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