Nicholas N. A. Kyei|Oona M. R. Campbell|Sabine Gabrysch
The Influence of Distance and Level of Service Provision on Antenatal Care Use in Rural Zambia
37 Military Hospital|London School of Hygiene & Tropical Medicine|Heidelberg University
antenatal care anc presents important opportunities reach women crucial interventions studies determinants anc use often focus household individual factors investigate role health service factors partly due lack appropriate data assessed distance facilities level service provision anc facilities zambia influenced number timing anc visits quality care receivedusing 2005 zambian national health facility census classified anc facilities according level service provision geographic information system linked facility information household data 2007 dhs calculate straightline distances performed multivariable multilevel logistic regression 2405 rural births investigate influence distance care level provision three aspects anc use attendance least four visits visit first trimester receipt quality anc 4 visits skilled health worker 8 interventions found effect distance timing anc number visits better level provision closest facility associated either earlier anc attendance higher number visits however strong influence distance facility level provision closest anc facility quality anc received 10 km increase distance odds women receiving good quality anc decreased quarter increase level provision category closest facility associated 54 increase odds receiving good quality ancto improve anc quality received mothers efforts focus improving level services provided anc facilities accessibility