Assessment of the barriers to the utilization of antenatal care services in Kazungula district, Zambia
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Globally, 1600 women and over 5000 newborn babies die daily of preventable causes and over 90% of these deaths occur in developing world. An estimated 358000 maternal deaths occurred worldwide in 2008 with developing countries accounting for 99%. In Zambia, maternal mortality ratio has been estimated to be 591 deaths per I 00,000 live births underscoring the great challenge posed by maternal and child health problems. At the same time, utilization of antenatal care services by pregnant women, supervision of deliveries by skilled person and postnatal care services is low in most regions of Zambia. Since professional attendance at delivery is assumed to reduce maternal and infant mortality, poor antenatal care (ANC) utilization may lead to increased infant and matern.al mortality and morbidity.This study sought to assess the barriers to utilization of antenatal care services in Kazungula district, Zambia. A qualitative exploratory study was used to uncover participants' experiences and perceptions on barriers to use of ANC.Focus group discussions were used to gather information from primegravidae and multigravidae not attending or irregularly attending ANC services and from traditional birth attendants. In-depth interviews were conducted with key informants namely the health centre in-charge and leader of safe motherhood support group.Data was analyzed through thematic content analysis. From the transcripts, patterns of experiences coming from direct quotes or through paraphrasing common ideas forming part of the themes were listed. Data from all the transcripts relating to the classified patterns were identified and placed under the relevant theme. Thereafter related patterns were combined and listed into sub-themes. The analysis involved drawing together and comparing discussions of similar themes and examining how these relate to the variations between individuals and groups that assisted in understanding the phenomenon of interests. The study revealed that utilization of ANC was impeded by multiple interrelated factors such as low socio economic and educational status of women, influence of the older generation, traditional and cultural practices. Previous negative experiences with health workers such as bad attitude of health workers and perceived poor quality of care were mentioned as factors that negatively affect utilization of ANC services. Other notable barriers were built in confidence resulting from previous safe deliveries, family size and competing priorities, fear of being tested for HJY and physical the accessibility.The study recommends that the district and its partners address the barriers if efforts in safe motherhood will yield meaningful impact. DHMT in the long term plan needs to train and deploy skilled personnel to rural health centres. They should have a deliberate policy on rural incentives to motivate trained staff to remote areas. More health posts need to be built as a way of taking health care services as close to the family as possible. In addition, for the short term plan there is need to provide inservice training for staff on safe motherhood and circulate guidelines. Orient staff on focused antenatal care (FANC).DHMT should ensure continuum of, care by supporting adequate supplies, equipment, drugs and transport to the health facilities.