‘Born before arrival’: user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia

BMC Pregnancy and Childbirth

Karen Marie Moland¹  Ana Lorena Ruano¹  Knut Fylkesnes¹  Selia Ng’anjo Phiri¹ 

[1] Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway

关键词: Zambia;    Responsiveness;    Born before arrival;    Health facility childbirth;    Home deliveries;   

Others  :  1125473
DOI  :  10.1186/1471-2393-14-323

 received in 2014-02-26, accepted in 2014-09-10,  发布年份 2014

【 摘 要 】

Background

Maternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. ‘Born before arrival’ (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth.

Methods

A qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis.

Results

Perspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth.

Conclusion

Trust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5.

【 授权许可】

   
2014 Ng’anjo Phiri et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]World Health Organization: Trends in Maternal Mortality: 1990–2010 WHO, UNICEF, UNFPA and The World Bank estimates. available at http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf?ua=1 webcite (accessed 12 February 2014)
• [2]Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375(9726):1609-1623.
• [3]Republic of Zambia: National Health Strategic Plan 2011–2015 Ministry of Health. 2011. available at http://www.moh.gov.zm/docs/nhsp.pdf webcite (accessed 20 February 2014)
• [4]Central Statistical Office [Zambia] MoHZ, and Macro International Inc: Zambia Demographic and Health Survey 1996. Calverton, Maryland, USA: Central Statistical Office and Macro International Inc; 1997.
• [5]Central Statistical Office [Zambia] CBoHZ, and ORC Macro: Zambia Demographic and Health Survey 2001–2002. Calverton, Maryland, USA: Central Statistical Office, Central Board of Health, and ORC Macro; 2003.
• [6]Central Statistical Office (CSO) MoH, Tropical Diseases Research Centre (TDRC), University of Zambia and Macro International Inc 2009: Zambia Demographic and Health Survey 2007. Calverton, Maryland, USA: CSO and Macro International Inc; 2007.
• [7]Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet 2006, 368(9543):1284-1299.
• [8]Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Marchal B, De Brouwere V, van Lerberghe W: Going to scale with professional skilled care. Lancet 2006, 368(9544):1377-1386.
• [9]Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994, 38(8):1091-1110.
• [10]World Health Organization: Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO. Geneva; 2004. available at http://whqlibdoc.who.int/publications/2004/9241591692.pdf?ua=1 webcite (accessed 12 February 2014)
• [11]Potter PC, Pelteret R, Reynolds L, Motala A, Kibel MA: Born before arrival. A study at the New Somerset Hospital, Cape Town. S Afr Med J 1984, 66(10):377-380.
• [12]De Brouwere V, Richard F, Witter S: Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Trop Med Int Health 2010, 15(8):901-909.
• [13]Ensor T, Cooper S: Overcoming barriers to health service access: influencing the demand side. Health Policy Plan 2004, 19(2):69-79.
• [14]Murray CJ, Frenk J: A framework for assessing the performance of health systems. Bull World Health Organ 2000, 78(6):717-731.
• [15]Pearson SD, Raeke LH: Patients' trust in physicians: many theories, few measures, and little data. J Gen Intern Med 2000, 15(7):509-513.
• [16]Byskov J, Bloch P, Blystad A, Hurtig AK, Fylkesnes K, Kamuzora P, Kombe Y, Kvale G, Marchal B, Martin DK, Michelo C, Ndawi B, Ngulube TJ, Nyamongo I, Olsen ØE, Onyango-Ouma W, Sandøy IF, Shayo EH, Silwamba G, Songstad NG, Tuba M: Accountable priority setting for trust in health systems–the need for research into a new approach for strengthening sustainable health action in developing countries. Health Res Policy Syst 2009, 7:23.
• [17]Ng'anjo Phiri S, Kiserud T, Kvale G, Byskov J, Evjen-Olsen B, Michelo C, Echoka E, Fylkesnes K: Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey. BMC Pregnancy Childbirth 2014, 14(1):219.
• [18]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24(2):105-112.
• [19]Thom DH, Hall MA, Pawlson LG: Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood) 2004, 23(4):124-132.
• [20]Calnan M, Rowe R: Researching trust relations in health care: conceptual and methodological challenges–introduction. J Health Organ Manag 2006, 20(5):349-358.
• [21]Moskop JC, Marco CA, Larkin GL, Geiderman JM, Derse AR: From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine–Part II: Challenges in the emergency department. Ann Emerg Med 2005, 45(1):60-67.
• [22]Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM: 'They treat you like you are not a human being': Maltreatment during labour and delivery in rural northern Ghana. Midwifery 2014, 30(2):262-268.
• [23]Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S: Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health 2009, 99(9):1666-1672.
• [24]Kruk ME, Paczkowski MM, Tegegn A, Tessema F, Hadley C, Asefa M, Galea S: Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health 2010, 64(11):984-988.
• [25]Kumbani LC, Chirwa E, Malata A, Odland JO, Bjune G: Do Malawian women critically assess the quality of care? A qualitative study on women's perceptions of perinatal care at a district hospital in Malawi. Reprod Health 2012, 9:30.
• [26]Njeru MK, Blystad A, Nyamongo IK, Fylkesnes K: A critical assessment of the WHO responsiveness tool: lessons from voluntary HIV testing and counselling services in Kenya. BMC Health Serv Res 2009, 9:243.
• [27]Otis KE, Brett JA: Barriers to hospital births: why do many Bolivian women give birth at home? Rev Panam Salud Publica 2008, 24(1):46-53.
• [28]Waiswa P, Kemigisa M, Kiguli J, Naikoba S, Pariyo GW, Peterson S: Acceptability of evidence-based neonatal care practices in rural Uganda - implications for programming. BMC Pregnancy Childbirth 2008, 8:21.
• [29]Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D: Factors affecting home delivery in rural Tanzania. Trop Med Int Health 2007, 12(7):862-872.
• [30]Gabrysch S, Simushi V, Campbell OM: Availability and distribution of, and geographic access to emergency obstetric care in Zambia. Int J Gynaecol Obstet 2011, 114(2):174-179.
• [31]Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H: Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth 2007, 7:29.
• [32]Maimbolwa MC, Yamba B, Diwan V, Ransjo-Arvidson AB: Cultural childbirth practices and beliefs in Zambia. J Adv Nurs 2003, 43(3):263-274.
• [33]Hadley MB, Tuba M: Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia's Copperbelt. Reprod Health 2011, 8:17.
• [34]Kyomuhendo GB: Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs and limited resources. Reprod Health Matters 2003, 11(21):16-26.
• [35]Veale DJ, Furman KI, Oliver DW: South African traditional herbal medicines used during pregnancy and childbirth. J Ethnopharmacol 1992, 36(3):185-191.
• [36]Sibley LM, Sipe TA: Transition to skilled birth attendance: is there a future role for trained traditional birth attendants? J Health Popul Nutr 2006, 24(4):472-478.