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Objective: 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. Methods: 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. Results: 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). Conclusion: 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. Significance: 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.
This was a cross-sectional study based on the 2013/14 ZDHS. The 2013/14 ZDHS is a nationally representative survey of 16,411 women aged 15–49 years and 14,773 men aged 15–59 years. The population that was focused on was that of females of the reproductive age, between 15 and 49 years. This study included all women who had a child within the 2 years preceding the survey. The utilization of PNC was considered for the last birth prior to the survey. All women age 15–49 that were either permanent residents of the households in the sample or visitors present in the household on the night before the survey were eligible to be interviewed. All women who had a child within 2 years preceding the survey but did not attend PNC were excluded. The ZDHS used a two-stage stratified sampling. For the selection of clusters and households, probability proportional to size at first stage, and equal probability systematic sampling was applied at second stage. The details of the ZDHS methodology are recorded in the reports (5). The PNC utilization study was based on data that was extracted from the 2013/14 ZDHS Women’s questionnaire. Women who reported having given birth two years prior to the survey and utilized PNC defined the sample of this study (n = 5,074). From these women aged 15–49 years who were captured in the survey, the proportion that attended PNC in the first 48 h after birth of the baby comprised de facto eligible sample. The explanatory variables included; mother’s age at birth (in years, ordered), birth order, place of delivery (health facility delivery or other place, e.g., home), residence (urban or rural), maternal education and wealth status, maternal and paternal occupation, birth attendance during delivery (skilled attendance), ANC timing, marital status, distance to a health facility, and being told about pregnancy complications. These factors were found to be significantly associated with PNC utilization in studies done for example, in Nepal and Tanzania (13, 14). The outcome of interest was PNC utilization (either in the first 48 h or after 48 h following the delivery of the baby) by women aged 15–49 years who had a baby 2 years prior to the survey considering the most recent birth. Descriptive and inferential statistics were used to examine if place of delivery was associated with PNC utilization in the first 48 h after birth. In the first step, univariate analysis (initially by cross tabulations by Pearson’s chi-squared test) and later multiple logistic regression, incorporating survey weights were performed to examine if place of delivery was associated with PNC in the first 48 h after birth. A p value of <0.05 was considered significant with 95% confidence interval (95% CI). STATA version 13 (Stata Corporation, College Station, TX, USA) was used for all analyses in this study. Ethical approval for the 2013/14 ZDHS was obtained from the Tropical Diseases Research Centre in Ndola, Zambia and the US Centre for Disease Control and Prevention Atlanta Research Ethics Review Board. Participation in the survey was based on informed and voluntary consent. The re-analysis of the data reported in this study did not infringe on participants’ privacy and was judged to pose no risk, since these data were already de-identified, approved, and made available for public use. Additionally, clearance was obtained from Excellency in Research Ethics and Science Committee that granted approval to conduct this study on the factors associated with maternal PNC utilization based on the 2013/14 ZDHS (Ref. no. 2016-June-014).
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