DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2016 No. 123

Bupe B. Bwalya

Mulenga C. Mulenga

James N. Mulenga

July 2016

This document was produced for review by the United States Agency for 

International Development.

Factors Associated with Postnatal Care 

for Newborns in Zambia: 

Analysis of the 2013-14 Demographic and Health Survey

Factors Associated with Postnatal Care 

for Newborns in Zambia: 

Analysis of the 2013-14 Demographic and Health Survey 

Bupe B. Bwalya1

Mulenga C. Mulenga2

James N. Mulenga2

ICF International 

Rockville, Maryland, USA 

July 2016 

1 Department of Mathematics and Statistics, School of Sciences, Engineering and Technology, Mulungushi 

University. 

2 Department of Economics, School of Social Science, Mulungushi University 

Corresponding author: Bupe B. Bwalya. Mulungushi University, Town Campus, Department of 

Mathematics and Statistics, School Sciences, Engineering and Technology, P.O. Box 80415, Kabwe, 

Zambia. Phone: +260 965 120512; Email: bwalya1983@gmail.com
Acknowledgments 

The authors wish to thank USAID through ICF International for according us an opportunity to be 

part of the 2016 DHS Fellows Program. Special thanks go to Wenjuan Wang and Shireen Assaf 

for their invaluable contribution to the preparation of the research paper. Thanks also go to the cofacilitators Damian Jeremiah Demian, Simona Simona, and Elizabeth Nansubuga for their support. 

We further wish to extend our gratitude to Rebecca Winter, who reviewed our paper and provided 

helpful comments and Nancy Johnson for final proof reading of the paper. 

Editor: Bryant Robey 

Document Production: Natalie La Roche 

The DHS Working Papers series is a prepublication series of papers reporting on research in 

progress that is based on Demographic and Health Surveys (DHS) data. This research is carried 

out with support provided by the United States Agency for International Development (USAID) 

through The DHS Program (#AIDOAA-C-13-00095). The views expressed are those of the 

authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and 

evaluate population, health, and nutrition programs. For additional information about The DHS 

Program, contact DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 

20850, USA. Phone: +1 301-407-6500; Fax: +1 301-407-6501; Email: reports@dhsprogram.com; 

Internet: www.dhsprogram.com. 

Recommended citation: 

Bwalya, Bupe B., Mulenga C. Mulenga, and James N. Mulenga. 2016. Factors Associated with 

Postnatal Care for Newborns in Zambia: Analysis of the 2013-14 Demographic and Health 

Survey. DHS Working Papers No. 123. Rockville, Maryland, USA: ICF International. 
iii 

Abstract 

Postnatal care (PNC) is critical for the survival of newborns. In Zambia, despite emphasis on PNC 

by the government and international organizations, PNC coverage continues to be low. This study 

assessed the demographic and socioeconomic factors associated with newborns’ receipt of PNC 

and the timing of first PNC in Zambia. Based on data from the 2013-14 Zambia Demographic and 

Health Survey (ZDHS), this study used bivariate, binary, and multinomial logistic regression 

analyses to examine PNC for births at home and at health facilities. The results indicate different 

factors associated with PNC and timing at which newborns receive their first PNC between births 

delivered at home and at health facilities. For home births, perceived child size at birth by mothers, 

region of residence, access or exposure to media, and mothers’ numbers of ANC visits are the 

major determinants of PNC. Regarding timing of first PNC within 2 days of childbirth, among 

newborns delivered at home the major determinants are perceived child size at birth by mothers, 

region of residence, mothers’ access to media, and number of ANC visits. In contrast, among 

newborns delivered in a facility, perceived size at birth, region of residence, and mothers’ 

employment status are the only factors associated with receiving PNC within the first 2 days. 

Therefore, recommendation is made to encourage delivery in a health facility, to emphasize the 

importance of ANC visits, and to disseminate information through various media and innovative 

programs such as Information Education and Communication (IEC). 

Key words: Postnatal care, timing of first postnatal checkup, newborn, demographic and 

socioeconomic factors, home births, facility births, Zambia 

1 

1. Introduction 

Worldwide, more than one million babies each year die on their first day of life. The day of birth 

is the most dangerous day for babies in nearly every country (Save the Children 2013; Singh et al. 

