 95% CI 3.69-145.91), private hospital/clinic (AOR 10.08 95% CI 3.35-30.35), and Mission hospital/clinic (AOR 8.56 95% CI 4.71-15.53). Additionally, women who were attended to by a skilled personnel during delivery of the baby were more likely to utilize PNC (AOR 2.30, 95% CI 1.57-3.37). Women from rural areas were less likely to utilize PNC in the first 48 h (AOR 0.70, 95% CI 0.53-0.90). Place of delivery was found to be linked with PNC utilization in this population although access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the rural and poor groups, interventions should aim to reach this group. The study results will help program managers to increase access to health facility delivery and direct interventional efforts toward the affected subpopulations, such as the young and rural women. Furthermore, results will help promote maternal health education on importance of health facility delivery and advise policy makers and program implementers.

Highlights

The World Health Organization reports that of the 289,000 maternal deaths that occur each year, worldwide [1], 50 to 71% occur within the postnatal period [2]
We sought to investigate the determinants of maternal Postnatal care (PNC) utilization in the first 48 h after delivery of a baby among childbearing women in Zambia, place of delivery was the main focus considered as a possible determinant, other factors such as place of residence and skilled attendance during delivery were investigated
It was found out that place of residence was associated with maternal PNC utilization in the first 48 h, women in rural areas were less likely to utilize PNC, emphasizing the need to reduce the inequities in service provision regardless of residence

Summary

Introduction

The World Health Organization reports that of the 289,000 maternal deaths that occur each year, worldwide [1], 50 to 71% occur within the postnatal period [2]. 99% of these maternal and neonatal deaths occur in low- and middle-income countries [4] to which Zambia belongs. PNC is the service provided to both the mother and her newborn baby within the first 6 weeks of a child’s birth [1]. The interventions include the umbilical cord care; special care for preterm, low-birth-weight and HIV-infected neonates [6], screening and treatment of infections and postnatal growth restriction, as well as assessment for factors predisposing to infant anemia [7]. In Zambia, PNC is scheduled as recommended by the Ministry of Health and as cited by Central Statistical Office (2014) into; within the first 6 h after birth, within 48 h, after 6 days, and within the last 6 weeks after the birth of the baby. In Zambia, maternal PNC coverage within the first 2 days has been estimated to be at 63%, which is below the national minimum target of 80% [4, 10]

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Discussion

Conclusion