Accessibility of women to secondary obstetric care in a rural district of Zambia and the implications for safe motherhood
Zulu, Alexandrina Alice
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The study was conducted in Chipata District Health Centres and Chipata General Hospital as a secondary referral matremity care. The study included both rural and urban Centres. The purpose of the study was to determine the accessibility of women to secondary obstetric care in a rural district and the implications for safe motherhood.Observation and literature has shown that despite the launching of Safe motherhood initiative some eleven years ago in Sub Sahara Africa, Safe motherhood in Zambia is still a big challenge. Maternal and Perinatal mortality remain high and accessibility to safe pregnancy and childbirth are not adequate.Literature review was based on those factors that affect accessibility in terms of distances, aflfordabililty and quality of care and also the acceptability of care by the mothers themselves. Maternal mortality ratios were reviewed both locally in the country and worldwide.Data were collected between February and March 1998 in Chipata District by interviewing 100 mothers, 75 from the rural and 25 urban and 17 staff in the centres incvolved. The mothers were pregnant with at least one child but not more than four attending Ante Natal clinic. The maternity records at Chipata General Hospital were reviewed for the period January 1995 to December 1997. Normal and abnormal deliveries were noted, maternal and perinatal mortality ratios worked out.The findings of the study revealed that the proportion of rural women that were physically accessible to secondary obstetric care was very small, only 3%. Ante Natal care was free in all the health centres and this increased attendance of about 97%. In some of the rural health centres, a minimal fee was charged for a delivery but at the secondary referral hospital, a considerable amount of admission and delivery fees were charged though there was no extra charge for Caesarean Sections. For the rural poor, cost sharing of the maternity services might be a barrier to safe Motherhood. 53% of mothers delivered at home (ZDHS 1996) and this could be attributed to the problems of accessibility to obstetric care by women in the light of poor physical access and unaffordable costs. Little or no education of women in child bearing age was also found to be a barrier to safe motherhood. 32%o had no education at all while 56%) had some primary education and many did not even complete it.The women who had been referred to hospital in good time who had favourable pregnancy outcome were (78%). Review of obstetric records at the secondary obstetric care unit however, revealed a maternity mortality ratio of 795 per 100,000 live births and 53 per 1,000 perinatal deaths in the year 1997. It was further observed that on an average, 8% of the deliveries were by Caesarean sections and the main indication was obstructed labour due to Cephalo-pelvic disproportion in about 36% in 1997.Much of the information obtained makes this study important to the health personnel and it is hoped that initiatives to make pregnancy and child birth safe will be every one's concern.
- Medicine