Factors Associated to Utilization of Post-Natal Care At 48 Hours: A Case Study of Kanyama 1st Level Hospital in Lusaka, Zambia

Download Article

DOI: 10.21522/TIJPH.2013.07.04.Art030

Authors : Angela C. Mwaba

Abstract:

The post-natal period is the critical stage in the prevention of maternal and neonatal deaths. Zambia has recorded a decline in maternal mortality from 597(2007) to 398/100 000 (ZDHS 2014). WHO recommends that all post-natal women must be reviewed within 48 hours after delivery to avert maternal and neonatal mortality rate.

This study was therefore conducted to assess the factors affecting the utilization of post-natal services at 48 hours at Kanyama first level hospital with over 1,000 deliveries every month.

A mixed survey (employing both quantitative and qualitative methods) was completed by 197 women using a structured questionnaire. Quantitative was cross sectional while qualitative a case study. Informants included health workers and mothers who had delivered within 6 days at this hospital. The data was analyzed using STRATA 13 for quantitative, descriptive and inferential statistics.

Key findings: utilization of post-natal services at the hospital was poor at 6%. No information was given to women to report back within 48 hours, inadequate space and staff to implement this guideline and no association between PNC utilization and social economic, demographic and geographic factors.

Conclusion: The survey showed that utilization of PNC at 48hrs was low. Social economic, demographic and geographic factors were not associated with PNC utilization.

To improve utilization, increase on staffing, improve on space, provide information to mothers and implementation of guidelines.

Keywords: Postnatal Care, Utilization, maternal mortality.

References:

[1].   Abel Ntambue ML, Françoise Malonga K, Dramaix-Wilmet M, Donnen P. Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo–a case study of Lubumbashi City. BMC Pregnancy Childbirth. 2012; 12(66):66. pmid: 22780957.

[2].   Addai I. Determinants of use of maternal-child health services in rural Ghana. J Biosoc Sci. 2000 Jan; 32(1):1–15. pmid: 10676056.

[3].   Agha S. Impact of a maternal health voucher scheme on institutional delivery among low income women in Pakistan. Reproductive Health. 2011; 8(1):10.http://dx.doi.org/10.1186/1742-4755-8-10 pmid: 21539744.

[4].   Agha S, Carton TW. Determinants of institutional delivery in rural Jhang, Pakistan. Int J Equity Health. 2011; 10(31):31. http://dx.doi.org/10.1186/1475-9276-10-31 pmid: 21801437.

[5].   Amin R, Shah NM, Becker S. Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: a cross-sectional analysis. Int J Equity Health. 2010; 9(9):9. http://dx.doi.org/10.1186/1475-9276-9-9 pmid: 20361875.

[6].   Anson O. Utilization of maternal care in rural HeBei province, the People’s Republic of China: individual and structural characteristics. Health Policy. 2004 Nov; 70(2):197–206. http://dx.doi.org/10.1016/j.healthpol.2004.03.001 pmid: 15364149.

[7].   Anwar I, Sami M, Akhtar N, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bull World Health Organ. 2008 Apr; 86(4):252–9. http://dx.doi.org/10.2471/BLT.07.042754 pmid: 18438513.

[8].   Annet Nankwanga (2004), Factors Influencing Utilization of postnatal services in Mulago and Mengo Hospitals in Kampala, Uganda.

[9].   Bupe B. Bwalya, Mulenga C. Mulenga and James N. Mulenga. Factors associated with Postnatal Care for Newborns in Zambia: Analysis of the 2013-14 Zambia Demographic and Health Survey.

[10].  Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria–looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009; 9(1):43. http://dx.doi.org/10.1186/1471-2393-9-43 pmid: 19754941.

[11].  Bwalya B, Mulenga CM and Mulenga JN (2017). Factors associated with postnatal care for newborns in Zambia: analysis of the 2013-14 Zambia demographic and health survey. (Published online 2017 Dec 13. doi: 10.1186/s12884-017-1612-1).

[12].  Delvaux, T., Buekens, P., Godin, I. & Bouston, M. (2001). Barriers to prenatal care in Europe. American Journal of Preventive Medicine, 21(1): 52-59.

[13].  Larsen A, Cheyip M, Aynalem G, et al. Uptake and predictors of early postnatal follow-up care amongst mother-baby pairs in South Africa: Results from three population-based surveys, 2010-2013. J Glob Health. 2017; 7(2):021001.

[14].  Vishnu K, Mandira A, Rajendra K and Tania G (2014). Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011. https://doi.org/10.1186/1472-6874-14-19.

[15].  Jat TR, Ng N, San Sebastian M. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Int J Equity Health. 2011; 10(1):59. doi: 10.1186/1475-9276-10-59.

