1.

1 Background

Postnatal care (PNC) is a critical component of maternal and newborn healthcare, essential for
preventing complications and promoting health during the postpartum period (World Health
Organization, 2020). The World Health Organization (WHO) recommends that women receive
postnatal care within the first 24-48 hours after birth and continue to receive care up to 6 weeks
postpartum (WHO, 2020). Despite this, utilization of PNC remains suboptimal, particularly in
low- and middle-income countries.

Globally, approximately 810 women die daily due to pregnancy-related complications, with most
deaths occurring during the postpartum period (WHO, 2020). Inadequate postnatal care is a
significant contributor to these deaths. According to a systematic review, the global rate of
postnatal care utilization within 2-6 days after birth was only 62.4% (Lincetto et al., 2020).

In Africa, the situation is more dire, with an estimated 196,000 maternal deaths occurring
annually (WHO, 2020). A study conducted in sub-Saharan Africa reported that only 45% of
women received postnatal care within 2-6 days after birth (Amo-Adjei et al., 2020).

In Zambia, maternal mortality remains high, with a ratio of 213 deaths per 100,000 live births
(Central Statistical Office, 2020). According to the Zambia Demographic and Health Survey
(2018), only 54% of women received postnatal care within 2-6 days after birth. Muchinga
Province, where Mpika District is located, has one of the lowest rates of postnatal care utilization
in the country.

This study aims to investigate the utilization of postnatal care within 2-6 days in Mpika District,
Muchinga Province, Zambia. Specifically, the research seeks to identify factors influencing the
utilization of postnatal care and explore the experiences of women receiving care during this
critical period. The study will be conducted at health facilities in Mpika District, providing
valuable insights into the postnatal care services in this underserved region.
1.2 Statement of the Problem

The utilization of postnatal care (PNC) in Zambia, particularly in rural areas like Mpika District,
Muchinga Province, remains a pressing concern. Despite its critical role in preventing maternal
and newborn complications, the uptake of PNC services is suboptimal. According to the Zambia
Demographic and Health Survey (2018), only 54% of women in Zambia receive postnatal care
within 2-6 days after birth. This percentage drops significantly in Muchinga Province, where
merely 41.5% of women access PNC services within the same timeframe. Specifically, Mpika
District reports a dismal 35.1% of women receiving postnatal care within 2-6 days after birth
(District Health Information System, 2022).

This situation is further complicated by the fact that approximately 22% of maternal deaths in
Zambia occur during the postpartum period, with most deaths being preventable (Central
Statistical Office, 2020). The existing literature highlights the importance of postnatal care, but
there is a notable gap in understanding the factors influencing PNC utilization in rural Zambia, as
well as the experiences of women receiving care in underserved areas. Moreover, the
effectiveness of existing interventions aimed at improving PNC utilization remains poorly
documented.

Addressing this knowledge gap is crucial, as it will inform evidence-based interventions to

improve postnatal care services, ultimately contributing to Zambia's efforts to reduce maternal
and newborn mortality rates. Enhancing our understanding of the postnatal care continuum will
improve health outcomes for mothers and newborns. This study seeks to investigate the
utilization of postnatal care within 2-6 days in Mpika District, providing valuable insights into
the factors influencing PNC uptake and the experiences of women receiving care in this
underserved region
1.3 Study Justification

This study contributes significantly to the global understanding of postnatal care utilization,
particularly in low-resource settings. By investigating the factors influencing postnatal care
uptake in Mpika District, Muchinga Province, Zambia, this research will add new insights to the
existing body of knowledge. Specifically, it will provide context-specific information on the
unique factors affecting postnatal care utilization in rural Zambia, facilitating targeted
interventions. Additionally, the study's findings will enable comparisons between rural and urban
areas, highlighting disparities and areas for improvement.

The significance of this study lies in its potential to improve maternal and newborn outcomes. By
identifying the factors influencing postnatal care utilization, the research will inform evidence-
based interventions to reduce maternal and newborn mortality rates. Furthermore, the study's
findings will contribute to the development of informed healthcare policies, prioritizing postnatal
care services in resource-constrained settings. The research will also build local research
capacity, fostering a culture of evidence-based practice among healthcare professionals.

Upon completion of this study, several changes are anticipated. The postnatal care utilization
rates in Mpika District and similar rural settings are expected to improve. Healthcare providers
will benefit from enhanced training and capacity building. Informed policy decisions and
resource allocation for postnatal care services will follow. The healthcare system will be
strengthened, leading to better maternal and newborn outcomes. Lastly, the study will increase
awareness and advocacy for postnatal care among local communities.

Ultimately, this study aligns with the Sustainable Development Goals (SDGs) 3.1 and 3.2,
aiming to reduce maternal and newborn mortality rates. By addressing the knowledge gap in
postnatal care utilization, this research will contribute to the global effort to improve maternal
and newborn health outcomes.
1.4 Research Questions

The study seeks to answer the following research questions:

1. What is the prevalence of postnatal care utilization within 2-6 days among women in
Mpika District, Muchinga Province, Zambia?

2. What are the socio-demographic, economic, and healthcare-related factors influencing

postnatal care utilization within 2-6 days among women in Mpika District?

3. What are the experiences and perceptions of women regarding postnatal care services
received within 2-6 days in Mpika District?