2012; Sines et al. 2007). Almost all newborn deaths are in developing countries, with the highest 

number in South Asia, and the highest mortality rates in sub-Saharan Africa (Save the Children 

2013). Most newborn deaths in sub-Saharan Africa occur among children delivered at home or 

elsewhere outside of a health facility (Sines et al. 2007). Studies have shown that neonatal deaths 

stem from poor maternal health, inadequate care during pregnancy, inappropriate management of 

complications during pregnancy and after delivery, poor hygiene during delivery and the first 

critical hours after birth, and lack of newborn care (Lukonga and Michelo 2015; Barbra 1997). 

Studies also show that most of the factors that lead to neonatal deaths could be averted through 

postnatal checkups (Kearns et al. 2014; Ghosh and Sharma 2010; Titaley et al. 2008). Postnatal 

care (PNC) is defined as the care given to the newborn baby immediately after birth (within 24 

hours) and for the first 6 weeks (42 days) of life, with the aim of ensuring optimum health for the 

newborn (WHO et al. 2015; Akunga et al. 2014; WHO 2001b, 2013, Save the Children 2007). 

The care received in PNC includes monitoring for danger signs in the newborn’s breathing, 

temperature, breastfeeding, and movement as well as counselling the mother about health, 

nutrition, and healthy lifestyle practices (Kante et al., 2015; UNICEF, 2015; Sines et al., 2007). 

Based on the World Health Organisation (WHO) recommendation, after an uncomplicated vaginal 

birth in a health facility, healthy newborns should receive care in the facility for at least 24 hours 

after birth. If the birth is at home, the first postnatal contact should be as early as possible within 

24 hours of birth. Regardless of place of delivery, at least three additional postnatal contacts are 

recommended for all mothers and newborns, on day 3 (48–72 hours), between days 7 and 14, and 

6 weeks after birth (WH, 2013). However, less than a quarter of newborns in less developed 

countries receive PNC within 2 days of delivery (UNICEF 2015; Sines et al. 2007). 

The 2013-14 Zambia Demographic Health Survey (ZDHS) shows some improvement in the 

survival rates of infants and of children under age 5 in recent years. Statistics show that the underfive mortality rate dropped from 128 deaths per 1,000 live births in 2003 to 75 deaths per 1,000 

live births in 2013-14, and infant mortality declined from 76 deaths per 1,000 live births in 2003 

to 45 deaths per 1,000 live births in 2013-14. Despite such improvements, there have been only 

marginal improvements in neonatal mortality (NNM) in the past 10 to 15 years, from 29 deaths 

per 1,000 live births between 1999 and 2003 to 24 deaths per 1,000 live births between 2009 and 

2013. This scenario may be explained in part by the low level of PNC (16%). Moreover, new births 

delivered at home or elsewhere outside of a health facility are even less likely to receive PNC 
2 

within the first 2 days (8%) than those delivered in a health facility (19%) (CSO et al., 2014). This 

is despite the fact that the Government of the Republic of Zambia through the Ministry of Health 

(MoH) and Ministry of Community Development Mother and Child Health (MCDMCH) and other 

cooperating partners have developed and put in place various policies, programs, and interventions 

aimed at improving the general welfare and health of children. 

Some of the policies that have been implemented or are still underway include: Expanded 

Programme on Immunisation (EPI), Integrated Management of Childhood Illnesses (IMCI), 

scaling up and sustaining high-impact nutrition interventions, including early initiation of 

breastfeeding, among others (MoH 2011). All these programs aim at reducing the persistent high 

levels of neonatal and postneonatal mortality in Zambia. 

In Zambia, studies based on nationally representative surveys like the ZDHS that are related to 

PNC among newborns are scarce. This is because data on PNC among newborns had never been 

collected until recently during the 2013-14 ZDHS. Despite this dearth in empirical literature in 

Zambia, studies in other countries have shown that, regardless of whether delivery was at home or 

in a health facility, several factors contribute to low levels of PNC, including mother’s age at birth 

(Kante et al. 2015), perceived size at birth (Sines et al. 2007; Titaley et al. 2009), maternal 

education (Kante 2015; Kearns et al. 2014), household wealth (Rwabufigiri 2016; Kante 2015; 

Kearns et al. 2014; Titaley et al. 2009), maternal employment status (Kante et al. 2015), geographic 

distance, such as household distance to a health facility (Kearns et al. 2014; Titaley et al. 2009), 

place of delivery, lack of antenatal care, and place of residence, among others (Dutoma et al. 2015; 

Kearns et al., 2014; Banda 2013; Bhattacherjee et al. 2013; Singh et al. 2012; Titaley et al. 2009). 

