Predictors on utilization of maternal, newborn and child health services among rural women in Manicaland Zimbabwe
Objective: The study sought to explore the factors that influence the utilization of maternal and child health services by rural women.
Design: The study used a descriptive cross sectional design. The Health Belief Model was utilized as the conceptual framework.
Setting: The study was conducted in Zimbabwe in 3 districts in Manicaland province namely Mutare, Mutasa and Chipinge.
Subjects: A sample of 490 subjects (146 men and 344 women) was selected through multi-stage cluster sampling. The study targeted women of child bearing age (15-49 years) who were either pregnant or had a child below 2 years and their male counterparts.
Materials and Methods: Questionnaires and focused group discussions were used for data collection. Three focused group discussions were conducted with women 15- 19 years, women 20-49 years and men 18-49 years.
Main Outcome Measures: Levels of utilization of maternal and child health services by rural women.
Results: The majority of pregnant women still book late for Antenatal Clinic (ANC) with 302 (62%) booking in the 3rd trimester. With regards to influencing the timing for ANC booking predictors such as religion, decision making, and satisfaction with services yielded statistically significant results. Compared to being Apostolic, being Pentecostal was associated with greater odds of having more ANC visits (β=0.04, SE=0.02, 95% CI=0.01; 0.07). Compared to husbands, decision by both husband and wife was associated with greater odds of having more ANC visits (β=0.03, SE= 0.01, 95% CI= 0.01; 0.06) and decision making by others (relatives and in-laws) was associated with even higher odds as compared to the decision by both (β=0.04, SE=0.06, 95% CI 0.01; 0.06). Religion had a significant association with the place of delivery (χ2=18.5, p< 0.00). Results revealed a weak correlation between place of birth and the decision maker for place of birth r = 0.3 (R2=0.06, F = 29.224). Compared to decision making by husbands, independent decisions by women were associated with greater odds of determining place of delivery strong (β=0.23, SE= 0.05, CI = 0.13 – 0.32) whereas mutual decision by the pregnant women and her partner was even associated with greater odds than both being a husband and independent decision making by women (β= 0.31, SE= 0.06, CI= 0.20 – 0.68). Satisfaction was a weak predictor (β = 0.60, SE = 0.12, CI = 0.37 – 0.83) for access and utilization of Post Natal Care (PNC) services. With regards to the uptake of PNC services, 54% (266) received PNC within 72 hours and only 27% received PNC at 6 weeks.
Conclusions: The study revealed that religion; decision making power, knowledge, quality perception, age of household head and satisfaction levels with Maternal, Newborn and Child Health (MNCH) services provided are strong and statistically significant predictors of access and utilization of MNCH services. Community social mobilization should be intensified to increase knowledge, modify health seeking behaviours and improve perceptions. Health education sessions should be tailor made to address specific targeted age groups for higher impact. Mentorship programs for health practitioners, customer satisfaction surveys and regular quality checks will improve utilization of MNCH services.