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Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia

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Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia her and ot C M h il n d i H Nyirenda et al., Clinics Mother Child Health 2018, s e c i a l n t i 15:2 l h C Clinics in Mother and Child Health DOI: 10.4172/2090-7214.1000297 ISSN: 2090-7214 Commentary Open Access Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia Herbert Tato Nyirenda1*, David Mulenga1, Tambulani Nyirenda2, Nancy Choka3, Paul Agina4, Brenda Mubita5, Rehema Chengo4, Shiphrah Kuria4 and Herbert BC Nyirenda6 1Department of Clinical Sciences, School of Medicine, Copperbelt University, Public Health Unit, Ndola, Zambia 2Department of Political and Administrative Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia 3Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia 4Amref Health Africa- Kenya, Wilson Airport, Nairobi, Kenya 5Amref Health Africa- Zambia, Copperbelt Provincial Health Office Ndola, Zambia 6Department of Adult Education and Extension Studies, School of Education, University of Zambia, Kabwe, Zambia *Corresponding author: Nyirenda HT, Department of Clinical Sciences, School of Medicine, Copperbelt University, Public Health Unit, Ndola, Zambia, E-mail: [email protected] Received date: June 26, 2018; Accepted date: July 10, 2018; Published date: July 16, 2018 Copyright: ©2018 Nyirenda HT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: The purpose of the assessment was to conduct an evaluation on the status of respectful maternal care Ndola and Kitwe districts in the Copperbelt Province. Methods: The assessment used a cross-sectional study design and captured quantitative data on self-reporting of experiences of respectful maternal care during child birth among women in the reproductive age group with a child below the age of 2 years. The study was conducted in two urban districts of the Copperbelt Province of Zambia specifically in Ndola and Kitwe districts. The sample size was 471 resident women of the selected 18 high volume health facilities. Cluster sampling was used to select the sampling units referred to as catchment areas of the health facilities. A structured interview questionnaire was used to conduct household interviews. Univariate and bivariate analysis were conducted on quantitative data to provide descriptive statistics. Chi-square analysis was performed to ascertain associations. Results: The study successfully visited and interviewed 470 women in household giving a 99% response rate. Findings show that 31% were aged between 20 to 24 years, three quarters (75%) were married/living with a partner, 4 in 10 (40%) had a basic education and two-thirds (66%) were not engaged in any form of employment or economic activity. The findings show that on average, 18% of the women had experienced physical abuse by a service provider during child birth. Prominent issues that led to ill-treatment included 43% of the women not provided comfort/pain-relief. On average 41% of the women received non-consented care from the service provider. Women (74%) indicated that the service provider did not allow women to assume position of choice during birth. The findings also show that about 22% of women’s right to confidentiality and privacy were not adhered to. Women (42%) also reported that there were no drapes or covering to protect their privacy and 19% indicated that there were no curtains or other visual barrier to protect woman during exams. Findings also show that on average 31% of women’s right to dignified care was not adhered to. Overall in the study, 13% of the women were discriminated based on specific attributes. The findings indicate that on average 39% of the women were abandoned or denied care. Key issues include, 65% of the women reported being left without care or unattended to and 28% service provider did not respond in a timely way. Further, only 6% of the women were detained in the health facility. Conclusion: The maternal outcomes observed such as home deliveries and deliveries by skilled and unskilled birth attendants mirror the quality of care in health facilities. Indications of non-adherence to the rights of child bearing women are a barrier to achieving quality of care for child bearing women. There is need to comprehensively train service providers in respectful maternal care and devise mechanisms for implementation and supportive supervision. Keywords: Respectful maternal care; Women’s rights; Health maternal mortality in Zambia had been decreasing, the decline was services; Self-reporting; Household insufficient to reach the 2015 target of 162.3 deaths per 100,000 live births (UNDP, 2013a). Most of the maternal deaths can be prevented Introduction by ensuring access to good quality maternal health services, [1] (USAID, 2014). Interventions that have been successful and need to be A child bearing women’s ability to access skilled care during scaled up include provision of and access to emergency obstetric