To increase coverage of PNC in Zambia, a better understanding of its associated factors is 

important. The objectives of this study were twofold: first, to assess the demographic and 

socioeconomic factors associated with any PNC for newborns and, second, to examine the 

demographic and socioeconomic factors associated with the timing of the first PNC. It is envisaged 

that an understanding of such factors may help develop necessary strategies and interventions to 

help improve PNC coverage and in turn improve neonatal survival in Zambia. 
3 

1.1. Conceptual Framework 

The above conceptual framework shows the linkages expected between postnatal checkup for 

newborns and demographic, socioeconomic, and antenatal care factors. The variables used in this 

conceptual framework were based on the empirical evidence from other similar studies and also 

their availability in the 2013-14 ZDHS. As the framework indicates, there could be direct links 

between socioeconomic factors and postnatal checkups for newborns. For instance, region and 

place of residence (urban or rural) are important factors as they may affect PNC coverage in that 

urban residents tend to have higher PNC coverage, as more health facilities are available in urban 

than rural areas. Mothers’ educational level, wealth, and employment status could be positively 

associated with newborns receiving PNC. Mothers with more education, wealth, and employment 

may have better understanding of the importance of PNC to their newborn’s survival. This, 

coupled with better access to media, may broaden women’s knowledge of how access to PNC can 

improve the health status and survival of newborn children. 

Further, demographic variables may also have some influence on a child’s receiving PNC. For 

example, first-order births and newborns whose mothers made the recommended four or more 

ANC visits may be more likely to receive PNC. 

Independent Variables Outcome Variable 

Socioeconomic Factors 

• Region 

• Place of residence 

• Mother’s education 

• Wealth 

• Maternal employment 

• Access to media 

Antenatal Care 

• Number of antenatal 

care visits 

Postnatal 

Checkup for 

Newborns 

Demographic Variables 

• Mother’s age at birth 

• Birth order 

• Perceived size of child at 

birth

5 

2. Data and Methods 

2.1. Data 

This study used data for women from the 2013-14 ZDHS to assess the demographic and 

socioeconomic factors associated with postnatal care for newborns. The ZDHS used a two-stage 

cluster sampling method. In the first stage, 722 enumeration areas (EAs)—305 in urban areas and 

417 in rural areas—were selected with probability proportional to SEA size. In the second stage, 

a complete list of households served as the sampling frame in the selection of households for 

enumeration. On average, 25 households were randomly selected in each cluster. All women age 

15-49 in the household were eligible to be interviewed. Women were asked to provide information 

about pregnancies resulting in a live birth during the 5 years preceding the interview. Data on 

postnatal care was collected for the most recent birth during that period. 

In the 722 selected clusters, 16,258 households were occupied at the time of data collection of 

which 15,920 were successfully interviewed, yielding a household response rate of 98%. In total, 

16,411 women were successfully interviewed. This analysis concentrated on the postnatal care 

received for the woman’s most recent birth in the 5 years preceding the survey. Among the most 

recent births, 514 caesarean births were excluded from the analysis sample because these births 

were likely to have received PNC regardless of the mothers’ demographic and socioeconomic 

characteristics. The final sample included 4,777 births, with 1,361 delivered at home and 3,416 

delivered in a health facility. 

2.2. Outcome and Explanatory Variables Used in the Analysis 

In the DHS Woman’s Questionnaire, all women who had a birth in the 5 years preceding the survey 

were asked this question about their most recent birth: “How long after delivery did the first check 

take place for last birth?” Responses to this question were used to construct the two outcome 

variables for this study. These variables are any postnatal checkup within 6 weeks after delivery 

(0 = No PNC; and 1=Yes any PNC) and timing of first PNC (0 = no checkup, 1 = less 2 days, and 

2 = 2 or more days. The categorization of timing was done in this way because most neonatal 

deaths usually occur within the 48 hours after the child’s birth (UNICEF 2009). The rationale 

behind using the two measures was based on the fact that not only is receiving any PNC cardinal 

but also receiving it within the most critical period (within 48 hours) can increase the chances of 

survival for the newborn. 