[16].  Titaley CR, Hunter CL, Heywood P, Dibley MJ. Why don't some women attend antenatal and postnatal care services? a qualitative study of community members’ perspectives in Garut, Sukabumi and Ciamis districts of west Java Province, Indonesia. BMC Pregnancy Childbirth. 2010; 10(1):61. doi: 10.1186/1471-2393-10-61.

[17].  Raghupathy S. Education and the use of maternal health care in Thailand. SocSci Med. 1996; 43(4):459–471. doi: 10.1016/0277-9536(95)00411-4.

[18].  Chakraborty N, et al. Determinants of the use of maternal health services in rural Bangladesh. Health Promotion Int. 2003; 18(4):327–337. doi: 10.1093/heapro/dag414.

[19].  World Health Organization. World health statistics 2013. Geneva: World Health Organization; 2013.

[20].  World Health Organization. WHO technical consultation on postpartum and postnatal care. Geneva: WHO; 2010.

[21].  Central Statistical Agency [Ethiopia] and ICF International. Ethiopia demographic and health survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.

[22].  Dhakal S, Chapman GN, Simkhada PP, van Teijlingen ER, Stephens J, Raja AE. Utilization of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth. 2007;7(1):19. http://dx.doi.org/10.1186/1471-2393-7-19 pmid: 17767710.

[23].  Banda ChembeChikoka –Onse (2017), Level and Knowledge on Post-Natal and its Associated Factors in Ndola, Zambia.

[24].  Baqui AH, Rosecrans AM, Williams EK, Agrawal PK, Ahmed S, Darmstadt GL, et al. NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity. Health Policy Plan. 2008 Jul; 23(4):234–43. http://dx.doi.org/10.1093/heapol/czn012 pmid: 18562458.

[25].  Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed effect and random effects models for meta-analysis. Res Synth Methods. 2010; 1(2):97–111. http://dx.doi.org/10.1002/jrsm.12.

[26].  Chakraborty N, Islam MA, Chowdhury RI, Bari W. Utilization of postnatal care in Bangladesh: evidence from a longitudinal study. Health Soc Care Community. 2002 Nov;10(6):492–502.

http://dx.doi.org/10.1046/j.1365-2524.2002.00389.x pmid: 12485137.

[27].  Crawley J. Reducing the burden of anemia in infants and young children in malaria-endemic countries of Africa: from evidence to action. Am J Trop Med Hyg. 2004 Aug; 71(2) Suppl: 25–34. pmid: 15331816.

[28].  Data Collection Techniques. Available on cyfar.org.

[29].  Dhaher E, Mikolajczyk RT, Maxwell AE, Krämer A. Factors associated with lack of postnatal care among Palestinian women: a cross-sectional study of three clinics in the West Bank. BMC Pregnancy Childbirth. 2008; 8(1):26.http://dx.doi.org/10.1186/1471-2393-8-26 pmid: 18638395.

[30].  Digambar A, Chimankar and HariharSahoo: Factors Influencing the Utilization of Maternal Health Services in Uttarakhand.

[31].  Dunlop, S., Coyte, P. C. &McIsaac, W. (2000). Socio-economic status and the utilization of physicians’ services: results from the Canadian National Health Population Health Survey. Social Science and Medicine, 51(1): 123-33.

[32].  Fatmi, Z. & Avan, B. I. (2002). Demographic, socio-economic and environmental determinants of utilization of antenatal care in a rural setting of Sindh, Pakistan.

[33].  Journal of Pakistan Medical Association, 52(4): 138-142.

[34].  Fort AL. Coverage of post-partum and post-natal care in Egypt in 2005–2008 and Bangladesh in 2004–2007: levels, trends and unmet need. Reproductive Health Matters. 2012 Jun; 20(39):81–92. http://dx.doi.org/10.1016/S0968-8080(12)39600-6 pmid: 22789085.

[35].  Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009; 9(1):34.http://dx.doi.org/10.1186/1471-2393-9-34 pmid: 19671156.

[36].  Gosh R, Shama AK. Intra and Inter-Household Differences in Antenatal Care, Delivery Practices and Postnatal Care between Last Neonatal Deaths and Last Surviving Children in a Peri-Urban Area of India. Journal of Biological Sciences. 2010; 42:511-30.

[37].  Grange J, Adhikari M, Ahmed Y, Mwaba P, Dheda K, Hoelscher M, Zumla A.

[38].  Groff Jade (2011). Revisioning Postpartum Care in the United States: Global Perspectives.

[39].  Guliani H, Sepehri A, Serieux J. What impact does contact with the prenatal care system have on women’s use of facility delivery? Evidence from low-income countries. SocSci Med. 2012 Jun;74(12):1882–90.http://dx.doi.org/10.1016/j.socscimed.2012.02.008 pmid: 22483706.

