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Background: Maternal and infant mortality remains a huge public health problem in developing countries. One of the strategies to minimise the risks of both maternal and infant mortality is access to and utilisation of antenatal care (ANC) services. Aim: This study aimed to investigate the accessibility factors that influence the use of ANC services in Mangwe district. Methods: A qualitative approach using explorative design was adopted to target women who have babies under 1 year of age. The study was conducted in Mangwe district, Matabeleland South province, Zimbabwe. Data were collected through semi-structured interviews and observations. Data saturation was reached after 15 women who were conveniently sampled were interviewed. Field notes were analysed thematically using Tech’s steps. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Accessibility factors such as lack of transport, high transport costs and long distances to health care facilities, health care workers’ attitudes, type and quality of services as well as delays in receiving care influence women’s utilisation of ANC services in Mangwe district, Zimbabwe. Conclusion: The study concluded that women were still facing problems of unavailability of nearby clinics; therefore, it was recommended that the government should avail resources for women to use. Recommendations: Mangwe District Health Department should provide mobile clinics rendering ANC services in distant rural areas.
The study adopted a qualitative approach using exploratory design. This study was conducted in Mabunga village, Mangwe district, Zimbabwe. Mangwe district is located in Matabeleland South province, in south-western Zimbabwe, close to the international border with Botswana. It is a sub-district of Bulilimamangwe district. Its main town, Plumtree, is located about 100 km by road, south-west of Bulawayo, the nearest large city. Permission to access records of women who attend ANC at Marula clinic was granted by the district administrator (DA), and the DA also allowed the investigator to proceed to Mabunga village. The headman of Mabunga village allowed the researcher to move around the village searching for participants with the help of the village health worker. The target population was sufficiently representative of different groups with regard to age, parity, socioeconomic status, marital status and level of education. The population included mothers who had babies of age under 12 months at the time of the study. A sample of 15 women were chosen based on the criterion of data saturation, where the researcher noted that they were receiving the same information from the participants. Purposive sampling was used in this study where the researcher searched for participants who met the selection criteria. These women were then approached depending on their availability at the time of study. Appointments were made with the participants. The first interview gave the researcher an opportunity to test if the research questions were clear. Questions were then adjusted in response to the pre-test findings. Data were collected through semi-structured interviews with individual participants. The purpose of the study was explained to the participants, and each participant signed a consent form. The time for interviews was set to suit the availability of each participant. Data were collected within eight days. Pseudo names were used so as to maintain confidentiality. The participants were told of the main reason for the use of pseudo names. All the participants were asked open-ended questions. The interviews were conducted in Ndebele by the researcher as all participants were Ndebele speaking. Each interview lasted between 45 min and 1 h. The interviews were audio taped and transcribed verbatim within 24 h of the interview. They were then translated into English before being analysed. Field notes were written immediately after each interview to describe the physical setting and the activities which occurred during each interview. The collected data were analysed using the thematic analytical approach. The collected data were analysed using the thematic analytical approach. All data were transcribed and then translated from Ndebele to English. Reliability of transcriptions was achieved through reading them while listening to the recordings. The researcher was familiarised with the depth and breadth of the content. A thorough analysis of the entire data set was performed once more before beginning to code, as the ideas, and the identification of possible patterns was shaped in the process of reading through. The data were initially coded and collated, and there was a long list of different codes the researcher would have identified across the data set. This phase, which re-focuses the analysis at the broader level of themes, rather than codes, involved sorting the different codes into potential themes, and collating all the relevant coded data extracts within the identified themes. The researcher devised a set of themes and refined them. During this phase, some themes collapsed into each other whereas other themes needed to be broken down into separate entities. The researcher had a satisfactory thematic map of data. The themes were defined and further refined, and they were not too diverse or complex. The Lincoln and Guba model of trustworthiness was adopted which includes credibility, confirmability, dependability and transferability;13 these are described below: To ensure credibility, the researcher actively participated in the collection of data. Prolonged engagement, taking down of field notes and observation of the participants’ responses were performed. The researcher gained a deeper understanding of the topic as well as specific aspects of the participant’s perceptions through the interviews. Findings were shown to the participants to allow them to confirm if they represent their opinions accurately and to ensure credibility of the tape recorders and field notes used in the data collection. In this study, dependability was achieved by describing the research findings, interpretations and recommendations, using an auditable trail so as to corroborate that the investigation was supported by data and was internally coherent. A voice recorder was used to increase reliability of all interviews. Confirmability in this study was ensured by the use of an independent coder who went through the transcriptions with the researcher and together they reached a consensus on the themes found. This was reflected by the voice of the participants and not the researcher’s perceptions. This was supported by integration of an audit procedure where the researcher described all the research processes, explained and justified what they intend to do and made presentations on the reasons for undertaking decisions. The researcher provided a complete description of the research methodology findings and verbatim quotes from individual interviews to ensure applicability of the study to other contexts. The researcher requested someone with research experience to randomly read selected transcripts and to identify major categories, so that readers may have a clear picture of the findings. Approval and ethical clearance were obtained from University of Venda Higher Degree and Research Ethics committees (SHS/15/PH/15/0707). A written informed consent was obtained from all participants prior to data collection.
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