Demographic variables included in the model were mother’s age at the last birth (under age 20, 

20-34, and 35-49), birth order (1st, 2nd, 3rd, and 4th or higher), and mother’s perception of the 

size of the child (small, average, or large). 
6 

Among the socioeconomic factors, we examined mother’s employment status (whether currently 

working or not), education attainment (none, primary, and secondary or higher), and household 

wealth status. The DHS wealth quintiles were grouped into a three-category wealth status variable 

(poor, middle, and wealthy) by combining the top 40% and the bottom 40% of the population. 

Media access was constructed on a combination of three variables (frequency of reading 

newspapers or magazines, listening to radio, and watching television). A mother is considered to 

have access to mass media if she watches TV, listens to radio, or reads a newspaper. Receipt of 

antenatal care was measured with the number of ANC visits the mother made for the last birth (0 = 

less than four, 1 = four or more). 

2.3. Statistical Analysis 

Separate analysis was conducted for home deliveries and facility deliveries because the factors 

that influence PNC for newborns delivered at home may be different from those for newborns 

delivered in a health facility (Fadel et al. 2015; Mohan et al. 2015; Sines et al. 2007). 

Descriptive statistics (both univariate and bivariate) were used to describe the overall coverage of 

PNC and timing of PNC, and by demographic and socioeconomic variables, as well as by the 

number of ANC visits received. 

To assess the adjusted associations between the independent variables and receipt of any PNC for 

newborns, two models were fitted, one for newborns delivered at home and the other for those 

delivered in a health facility. Odds ratios with 95%, 99%, and 99.9% confidence intervals were 

reported. 

In addition, two multinomial regression models were used to assess the association between timing 

of the first PNC and the identified correlates, stratifying by place of delivery. In both models, 

“never received any PNC” was the reference category. All the estimates were weighted to reflect 

the population. The effect of the complex multistage sampling design that was used in the 2013-

14 ZDHS was considered. Data were analyzed using STATA 13.0 software. 
7 

3. Results 

3.1. Description of the Analysis Sample 

Table 1 describes births included in the analysis by mother’s characteristics. For both home and 

facility births, about two-thirds of the mothers were age 20-34 at the time of birth. Newborns 

delivered at home had a higher proportion of 4th order births (60%) than newborns delivered in a 

health facility (40%). Less than two-thirds of newborns were perceived by their mothers to have 

average size at birth (61% delivered at home and 57% delivered in a facility). 

By geographic distribution, a larger share of home births took place in Central and Southern 

regions (18% and 19%), while Eastern, Copperbelt, and Lusaka regions had a larger share of 

facility births (14%, 15%, and 19%). Nine in every 10 home deliveries were in rural areas (91%) 

compared with about 6 in every 10 deliveries in a health facility (58%). A majority of mothers had 

primary education, whether they delivered at home or in a health facility (66% and 50%). Among 

newborns delivered at home, more than two-thirds were in poor households, while among those 

delivered at a health facility, poor and rich households accounted for about 40% each. Sixty-three 

percent of mothers of newborns delivered at home were employed at the time of the survey, as 

were 53% of mothers of newborns delivered in a health facility. Nearly three-fourths (73%) of the 

mothers of newborns delivered in a health facility had access to media compared with about half 

(54%) of mothers of newborns delivered at home. 

Overall, more than half (53%) of the mothers of the newborns had four or more ANC visits. 

Disaggregated by place of delivery, 55% of mothers of newborns delivered in a health facility had 

four or more ANC visits compared with 46% among those delivered at home. 
8 

Table 1: Percent distribution of the sample by demographic, socioeconomic, antenatal care 

