Factors associated with the participation of safe motherhood action groups in accelerating institutional deliveries among maternal women in Shibuyunji rural District of Lusaka Province

Abstract

The low utilization of health facilities for delivery in Sub-Saharan Africa is a major concern despite the availability of global Motherhood initiatives to increase health facility usage. The concept of using Safe Motherhood Action Groups (SMAGs) is emerging to be a useful tool for referral of mothers to health facilities either for care without delay. Despite the availability of SMAGs in Shibuyunji District, statistics have shown that institutional deliveries were below (48%) the MoH‟s target of 60% in 2016, with increased community-based maternal deaths. We therefore examined the factors associated with the participation of SMAGs in acceleration of institutional deliveries among maternal women in Shibuyunji rural district. An analytical cross sectional study was conducted involving 239 maternal women. A check list was used to collect data of respondents from the health facility delivery register and postnatal care register. A semi-structured questionnaire was administered. Step-wise, backward regression analysis using Stata Version 14 was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of associated factors with SMAGs accelerating institutional deliveries among maternal women. All independent variables that were significant at univariate level were included in the Multivariable regression analysis until the final model was obtained. The study revealed that 93% of the women were assisted by SMAG to access the health facility for delivery. The study showed the key predictors for as shown; Women who lived 10 km away from the health facility had a reduced odds of delivering at the health facility by 90% [AOR 0.1; 95% CI 0.03-0.39; P=0.001] [AOR 0.1; 95% CI 0.03-0.39; P=0.001], The pregnant women who did not know the benefits of delivering from the health facility had a reduced odds of delivering from the facility by 93% [AOR 0.07; 95% CI 0.014-0.37; P= 0.002]. Pregnant women who reported not being visited at their home by SMAGs had a reduced odds of delivering from the health facility by 70% [AOR 0.3; 95% CI 0.09-0.86; P= 0.027]. Evidence in this study has demonstrated that district institutional deliveries were low against the MoH target of 60% health facility deliveries. Nonetheless, participation of SMAGs in accelerating institutional deliveries among women in Shibuyunji district had a relative influence in the community, given evidence that women who were home visited by SMAGs, pregnant women who knew the benefits of delivering from the health facility and women who lived within 0 – 5km to the HF were more likely to deliver at the HF, providing a differential imbalance among maternal women who lived in further places of Nakaiba, Chintanga and Masiteki. These findings may be a reflection of inequalities associated with access and limitations in awareness efforts of the SMAG program in Shibuyunji. Thus, a need for effective and sustainable means of transport to improve access by linking communities to the health facility care through SMAGs who should be placed in strategic areas of the district. Keywords: SMAGs Participation, Health Facility Delivery, Maternal Women, Acceleration of Institutional Deliveries.