1.5 Objectives

1.5.1 General Objective

The general objective of this study is to investigate the utilization of postnatal care within 2-6
days and its associated factors among women in Mpika District, Muchinga Province, Zambia.

1.5.2 Specific Objectives

The specific objectives of this study are:

1. To determine the prevalence of postnatal care utilization within 2-6 days among women
in Mpika District.

2. To identify the socio-demographic, economic, and healthcare-related factors influencing

postnatal care utilization within 2-6 days among women in Mpika District.

3. To explore the experiences and perceptions of women regarding postnatal care services
received within 2-6 days in Mpika District.
1.6 Conceptual Framework

Figure 1: Conceptual framework

The conceptual framework for this study illustrates the relationship between multiple factors
influencing postnatal care utilization within 2-6 days among women in Mpika District, Zambia.
The framework is built around three primary groups of independent variables: socio-
demographic factors (age, education, marital status, parity), economic factors (household
income, employment status, transportation access), and healthcare-related factors (facility
proximity, provider availability, quality of care). These independent variables are expected to
directly impact postnatal care utilization.

Additionally, the framework includes experiences and perceptions of postnatal care services
(e.g., satisfaction, trust, cultural beliefs) as a mediating variable that potentially strengthens or
alters the influence of the independent variables on postnatal care utilization. This mediating
variable highlights the role of subjective experiences in healthcare decisions.
The dependent variable—postnatal care utilization within 2-6 days—serves as the primary
outcome. This framework thus provides a structured approach to investigating how socio-
economic, healthcare-related, and experiential factors contribute to the utilization of essential
postnatal services among women in the study region.
1.7 Research Hypotheses

Null Hypotheses (H0)

1. There is no significant association between socio-demographic factors (age, education,

marital status, parity) and postnatal care utilization within 2-6 days among women in
Mpika District.

2. There is no significant relationship between economic factors (income, employment,

health insurance) and postnatal care utilization within 2-6 days among women in Mpika
District.

3. Healthcare-related factors (access to healthcare, quality of care, healthcare provider

characteristics) do not significantly influence postnatal care utilization within 2-6 days
among women in Mpika District.

Alternative Hypotheses (H1)

1. There is a significant association between socio-demographic factors (age, education,

marital status, parity) and postnatal care utilization within 2-6 days among women in
Mpika District.

2. There is a significant relationship between economic factors (income, employment,

health insurance) and postnatal care utilization within 2-6 days among women in Mpika
District.

3. Healthcare-related factors (access to healthcare, quality of care, healthcare provider

characteristics) significantly influence postnatal care utilization within 2-6 days among
women in Mpika District.
1.8 Operational Definitions

1. Postnatal Care Utilization: The percentage of women who receive postnatal care
services from a skilled healthcare provider within 2-6 days after childbirth.

2. Socio-demographic Factors:

 Age: The woman's age at the time of childbirth, categorized into 15-24, 25-34,
and 35-49 years.

 Education: The highest level of education attained by the woman, categorized

into primary, secondary, or tertiary.

 Marital Status: The woman's marital status at the time of childbirth, categorized
into married, single, divorced, or widowed.

 Parity: The number of live births a woman has had, categorized into primipara
(1), multipara (2-4), or grand multipara (5+).

3. Economic Factors:

 Income: The woman's monthly household income, categorized into low (<ZMK
5,000), medium (ZMK 5,000-10,000), or high (>ZMK 10,000).

 Employment: The woman's employment status at the time of childbirth,

categorized into employed or unemployed.

 Health Insurance: Whether the woman has health insurance coverage,

categorized into yes or no.

4. Healthcare-related Factors:

 Access to Healthcare: The distance to the nearest healthcare facility, categorized

into <5 km, 5-10 km, or >10 km.
  Quality of Care: The woman's perception of care quality, categorized into good,
fair, or poor.

 Healthcare Provider Characteristics: The type of healthcare provider,

categorized into doctor, nurse, or midwife.

5. Maternal Health Outcomes:

 Maternal Mortality: Death occurring during pregnancy, childbirth, or within 42

days postpartum.

 Morbidity: Self-reported maternal health problems or complications during

pregnancy or postpartum.

 Health Status: Self-reported general health status, categorized into good, fair, or
poor.

6. Newborn Health Outcomes:

 Newborn Mortality: Death occurring within the first 28 days of life.

 Morbidity: Self-reported newborn health problems or complications.

 Health Status: Self-reported newborn general health status, categorized into

good, fair, or poor.
References

American Psychological Association. (2020) Publication Manual of the American Psychological

Association (7th ed.). Washington, DC: American Psychological Association.

Central Statistical Office. (2020) Zambia Demographic and Health Survey 2018. Lusaka: Central
Statistical Office.

District Health Information System. (2022) Mpika District Health Report. Mpika: District Health
Office.

Ministry of Health. (2020) Zambia National Health Strategic Plan 2021-2025. Lusaka: Ministry
of Health.

United Nations. (2020) Sustainable Development Goals. New York: United Nations.

World Health Organization. (2020) Postnatal Care for Mothers and Newborns. Geneva: World
Health Organization.

ZDHS (2018) Zambia Demographic and Health Survey. Lusaka: ZDHS.