The Influence of Distance and Level of Service Provision on Antenatal Care Use in Rural Zambia

Nicholas N A Kyei,Oona M R Campbell,Sabine Gabrysch,Jose M Belizan

doi:10.1371/journal.pone.0046475

Nicholas N A Kyei, Oona M R Campbell + Show 2 more

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https://doi.org/10.1371/journal.pone.0046475

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Abstract

BackgroundAntenatal care (ANC) presents important opportunities to reach women with crucial interventions. Studies on determinants of ANC use often focus on household and individual factors; few investigate the role of health service factors, partly due to lack of appropriate data. We assessed how distance to facilities and level of service provision at ANC facilities in Zambia influenced the number and timing of ANC visits and the quality of care received.Methods and FindingsUsing the 2005 Zambian national Health Facility Census, we classified ANC facilities according to the level of service provision. In a geographic information system, we linked the facility information to household data from the 2007 DHS to calculate straight-line distances. We performed multivariable multilevel logistic regression on 2405 rural births to investigate the influence of distance to care and of level of provision on three aspects of ANC use: attendance of at least four visits, visit in first trimester and receipt of quality ANC (4+ visits with skilled health worker and 8+ interventions).We found no effect of distance on timing of ANC or number of visits, and better level of provision at the closest facility was not associated with either earlier ANC attendance or higher number of visits. However, there was a strong influence of both distance to a facility, and level of provision at the closest ANC facility on the quality of ANC received; for each 10 km increase in distance, the odds of women receiving good quality ANC decreased by a quarter, while each increase in the level of provision category of the closest facility was associated with a 54% increase in the odds of receiving good quality ANC.ConclusionsTo improve ANC quality received by mothers, efforts should focus on improving the level of services provided at ANC facilities and their accessibility.

Highlights

Even though significant progress has been made in reducing maternal deaths globally since the 1990s [1,2,3], many women and their newborns are still dying from preventable pregnancy- and birth-related complications, especially in sub-Saharan Africa [4]
Outcome variables We explored the effect of distance and level of provision on three binary outcome variables obtained from the Demographic and Health Survey (DHS): (1) attendance of at least the four recommended Antenatal care (ANC) visits; (2) ANC visit in the first trimester and (3) receipt of ‘‘good quality ANC’’
Our study showed that most rural women in Zambia lived far away from facilities providing an optimum level of service, and that both farther distance to and level of provision at the closest ANC facility were associated with the quality of ANC received by expectant mothers in rural Zambia

Summary

Introduction

Even though significant progress has been made in reducing maternal deaths globally since the 1990s [1,2,3], many women and their newborns are still dying from preventable pregnancy- and birth-related complications, especially in sub-Saharan Africa [4]. Antenatal care (ANC), while not sufficient to reduce maternal mortality on its own, still presents an important opportunity to reach women with a number of interventions crucial for their health and that of their babies [6]. Antenatal care (ANC) presents important opportunities to reach women with crucial interventions. We assessed how distance to facilities and level of service provision at ANC facilities in Zambia influenced the number and timing of ANC visits and the quality of care received

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