Birth outcomes and healthcare utilization in rural Zambia: Association with birth location

Background:

Prenatal and birth care can reduce perinatal mortality, but many Zambians do not access available services. We investigated care utilization and birth outcomes by birth location.

Methods:

We analyzed 2011-2012 prenatal, delivery, and follow-up records from Better Health Outcomes through Mentoring and Assessment (BHOMA), a primary care project in rural Lusaka province. Primary outcomes were stillbirth and early neonatal death. Continuous variables were compared with ANOVA, categorical variables with Chi-square, and mortality rates with logistic regression.

Results:

Of 2991 women who attended at least 1 prenatal visit, 1659 (55.5%) delivered in a facility and 1332 (44.5%) at home. Home-birth women were less likely to start prenatal care in the first trimester, attend the minimum WHO-recommended 4 prenatal visits, undergo HIV testing, and attend postpartum care (each p<0.05). Stillbirth rates were equivalent (8.4 vs. 7.3, OR 1.15, 95% CI 0.51-2.62). Early neonatal death rates were higher at home (12.9 vs. 3.6, OR 3.57, 95% CI 1.40-9.07). Home-birth women were no less likely to reside in an area with a 24-hour delivery facility (91.0% vs. 91.9%, p=0.397). Home-birth women’s clinics were farther from the district health office (median 45 vs. 20 km, p<0.001).

Conclusions:

Home delivery was associated with accessing less prenatal care, similar stillbirth rates, and higher early neonatal death rates. Homebirth women’s clinics were farther from the district health office. These clinics may face difficulties with commodities and staffing, or serve larger geographic areas. Quality improvement within Zambia’s public health system is needed to ensure that women and neonates receive quality care.