services according to place of delivery, 2013-14 ZDHS 

Variable 

Home Facility Total 

% n % n % n

Mother’s Age at Birth 

<20 13.4 183 20.3 694 18.3 877 

20-34 66.0 899 66.9 2,286 66.7 3,187 

35+ 20.6 280 12.8 436 15.0 715 

Birth Order

1st 10.5 143 25.2 860 21.0 1,003 

2nd 15.3 208 18.7 640 17.7 847 

3rd 14.6 199 16.4 561 15.9 761 

4th or more 59.6 811 39.7 1,355 45.4 2,168 

Perceived Size at Birth 

Small 13.8 188 9.8 336 11.0 524 

Average 60.7 827 57.0 1,946 58.0 2,772 

Large 25.5 347 33.2 1,134 31.0 1,483 

Region 

Central 18.2 248 7.3 248 10.4 496 

Copperbelt 6.5 88 14.9 508 12.5 596 

Eastern 10.1 138 13.8 472 12.8 610 

Luapula 9.0 123 9.1 310 9.0 432 

Lusaka 3.2 44 18.9 646 14.4 689 

Muchinga 7.0 95 5.7 196 6.1 291 

Northern 14.5 197 6.9 236 9.1 434 

North Western 3.7 50 5.4 184 4.9 234 

Southern 18.7 255 12.0 410 14.0 667 

Western 9.0 123 6.0 206 6.9 329 

Type of Place of Residence 

Urban 9.5 130 42.3 1,445 33.0 1,575 

Rural 90.5 1,231 57.7 1,971 67.0 3,204 

Highest Educational Level 

None 16.7 227 8.5 290 10.8 517 

Primary 65.9 895 50.1 1,711 54.6 2,608 

Secondary+ 17.3 235 41.4 1,415 34.6 1,650 

Wealth Index 

Poor 69.5 946 39.7 1,355 48.2 2,304 

Middle 21.7 296 20.3 695 20.7 990 

Rich 8.8 119 40.0 1,365 31.1 1,485 

Mother’s Employment Status 

Unemployed 37.1 504 46.8 1,593 44.0 2,099 

Employed 62.9 854 53.2 1,813 56.0 2,667 

Media Access 

No access 45.8 623 27.1 925 32.4 1,550 

Access to media 54.2 739 72.9 2,491 67.6 3,229 

Number of ANC visits 

<4 54.1 736 44.6 1,523 47.3 2,261 

4+ 45.9 625 55.4 1,893 52.7 2,518 

Total 100 1,361 100 3,416 100 4,777
9 

3.2. Coverage of Postnatal Care and Timing of the First PNC for Newborns 

Figure 1 shows the percentage of newborns who received PNC after birth by place of delivery. 

Overall, 45% of the newborns received PNC after birth. Disaggregated by place of delivery, 58% 

of newborns delivered in a health facility received PNC compared with less than half (48%) of 

newborns delivered at home. 

Figure 1: Percentage of newborns who received any postnatal care, by place of delivery 

Figure 2 shows the percent distribution of timing of first PNC after birth by place of delivery. 

Overall, only 16% of newborns received their first PNC within the first 2 days. Among newborns 

delivered in a health facility, 19% received their first PNC within the first 2 days compared with 

8% among newborns delivered at home. 

58.0

48.3 44.8

Facility births Home births Total
10 

Figure 2: Percent distribution of newborns by timing of the first postnatal checkup 

3.3. Bivariate Analysis Results of Postnatal Care for Newborns 

Table 2 shows the percentage of newborns who received PNC after birth according to demographic 

and socioeconomic characteristics. Overall among newborns, PNC coverage varied significantly 

across geographic regions for both home and facility deliveries. 

Similarly, PNC coverage varied significantly across place of residence, with newborns delivered 

at health facilities in rural areas less likely to receive PNC than newborns delivered at health 

facilities in urban areas (55% versus 62%). In addition, PNC coverage varied significantly by 

whether mothers of newborns had access to media. Among newborns whose mothers had access 

to media, a higher proportion received PNC compared with newborns whose mothers did not have 

access to media—at 53% versus 42% for home deliveries and 60% versus 53% for deliveries in a 

health facility. 

19.0

8.3

16.0

38.9 40.0 39.2 42.0

51.7

44.8

Facility births Home births Total

Within 2 days 2 or more days None
11 

Table 2: Percentage of newborns who received any postnatal checkups after birth, according to 

demographic and socioeconomic characteristics by place of delivery, 2013-14 ZDHS 

Variable 

Home births Facility births 

% CI p-values % CI p-values 

Mother’s Age at birth 

<20 42.4 [34.3,50.9] 

0.266 

56.2 [51.3,61.0] 

20-34 49.7 [45.8,53.5] 58.9 [55.7,62.1] 0.422 

35+ 47.7 [40.8,54.6] 55.8 [49.6,61.8] 

Birth Order 

1st 49.2 [40.5,57.9] 

0.879 

58.0 [53.5,62.5] 

0.968 2nd 45.4 [37.6,53.4] 58.9 [53.6,63.9] 

3rd 49.4 [41.7,57.1] 58.1 [52.7,63.3] 

4th or more 48.6 [44.0,53.2] 57.5 [53.6,61.2] 

Perceived Size at Birth 

Small 42.6 [35.0,50.6] 

0.195 

57.4 [51.3,63.3] 