care, antenatal, childbirth and postnatal is fundamental in improving improved referral systems, improved use of contraception for birth maternal, neonatal and child health outcomes. The 2013 Millennium spacing, prevention of early marriages, and the deployment of more Development Goal (MDG) Progress Report noted that although trained midwives and birth attendants, (SMGL 2016 annual report). Clinics Mother Child Health, an open access journal Volume 15 • Issue 2 • 1000297 ISSN:2090-7214 Citation: Nyirenda HT, Mulenga D, Nyirenda T, Choka N, Agina P, et al. (2018) Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia. Clinics Mother Child Health 15: 297. doi:10.4172/2090-7214.1000297 Page 2 of 9 Lack of the capacity to efficiently and effectively provide maternal respondents in health centres. Mothers were left without attention health services contribute to maternal mortality. In the 2017-2021 during labour in 39.3% of cases. National Health Strategic Plan, Zambia aims to enhance capacity The purpose of the assessment was to conduct an evaluation on the building in oversight functions and strengthen institutional capacity. status of respectful maternal care Ndola and Kitwe districts in the This is aligned to governments goal to reduce Maternal Mortality Copperbelt Province. Ratio from 398/100,000 live births in 2014 to 100/100,000 live births by 2021. In the 2017-2021 National Health Strategic Plan, inadequate Methods community involvement for RMNCAH is one of the key challenges with regard to reproductive and maternal health. Inadequate Study setting, design and population involvement of the community negatively affects the uptake of reproductive and maternal health services because of a weak link or The study was conducted in two urban districts of the Copperbelt gap that exists between communities and formal health systems. Province of Zambia specifically in Ndola and Kitwe districts. The According to the Alma Ata declaration of 1978, primary health care assessment used a cross-sectional study design and captured relies, at local and referral levels, on health workers, including quantitative data. The study targeted women in the reproductive age physicians, nurses, midwives, auxiliaries and community workers as group specifically women with a child below the age of two years. applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to Sampling and sample size respond to the expressed health needs of the community. The National Health Policy (2012) aims to strengthen community involvement in A total of 18 high volume health facilities 9 health facilities in Ndola maternal and child health including the roles of Traditional birth and 9 health facilities in Kitwe) were purposively selected to serve as a attendants and Safe Motherhood Action Groups. benchmark for the catchment communities (households). According to the Ministry of Health 2012 List of Health Facilities in Zambia, According the Zambia Demographic Health Survey (ZDHS urban health centres or clinics (UHC) ought to serve a catchment 2013/2014) [2], the total fertility rate for Zambia is 5.3. 76% of births population between 30,000 to 50,000 people (MoH, 2012) [6]. take place in a health facility, while 31% take place at home. 64% of Therefore, probability (random) sampling was used to select births are assisted by a skilled health worker (doctor, clinical officer, participants at household level through cluster sampling method in nurse, or midwife), with 5% assisted by a doctor. However, it is communities of the selected health centres. The formula with finite important to understand the quality of care experienced by women population correction was used to calculate a sample of women with during childbirth in facilities. Lack of Respectful Maternal Care (RMC) children below the age of 2. Given that the percentage of deliveries by health facility staff negatively affects the quality of care and demand assisted by a Skilled Birth Attendant (SBA) in the Copperbelt province for health services by women of childbearing age. In light of this, the was 81% (CSO,2013/2014 ZDHS) [2] and a population of children Zambian government through the 2017-2021 NHSP highlights the aged below 2 years was 25,538 in Ndola district and 29,581 in Kitwe need to strengthening respectful maternity care. district (CSO, 2010 census report) [7]. Therefore, given that; There are seven universal rights of childbearing women defined in N=Number of children below age 2 (Ndola 25538 and Kitwe 29581), the White Ribbon Alliance’s Respectful Maternity Care Charter. These Z=1.96 at 95%, P=Proportion of facility deliveries at 0.81 and rights include; Every woman has the right to be free from harm and ill d=Precision (in proportion of one) at 5%, the sample size was 471. treatment; Every woman has the right to information, informed Cluster sampling was used to select the sampling units referred to as consent and refusal, and respect for her choices and preferences, catchment areas of the health facilities.
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