Factors affecting utilization of skilled birth attendants in Northern Zambia
A Nakambale, S Nzala and A Hazemba
Ndola Central Hospital, Zambia
University of Zambia, Zambia
: J Womens Health, Issues Care
Abstract
Background: World Health strongly advocates for “skilled care at every delivery” to reduce the global burden of 536,000 maternal deaths and 3.7 million newborn deaths each year. Improving delivery care is an essential element of attaining improved maternal and child health. Skilled care at delivery can prevent up to 75% or more of maternal deaths (WHO, 2008). In the more developed countries, skilled attendance at delivery is about 99.5% whereas that of Africa is 62.5% (WHO, 2008) and Zambia was at 47% in 2008 (2007 ZDHS below WHO target of 85% in 2010 (WHO, 2005). The MDG for Zambia was to reduce maternal mortality which currently stands at 398/100,000 live births to 162/100,000 live births by 2015. Kasama district has low institutional deliveries with more than half (56%) of pregnant women delivering at home without the assistance of a skilled attendant. Despite high antenatal attendance (95%), use of skilled attendants at birth is still very low. Methods: The study was conducted in Northern Province of Zambia. The triangulation approach method was used to collect data in which a semi structured interview schedule was administered to 340 eligible women (170 cases and 170 controls) with children aged six months and below accessing various health services at three selected health centers under study. Mothers who were delivered by skilled birth attendants were controls while those who were delivered by unskilled attendants were cases. Three focus group discussions were also conducted at each health center. Results: The study found out that the presence of male midwives at delivery centers, use of herbs to quicken labor and distance to health facilities (p value=0.005, 0.001 and 0.001) respectively were the most frequently identified contributing factors to low utilization of skilled attendants at delivery in this study. Respondents who were not comfortable with males attending to women during labor were 1.271 [OR (95%CI)=(1.029, 1.570)] more likely to be delivered by unskilled birth attendants than those who were not while those who took traditional herbs on their last pregnancy were 1.717 [OR (95% CI)=1.717 (1.407, 2.096)] to be delivered by unskilled attendants. Discussion: The study demonstrated that majority of the women are not comfortable to be attended to by male midwives especially during labor as they believe it is against their tradition for a man other than their husbands to see their nakedness. It also discovered that majority of the women take traditional herbs during pregnancy as a preventive measure of obstructed labor thereby putting their lives and that of their unborn babies at risk. The knowledge levels of women about danger signs of pregnancy was alarmingly lower than expected. This coupled with lack of preparedness and long distances to health facilities contributes to the delay in seeking skilled care leading to mortalities.
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