Average 50.6 [45.8,55.3] 57.8 [54.5,61.1] 0.946 

Large 45.9 [39.4,52.5] 58.4 [53.8,62.9] 

Province 

Central 69.9 [60.9,77.6] 

<0.001 

75.0 [67.0,81.7] 

<0.001 

Copperbelt 50.7 [37.1,64.2] 55.8 [47.4,63.9] 

Eastern 58.9 [47.7,69.1] 62.2 [55.7,68.3] 

Luapula 29.0 [21.1,38.4] 44.4 [37.8,51.2] 

Lusaka 61.5 [44.6,76.1] 71.0 [62.1,78.5] 

Muchinga 50.8 [40.3,61.3] 72.5 [65.8,78.2] 

Northern 67.9 [60.2,74.8] 69.8 [61.8,76.8] 

North Western 62.2 [51.0,72.3] 63.0 [55.6,69.8] 

Southern 11.7 [7.6,17.5] 12.7 [8.9,17.9] 

Western 42.2 [33.2,51.8] 71.0 [62.8,78.1] 

Type of Residence 

Urban 56.7 [47.9,65.1] 0.054 62.0 [56.9,66.8] 0.027 Rural 47.4 [43.7,51.1] 55.0 [51.6,58.4] 

Highest Educational Level 

None 48.0 [40.8,55.3] 

0.428 

61.1 [54.4,67.3] 

Primary 47.2 [42.9,51.6] 59.1 [55.7,62.5] 0.259 

Secondary + 52.6 [45.5,59.6] 55.9 [51.5,60.3] 

Wealth Index 

Poor 47.7 [43.7,51.7] 

0.710 

56.4 [52.9,59.9] 

Middle 50.8 [43.1,58.4] 55.9 [50.7,61.0] 0.244 

Rich 46.6 [36.9,56.6] 60.6 [55.4,65.5] 

Womens Employment Status 

Unemployed 49.3 [43.1,55.5] 0.662 59.3 [55.0,63.4] 0.342 Employed 47.5 [43.1,52.0] 56.9 [53.5,60.3] 

Media Exposure 

No access 42.2 [37.3,47.2] 0.002 53.3 [49.2,57.3] 0.009 Access to media 53.4 [48.7,58.0] 59.7 [56.2,63.1] 

ANC visits 

<4 45.6 [41.2,50.0] 0.060 57.8 [54.2,61.4] 0.912 4+ 51.4 [46.7,56.2] 58.1 [54.5,61.6] 

Total 48.3 [44.8,51.7] 58.0 [55.1,60.8] 
12 

3.4. Bivariate Analysis Results of Timing of the First Postnatal Checkups 

Table 3 shows the percentage of newborns by timing of first PNC according to demographic and 

socioeconomic characteristics. Among home deliveries, Copperbelt region had the highest 

proportion of newborns who received their first PNC within 2 days (20%), while Northern region 

had the lowest (2%). Among facility deliveries, Eastern region had the highest proportion of 

newborns who received their first PNC within 2 days (32%), while North Western region had the 

lowest (3%). 

In addition, among newborns delivered at home, the proportion receiving their first PNC within 2 

days after birth was twice as high in urban areas as in rural areas (15% versus 8%). For facility 

deliveries, newborns in urban areas had a slightly higher proportion receiving their first PNC 

within 2 days compared with those in rural areas (41% versus 38%). 

Among home deliveries, a lower proportion of newborns of mothers with a primary education 

received their first PNC within 2 days of delivery compared with those newborns of mothers with 

secondary or more education (7% versus 15%). Among newborns delivered at home, the 

proportion receiving first PNC within 2 days increased as household wealth increased. Newborns 

in households classified as rich had twice as high a proportion receiving their first PNC within the 

first 2 days as newborns in poor households (14% versus 7%). 

Also among home deliveries, newborns whose mothers had access to media had about twice the 

proportions with first PNC within 2 days compared with newborns whose mothers had no access 

to media (11% vs. 6%). Likewise, among newborns delivered in a health facility, those whose 

mothers had access to media were more likely to receive their first PNC within 2 days compared 

with newborns whose mothers did not have access to media (20% versus 17%). 
13 

Table 3: Percent distribution of newborns delivered at home and in a health facility by timing of the postnatal checkups according to demographic and socioeconomic characteristics, 2013-14 ZDHS 

Variable 

Home births Facility births 

None PNC within 2 days PNC ