Levels,trends and determinants of maternal health service utilisation in Zambia evidence from ZDHS: 1992-2014
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This study assessed the utilisation of Maternal Health Services from skilled personnel, as a „Continuum of Care‟ in Zambia between 1992 and 2014.The Continuum of Care for Maternal New-born and Child Health advocates for the continuous uptake of antenatal, birth and postnatal care services from medically trained health professionals. This Continuity of Care has been widely recognised as a key strategy for improving health outcomes of both mothers and new-borns in reproductive health. Over the years, Antenatal care use in Zambia has been well above World Health Organisation target of 90 per cent coverage by 2015, unlike Delivery and Postnatal care service utilisation which range between 51 to 64 per cent and 12 to 60 per cent respectively during the period. Women reception of Antenatal care alone is not enough however, as the majority of fatal complications in reproductive health arise during or shortly after delivery. This was quantitative study that employed a time series design of cross-sectional data extracted from the 1992 to 2014 ZDHS surveys. The woman aged 15 to 49 years who had at least one live birth in the 5 years preceding the surveys was the unit of analysis of the study. Determination of factors associated with the use of skilled maternal health services along a continuum of care was achieved using a multi-variable logistic regression model in Stata. The study revealed that women in Zambia do overwhelmingly undertake antenatal care visits although delivery and postnatal care service utilisation are still low. Findings regarding maternal health service utilisation as a continuum of care show that, despite a gradual improvement over the years, the general pattern of utilisation across time still indicates a low proportion of women completing the same. This could be attributed to various cultural factors. Regression results indicate that maternal health care-seeking behaviours in Zambia are shaped by various factors including, mother‟s education, residence type, exposure to media, number of children ever born and the birth rank for one period or the other and husband/partner‟s approval of health service use. Moreover, maternal age at birth of the child, the household wealth status and husband/partner„s level of education were not significant predictor variables for the use of maternal health services, largely resulting from probable government policy that reduced inequalities in accessing health care. A large proportion of women in Zambia, do not complete the continuum of care and therefore, future measures including stressing the importance of skilled birth attendance and postnatal care should be emphasised during antenatal visits. Both, women and men„s education and exposure to media are therefore major policy variables that can be used to change health beliefs and vi personal characteristics of the users. The findings clearly point to the need for a further qualitative study to enrich the current study on why many women from the same socio-economic standing attend antenatal care and yet fewer continue to attend skilled delivery and postnatal care services despite most deaths occurring during and after delivery. Thus, the findings of the study therefore provide evidence on the current levels, trends and determinants of maternal health service utilisation between 1992 and 2014 in Zambia, and the knowledge obtained serves as a basis for addressing MHC utilisation challenges. Keywords: Maternal Health, Continuum of Care, Determinants, Skilled.
The University of Zambia