[40].  Gulliford, M., Morgan, M., Hughes, D., Beech, R., Figeroa-Munz, J., Gibson, B., Hudson, M., Arumugam, C., Connell, P., Mohiddin, A. & Sedgwick, J. (2001). Access to health care. Report of a scooping exercise for the National Coordinating Centre for NHS Service Delivery and Organization R & D (NCCSDO).

[41].  Halder AK, Saha UR, Kabir M. Inequalities in reproductive healthcare utilization: evidence from Bangladesh Demographic and Health Survey 2004. World Health Popul.2007Apr;9(2):48-63. http://dx.doi.org/10.12927/whp.2007.18853 pmid: 18270506.

[42].  Int J Gynaecol Obstet. 2010 Mar; 108(3):181-3Tuberculosis in association with HIV/AIDS emerges as a major non-obstetric cause of maternal mortality in Sub-Saharan Africa.

[43].  Iyoke CA, Ifeadike CO, Nnebue CC, Onah HE, Ezugwu FO. Perception and care-seeking behavior for post-partum morbidity among mothers in Enugu south east, Nigeria. Niger J Med. 2011 Apr-Jun; 20(2):260–5. pmid: 21970240.

[44].  Jat TR, Ng N, San Sebastian M. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Int J Equity Health. 2011; 10(1):59. http://dx.doi.org/10.1186/1475-9276-10-59 pmid: 22142036.

[45].  Jacobs Choolwe, MosaMoshabela, SitaliMaswenyeho, Nildah Lambo and Charles Michelo (2017). predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the remote and Poorest Rural Communities of Zambia: A multilevel Analysis.

[46].  Jat TR, Ng N, San Sebastian M. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Int J Equity Health. 2011; 10(1):59. http://dx.doi.org/10.1186/1475-9276-10-59 pmid: 22142036.

[47].  Joana Armstrong Schellenberg, Racheal A Haws, Adiel K Mushi, Hassan Mshinda, Marcel Tanner and David Schellenberg (2009), The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural Southern Tanzania.

[48].  Kalmuss, D. &Fennelly, K. (1990). Barriers to prenatal care among low-income women in New York City. Family Planning Perspective, 22(5): 215-8, & 231.

[49].  Kabakian-Khasholian T, Campbell OMR. A simple way to increase service use: triggers of women’s uptake of postpartum services. BJOG. 2005 Sep;112(9):1315–21. http://dx.doi.org/10.1111/j.1471-0528.2004.00507.x pmid: 16101614.

[50].  Kaufmann, K. (2002). An analysis of transport in the Zululand health district. Conference report. Retrieved from www.rudasa.org.za/conference/conf.php/conf6/jass.php.

[51].  Kogan, M. D. & Leary, M. (1990). Factors associated with postpartum care among Massachusetts’s users of the maternal and infant care program. Family Planning Perspectives, 22(3): 128-131.

[52].  Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al.; Lancet Every Newborn Study Group. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014 Jul 12; 384(9938):189–205.http://dx.doi.org/10.1016/S0140-6736(14)60496-7 pmid: 24853593.

[53].  Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010 Apr; 39 Suppl 1: i144–54. http://dx.doi.org/10.1093/ije/dyq031pmid: 20348117.

[54].  LeVine RA, LeVine SE, Rowe ML, Schnell-Anzola B. Maternal literacy and health behavior: a Nepalese case study. SocSci Med. 2004 Feb; 58(4):863–77.http://dx.doi.org/10.1016/S0277-9536(03)00261-2 pmid: 14672599.

[55].  Liu X, Zhou X, Yan H, Wang D. Use of maternal healthcare services in 10 provinces of rural western China. Int J Gynaecol Obstet. 2011 Sep; 114(3):260–4.http://dx.doi.org/10.1016/j.ijgo.2011.04.005 pmid: 21752373

[56].  Lusaka District Health Office, 2016 Labour Ward Report.

[57].  Matijasevich A, Santos IS, Silveira MF, Domingues MR, Barros AJ, Marco PL, et al. Inequities in maternal postnatal visits among public and private patients: 2004 Pelotas cohort study. BMC Public Health. 2009; 9(1):335.http://dx.doi.org/10.1186/1471-2458-9-335 pmid: 19751521.

[58].  Mistry R, Galal O, and Lu M. Women’s autonomy and pregnancy care in rural India: a contextual analysis. SocSci Med. 2009 Sep; 69(6):926–33.http://dx.doi.org/10.1016/j.socscimed.2009.07.008 pmid: 19656604.

