Abstract :
Postnatal care (PNC) is a critical intervention for reducing maternal and neonatal morbidity and mortality, yet its utilization remains low in many rural African settings. This study assessed factors influencing low attendance of postnatal mothers at six days at Siavonga District Hospital, Zambia. A cross-sectional study design was employed involving 384 postnatal women selected from Maternal and Child Health (MCH) registers. Data were collected using structured questionnaires and analysed using SPSS version 24. Descriptive statistics and Pearson’s chi-square tests were used to determine associations between socio-demographic variables and PNC attendance.
Only 14.2% of mothers attended postnatal services at six days, indicating critically low utilization. Significant factors associated with non-attendance included maternal age, parity, education level, distance to the health facility, and knowledge of PNC services. Social and cultural practices such as postpartum seclusion, negative perceptions of health workers, long waiting times, and limited partner support were also identified as key barriers.
The findings highlight the need for community-based awareness programs, improved quality of care at facilities, and strengthened male involvement strategies. Enhancing early postnatal follow-up services could substantially improve maternal and newborn health outcomes in rural Zambia.
Keywords :
health service utilization, Maternal Health, neonatal health, postnatal care, rural health, ZambiaReferences :
- Aboagye, R. G., Seidu, A. A., Ahinkorah, B. O., Cadri, A., Frimpong, J. B., Hagan, J. E., Kassaw, N. A., & Yaya, S. (2022). Association between frequency of mass media exposure and maternal health care service utilization among women in sub- Saharan Africa: Implications for tailored health communication and education. PLoS ONE, 17(9 September). https://doi.org/10.1371/journal.pone.0275202
- Acharya, D., Khanal, V., Singh, J. K., Adhikari, M., & Gautam, S. (2015). Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal. BMC Research Notes, 8(1). https://doi.org/10.1186/s13104-015-1312-8
- Adams, Y. J., Miller, M. L., Agbenyo, J. S., Ehla, E. E., & Clinton, G. A. (2023). Postpartum care needs assessment: women’s understanding of postpartum care, practices, barriers, and educational needs. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05813-0
- Assefa, Y., Van Damme, W., Williams, O. D., & Hill, P. S. (2017). Successes and challenges of the millennium development goals in Ethiopia: Lessons for the sustainable development goals. BMJ Global Health, 2(2). https://doi.org/10.1136/bmjgh-2017-000318
- Atahigwa, C., Kadengye, D. T., Iddi, S., Abrams, S., & Van Rie, A. (2020). Trends and determinants of health facility childbirth service utilization among mothers in urban slums of Nairobi, Kenya. Global Epidemiology, 2(3), 100029. https://doi.org/10.1016/j.gloepi.2020.100029
- Birhane, B. M., Assefa, Y., Belay, D. M., Nibret, G., Munye Aytenew, T., Liyeh, T. M., Gelaw, K. A., & Tiruneh, Y. M. (2024). Interventions to improve the quality of maternal care in Ethiopia: a scoping review. In Frontiers in Global Women’s Health (Vol. 5). Frontiers Media SA. https://doi.org/10.3389/fgwh.2024.1289835
- Callaghan-Koru, J. A., Seifu, A., Tholandi, M., De Graft-Johnson, J., Daniel, E., Rawlins, B., Worku, B., & Baqui, A. H. (2013a). Newborn care practices at home and in health facilities in 4 regions of Ethiopia. http://www.biomedcentral.com/1471-2431/13/198
- Callaghan-Koru, J. A., Seifu, A., Tholandi, M., De Graft-Johnson, J., Daniel, E., Rawlins, B., Worku, B., & Baqui, A. H. (2013b). Newborn care practices at home and in health facilities in 4 regions of Ethiopia. http://www.biomedcentral.com/1471-2431/13/198
- Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W., & Akhter, H. H. (2003a). Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International, 18(4), 327–337. https://doi.org/10.1093/heapro/dag414
- Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W., & Akhter, H. H. (2003b). Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International, 18(4), 327–337. https://doi.org/10.1093/heapro/dag414
- Chowdhury, S. R., Islam, M. N., Sheekha, T. A., Kader, S. B., & Hossain, A. (2023). Prevalence and determinants of noncommunicable diseases risk factors among reproductive-aged women: Findings from a nationwide survey in Bangladesh. PLoS ONE, 18(6 June). https://doi.org/10.1371/journal.pone.0273128
- Dhaher, E., Mikolajczyk, R. T., Maxwell, A. E., & Krämer, A. (2008). Factors associated with lack of postnatal care among Palestinian women: A cross-sectional study of three clinics in the West Bank. BMC Pregnancy and Childbirth, 8. https://doi.org/10.1186/1471-2393-8-26
- Dhakal, S., Chapman, G. N., Simkhada, P. P., van Teijlingen, E. R., Stephens, J., & Raja, A. E. (2007a). Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy and Childbirth, 7. https://doi.org/10.1186/1471-2393-7-19
- Dhakal, S., Chapman, G. N., Simkhada, P. P., van Teijlingen, E. R., Stephens, J., & Raja, A. E. (2007b). Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy and Childbirth, 7. https://doi.org/10.1186/1471-2393-7-19
