Background
Methods
Study setting
Study design
Participants and recruitment
Type of Tool | Respondents | Number of Interviews (Key Informat Interviews) | Number of participants per interview | Total number of participants |
---|---|---|---|---|
Key Informat Interviews | Medical Officers, Clinical Care Experts and Maternal and Child Health Cordinator | 12 (3 in each of the 4 districts) | 1 | 12 |
Health Facility in-charge | 4 (1 in each of the 4 districts) | 1 | 4 | |
Focus Group Discussions | Mothers of children below one year | 4 (1 in each of the health facilities from each district) | 8–10 | 38 |
Community Health Volunteers (CHWs, NHC, TBAs)a | 4 (1 in each of the health facilities from each district) | 6–8 | 30 | |
Total | 24 | 84 |
Data collection
Data management and analysis
Results
Characteristics of the participants
Theme | Sub-Themes | ||
---|---|---|---|
Mothers | Community Health volunteers | Healthcare Provider | |
1. Factors that affect timing of the first ANC appointment | • Uncertainty in the timing of ANC initiation • Lack of transport | • Waiting for elderly women to confirm pregnancy | • Waiting for elderly women to confirm pregnancy |
2. Factors that affect failure to return for subsequent appointments | • Unavailability/Low quality services at health posts closest to women º Inadequate supplies at the health facilities º Inadequate health personnel • Lack of awareness and education about the services | • Low quality services at health posts | • Unavailable and Poor-quality services in the health posts • Inadequate supplies • Unavailable/Inadequate skilled health care providers |
3. Factors that affect both timing of the first ANC appointment and return for subsequent appointments | • Livelihoods as a priority Nomadic lifestylesBusy schedules with house chores house chores • Long distances to the health facilities | • Denied subsequent care for ANC • Nomadic lifestyles • Long distances to the health facilities | • Nomadic lifestyles • Seasonal migration to places where they might be no health centres • Lack of transport • Lack of money for transport |
4. Opportunities for the intervention to modify factors affecting timing of the first ANC appointment and failure to return for subsequent appointments. | • Assessment of Health Status • To confirm if really pregnant • Check the health of the unborn baby • Need to get tested for HIV • Need to receive medication such as IPTp • Protection for the unborn baby • To obtain ANC cards • Financial charges imposed on women for late booking | • Assessment of Health Status º To check the health of the mother and their unborn baby • To obtain ANC cards • Incentives provided by NGO | • Assessment of Health Status º To confirm if really pregnant • Access for services such as mosquito nets, folic acid and test for HIBV • Incentives provided by NGO |
Factors that affect timing of the first ANC appointment
Delayed initiation of ANC
Most of these women will be quiet about their pregnancy, and they wait until it [pregnancy] shows (FGD, Mungwi, female, NHC).
Uncertainty in the timing of ANC initiation
Some go at four months, others at six and even at seven, but it is not very clear the exact month but I think it depends on how you feel in the body (FGD, Mungwi, mother, 20-34 years).
Waiting for confirmation of pregnancy by elderly women
Most of the women in this place start going for ANC very late, most of them after the second trimester. This is because most of them traditionally believe that they will only come for antenatal care after an elderly woman such as an auntie or grandmother confirms that they are pregnant (In-depth interview [IDI], Chiengi, midwife, 35-49 years).
Factors that affect failure to return for subsequent appointments
Long distances to the facility
... most women go to the health post, but very few come to the health facilities because many of them cannot walk to the health facility (IDI, Luwingu, healthcare worker, 35-49 years).
What I can say is that the distance from here to the hospital [clinic] is very far, the four times they tell us to come for antenatal care is not easy, again walking back there, especially when you are almost due, the clinic is very far, for me most times I fail to keep coming back because of distance (FGD, Samfya, mother, 35-49 years).
(un) availability/poor quality of services
For some of us, the clinic is far from where we come from and to be honest what you are saying does not happen for some of us ... Those tests are just for others who live close to the clinic (FGD, Mungwi, mother, 35-49 years).
The antenatal care we provide at the health post is also questionable because you know, we usually lack certain things, you know the focused ANC we provide should be really focused antenatal, but you find that sometimes you do not have everything (IDI, Chiengi, midwife, 35-49 years).
Factors that affect both delayed timing of the first ANC and return for subsequent appointments
Livelihoods as a priority
… a large population is mobile due to seasonal migration of people, when you consider the fishing period where men and women and their families move to the fishing camp, and also once they discover that ‘my pregnancy is fine and I’ve been checked and okay, all is fine’, women think they are fine, they do not see any need to come back for ANC, and they disappear (IDI, Samfya, healthcare worker, 35- 49 years).
Busy schedules with house chores
Sometimes we get very busy at home such that leaving all the work for the clinic becomes a problem. To be honest for my situation at home, without someone to take care of the children at home and others, it becomes hard to abandon the work (FGD, Chiengi, mother, 35-49 years).
Opportunities for the intervention to modify the different factors
Need to confirm pregnancy
We go for ANC because we want to know what is in the abdomen ..., because sometimes you may think you are carrying a baby when in fact you are not (FGD, Mungwi, mother, 20-34 years).
Assessment of health status
Like for me [number 7] why I come here I would want the nurse to tell me and just to know how the baby is and to know my health because if you are just at home you can’t know whether the baby is healthy or not (FGD Mungwi, woman 20-34 years).
Even me that’s what I know, that a woman who is pregnant should go to the clinic, so that they test your blood [and] if they find that you have the disease [HIV] they will tell you and put you on medication so that you protect the baby from having the disease (FGD, Samfya, mother, 20-34 years).
Promotion of antenatal care through punishment/incentives
Yes, like my friend has said, we are charged for delaying to start ANC ... they say if you come after three months you should pay 15 kwacha (FGD, Chiengi, mother, 20-34 years).
We fear not being attended to well or being chased away when we come back because if you have no ANC card, they know for sure that one missed ANC. So, we have to come even if it is once so that at least you get a card (FGD, Samfya, Mother, 35-49 years).
They know that if they do not attend ANC, they will not get the ANC card, and without the card it becomes a problem at the clinic for delivery ... that is why they make sure they come even if it is once (FGD, Luwingu, CHW, 35-49 years).
We have seen the numbers of women attending ANC increase when we distribute incentives, although once, especially with the coming in of partners like MSF, they give out Chitenge materials and baby packs, and that acts also like a motivator to the women (IDI, Luwingu, healthcare worker, 35-49 years).