[59].  Mullany BC, Becker S, Hindin MJ. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health Educ Res. 2007 Apr; 22(2):166–76.http://dx.doi.org/10.1093/her/cyl060 pmid: 16855015.

[60].  National Maternal Death Surveillance and Response (MDSR) Report. (2016).

[61].  Opportunities for Africa’s newborns. Geneva: World Health Organization; 2006.

[62].  Organizing Your Social Sciences Research Paper: Types of Research Designs. Available on liguides.usc.edu.

[63].  Postpartum empowerment: an integrated approach driving demand and delivery of high quality, low-cost postnatal services in Kenya. Nairobi: Jacaranda Health Organization; 2012. Available from: http://savinglivesatbirth.net/summaries/162

[64].  Rahman MM, Haque SE, Zahan MS. Factors affecting the utilization of postpartum care among young mothers in Bangladesh. Health Soc Care Community. 2011 Mar; 19(2):138–47. pmid: 20880103

[65].  Ram F, Singh A. Is antenatal care effective in improving maternal health in rural Uttar Pradesh? Evidence from a district level household survey. J Biosoc Sci. 2006 Jul; 38(4):433–48. http://dx.doi.org/10.1017/S0021932005026453 pmid: 16762083

[66].  Ronsmans C, Graham WJ; Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006 Sep 30; 368(9542):1189–200. http://dx.doi.org/10.1016/S0140-6736(06)69380-Xpmid: 17011946

[67].  Sarma S, Rempel H. Household decisions to utilize maternal healthcare in rural and urban India. World Health Popul. 2007 Jan;9(1):24–45.http://dx.doi.org/10.12927/whp.2007.18712 pmid: 18270498

[68].  Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007 Oct; 85(10):812–9.http://dx.doi.org/10.2471/BLT.06.035659 pmid: 18038064

[69].  Sharma SK, Sawangdee Y, Sirirassamee B. Access to health: women’s status and utilization of maternal health services in Nepal. J Biosoc Sci. 2007 Sep; 39(5):671–92. http://dx.doi.org/10.1017/S0021932007001952 pmid: 17359562

[70].  Singh A, Padmadas SS, Mishra US, Pallikadavath S, Johnson FA, Matthews Z. Socio-economic inequalities in the use of postnatal care in India. PLoS One. 2012; 7(5): e37037.

http://dx.doi.org/10.1371/journal.pone.0037037 pmid: 22623976

[71].  Singh PK, Rai RK, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in rural India. PLoS One. 2012; 7(2): e31666.

http://dx.doi.org/10.1371/journal.pone.0031666 pmid: 2235536

[72].  Stupp PW, Macke BA, Monteith R, Paredez S. Ethnicity and the use of health services in Belize. J Biosoc Sci. 1994 Apr; 26(2):165–77.http://dx.doi.org/10.1017/S0021932000021209 pmid: 8014173

[73].  Tang J, Li NX. Use of maternal health care services in poor regions in Sichuan. Sichuan Da XueBao Yi Xue Ban. 2008 Nov; 39(6):1004–6. Chinese. pmid: 19253847

[74].  Titaley CR, Dibley MJ, Roberts CL. Factors Associated with Non-Utilization of Postnatal Care Services in Indonesia. J Epidemiol Community Health. 2009;69(10):827-31

[75].  Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division. Geneva: World Health Organization; 2014.

[76].  Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank Estimates. Geneva: World Health Organization; 2012.

[77].  UNICEF.A Promise Renewed. New York: UNICEF; 2015.

[78].  USAID/BASICS (Basic Support for Institutionalizing Child Survival) and the Prevention of Postpartum Hemorrhage Initiative. Integrated maternal and newborn care: supervisory and evaluation checklists. Arlington: United States Agency for International Development; 2009. Available from: http://www.basics.org/documents/Supervisory-and-Evaluation-Checklists_Newborn-Toolkit_BASICS.pdf [cited 2015 Jan 26].

[79].  World Health Organization Recommendations on Postnatal Care of the Mother and Newborn (2013).

[80].  WHO recommendations on postnatal care of the mother and newborn. Geneva: World Health Organization; 2014.

[81].  WHO technical consultation on postpartum and postnatal care. Geneva: World Health Organization; 2010.

[82].  Yinager Gebeyehu Workineh, Desta Aregawi Hailu, Factors Affecting Utilization of Postnatal Services in Amhara Region, Jabitena District, Ethiopia. Science Journal of Public Health. Vol. 2, No.3, 2014, pp, 169-176. doi: 10:11666648/j.sjph.20140203.15

[83].  Zambia Demographic Health Survey (ZDHS) 2013-14.

[84].  Zambia Demographic Health Survey (ZDHS) 2007.