title: Knowledgeable antenatal care as a pathway to skilled delivery: modelling the interactions between use of services and knowledge in Zambia.
abstract: The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective of this study is to understand the interaction between use of skilled and unskilled ANC, knowledge of obstetric complications and danger signs, and the eventual use of a facility for delivery. The study makes use of data from a survey of around 1700 women who had recently given birth across 11 districts of Zambia in 2011. Multivariate analysis is used to explore the associations between ANC use, knowledge and place of delivery. The results suggest that place of care and number of visits is strongly associated with the eventual use of a facility for delivery; an effect that is stronger in remote areas. Both skilled and unskilled ANC and obstetric knowledge is linked to higher use of facility delivery care while care provided at home appears to have an opposite effect. The research suggests that ANC influences later use of delivery care in two ways: by developing a habit to use formal care services and in increasing maternal knowledge. The work might be generalized to other health seeking behaviour to explore how the quantity and quality of initial contacts influence later use of services.
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia t.r.a.ensor@leeds.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Ensor
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
authors.forename: Paula
authors.initials: P
authors.lastname: Quigley
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Green
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
authors.forename: Abdul
authors.initials: A
authors.lastname: Razak Badru
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
authors.forename: Dynes
authors.initials: D
authors.lastname: Kaluba
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
authors.forename: Seter
authors.initials: S
authors.lastname: Siziya
mesh_terms: D000328:Adult; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult; D015024:Zambia
keywords: Maternal mortality; obstetric danger signs; skilled delivery antenatal care