- Dhakal, S., Chapman, G. N., Simkhada, P. P., van Teijlingen, E. R., Stephens, J., & Raja, A. E. (2007c). Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy and Childbirth, 7. https://doi.org/10.1186/1471-2393-7-19
- Fagbamigbe, A. F., & Idemudia, E. S. (2015a). Assessment of quality of antenatal care services in Nigeria: Evidence from a population-based survey. In Reproductive Health (Vol. 12, Number 1). BioMed Central Ltd. https://doi.org/10.1186/s12978-015-0081-0
- Fagbamigbe, A. F., & Idemudia, E. S. (2015b). Assessment of quality of antenatal care services in Nigeria: Evidence from a population-based survey. In Reproductive Health (Vol. 12, Number 1). BioMed Central Ltd. https://doi.org/10.1186/s12978-015-0081-0
- Ganle, J. K., Parker, M., Fitzpatrick, R., & Otupiri, E. (2014a). Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: A descriptive study. International Journal for Equity in Health, 13(1). https://doi.org/10.1186/s12939-014-0089-z
- Ganle, J. K., Parker, M., Fitzpatrick, R., & Otupiri, E. (2014b). Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: A descriptive study. International Journal for Equity in Health, 13(1). https://doi.org/10.1186/s12939-014-0089-z
- He, Z., Zhang, C., Wang, S., Bishwajit, G., & Yang, X. (2021). Socioeconomic Determinants of Maternal HealthCare Utilisation in Zambia: 1997-2014. Inquiry (United States), 58. https://doi.org/10.1177/00469580211067480
- Le, K., & Nguyen, M. (2024). Maternal education and child mortality: Evidence from developing countries. International Journal of Educational Development, 110, 103135. https://doi.org/10.1016/j.ijedudev.2024.103135
- Mkandawire, E., & Hendriks, S. L. (2018). A qualitative analysis of men’s involvement in maternal and child health as a policy intervention in rural Central Malawi. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-018-1669-5
- Mselle, L., O’Hearn, S., Aston, M., Murphy, G. T., & Rigby, J. (2023). Improving comprehensive emergency obstetric and newborn care in Tanzania: A qualitative study. Midwifery, 123, 103698. https://doi.org/10.1016/j.midw.2023.103698
- Mukunya, D., Tumwine, J. K., Nankabirwa, V., Ndeezi, G., Odongo, I., Tumuhamye, J., Tongun, J. B., Kizito, S., Napyo, A., Achora, V., Odongkara, B., & Tylleskar, T. (2017). Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda. Global Health Action, 10(1). https://doi.org/10.1080/16549716.2017.1410975
- Munabi-Babigumira, S., Lewin, S., Glenton, C., Velez, M., Gonçalves-Bradley, D. C., & Bohren, M. A. (2021). Factors that influence the provision of postnatal care by health workers: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2021(7). https://doi.org/10.1002/14651858.CD014790
- Mwaba, A. C. (2019). Factors Associated to Utilization of Post-Natal Care At 48 Hours: A Case Study of Kanyama 1st Level Hospital in Lusaka, Zambia. Texila International Journal of Public Health, 7(4). https://doi.org/10.21522/TIJPH.2013.07.04.Art030
- Najjuuko, C., Xu, Z., Kizito, S., Lu, C., & Ssewamala, F. M. (2025). Patterns of maternal and child health services utilization and associated socioeconomic disparities in sub-Saharan Africa. Nature Communications , 16(1). https://doi.org/10.1038/s41467-025-61350-8
- Phiri, M., Musonda, E., Shasha, L., Kanyamuna, V., & Lemba, M. (2023). Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis. BMC Women’s Health, 23(1). https://doi.org/10.1186/s12905-023-02168-8
- Shanto, H. H., Al-Zubayer, M. A., Ahammed, B., Sarder, M. A., Keramat, S. A., Hashmi, R., Haque, R., & Alam, K. (2023). Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries. International Journal of Public Health, 68. https://doi.org/10.3389/ijph.2023.1606288
- Sialubanje, C., Massar, K., Hamer, D. H., & Ruiter, R. A. C. (2015). Reasons for home delivery and use of traditional birth attendants in rural Zambia: A qualitative study. BMC Pregnancy and Childbirth, 15(1). https://doi.org/10.1186/s12884-015-0652-7
- Singh, A., Padmadas, S. S., Mishra, U. S., Pallikadavath, S., Johnson, F. A., & Matthews, Z. (2012a). Socio-economic inequalities in the use of postnatal care in india. PLoS ONE, 7(5). https://doi.org/10.1371/journal.pone.0037037
- Singh, A., Padmadas, S. S., Mishra, U. S., Pallikadavath, S., Johnson, F. A., & Matthews, Z. (2012b). Socio-economic inequalities in the use of postnatal care in india. PLoS ONE, 7(5). https://doi.org/10.1371/journal.pone.0037037
- Titaley, C. R., Hunter, C. L., Dibley, M. J., & Heywood, P. (2010a). Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia. http://www.biomedcentral.com/1471-2393/10/43
- Titaley, C. R., Hunter, C. L., Dibley, M. J., & Heywood, P. (2010b). Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia. http://www.biomedcentral.com/1471-2393/10/43
- Wudineh, K. G., Nigusie, A. A., Gesese, S. S., Tesu, A. A., & Beyene, F. Y. (2018). Postnatal care service utilization and associated factors among women who gave birth in Debretabour town, North West Ethiopia: A community- based cross-sectional study. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-018-2138-x

