EFFECT OF ANTENATAL EDUCATION ON KNOWLEDGE AND UTILIZATION OF FACILITY BASED DELIVERY SERVICES AMONG PREGNANT WOMEN IN MPIKA DISTRICT, ZAMBIA

Abstract

Background: Facility based delivery services have been promoted to improve maternal and child health care in Zambia. Despite the efforts to expand health care services and promote institution based delivery services in the country by government through the Ministry of Health, an estimated 84% of births still take place at home (ZSA, 2018). This underutilization of maternal health care services by the women results in insignificant decline of maternal mortality ratio. In Mpika District the utilization of facility based delivery services is still low (76%) and home deliveries account for 24 percent (Mpika HIMS, 2022). Moreover, the pattern of utilization of delivery services is not known. The aim of this study therefore, was to determine the effect of antenatal education on the knowledge and utilization facility based delivery services among pregnant mothers in two health facilities in Mpika District. Objective: To ascertain the effect of antenatal education on knowledge and utilization of facility based delivery services among pregnant mothers in two health facilities in Mpika District. Methods & Materials: This study adopted a quasi-experimental design of two groups of pre and post intervention among mothers attending antenatal clinic in two health facilities in Mpika District.  The study population consisted of 276 pregnant women in the second trimester for both the intervention (141) and control (135) groups. Data was collected using face to face interviews. The pre-intervention data collection was done in 5weeks and the post intervention data collection is yet to be concluded. Pre-intervention results: The respondents were pregnant women between 16 years up to 42 years with a significant proportion (8-11%) of teenagers (less than 18 years old) in both the control and intervention groups indicating a concern for teen pregnancies in rural areas. (Mean age: 24.5 years (SD: 5.2). The study findings also provide information that there were low levels of formal education among respondents (4-5%) and their husbands (4-12%). Primary education was the most common level of education among respondents (56-58%) and their husbands (41%). Secondary education was the second most common level among respondents (38-39%) and their husbands (48%). (Mean years of education: 6.5 years (SD: 2.1). The study findings showed that a significant proportion from both groups were single mothers (11%) or cohabiting (23-26%). The proportion of married respondents was significantly higher than the proportion of single respondents (p < 0.001). There were, 97% (269) who did not have formal work only 3% (10) had formal work from both groups. The proportion of unemployed respondents is significantly higher than the proportion of employed respondents (p < 0.001). Concerning number of children, the most of respondents from the two groups have had one or two children (30-37%). On the other hand, 33% of the respondents from the control group and 30% of the intervention group have had 3 children while 16% from both groups had 2 children each and 7% of the controls and 10% of the study participants had 4 and more children (Mean parity: 2.3 (SD: 1.5). Concerning knowledge on Danger Signs only 39% of respondents knew more than two danger signs experienced during labor is statistically significant (p < 0.01), indicating that a significant proportion of respondents had limited Knowledge on this topic. Vaginal bleeding and prolonged labor were the most commonly known danger signs, but knowledge on other signs was limited. The results also showed that 99% (274) of the respondents from both groups knew that an unexpected problem could occur during pregnancy and child birth. The study also indicates that 39% of the respondents from the control group and 33% from the intervention group did not have knowledge on any danger sign related to postpartum and 36% of the control group and 36% of the intervention group respondents knew vaginal bleeding as a danger sign while 28% (38) from the control group and 21% (29) from the intervention group had knowledge on more than two danger signs. The results further showed that 99% of the respondent from both groups knew that a woman can have complications if she does not attend antenatal clinic and all (276) the respondents from both groups knew that a woman can have complications if she decides to deliver from home. The current study also shows that 37% (63) of the control group respondents and 48% (68) of the intervention group attended antenatal clinic 3 times during the last pregnancy while the other 37% of the control group and 35% from the intervention group only managed to attend ANC twice. Only 10% of the respondents from the control group and 11% (15) from the intervention group attended 4 or more visits with the other 5% attending once from each group. The study results showed that only 32% of the respondents from both groups started attending antenatal at the recommended stage of pregnancy thus; 1-3 months, whilst 68% of the respondents from both groups started antenatal clinic at 4-6 months. Concerning health education, a significant proportion of respondents from both groups (44%) attended only 1-2 health education sessions, indicating a potential knowledge gap in pregnancy and childbirth care (p < 0.05). Only a small percentage of respondents (5%) attended 5-6 health education sessions, suggesting that most women may not be receiving comprehensive education on pregnancy and childbirth care (p < 0.01). The study results also showed that husbands and significant others play a crucial role in disseminating information to pregnant women, with 53% of respondents relying on them for information on antenatal care (p < 0.05).  Furthermore, there was a significant gap in health education on critical topics, with only 34% of respondents receiving information on birth preparedness and complication readiness, and only 10% receiving information on the importance of delivering at a hospital (p < 0.05). the study results also showed that the content of health education varies widely, with 40% of respondents receiving education on other topics rather than birth preparedness and complication readiness (p < 0.05). Conclusion: Health education during antenatal care improves knowledge and utilization of delivery facilities. Prioritizing health education, involving husbands/significant others, and tailoring content to address specific needs can improve maternal and neonatal health outcomes. Recommendations: Implement targeted health education programs during antenatal care, involve husbands/significant others, and tailor content to address specific needs and gaps in knowledge.

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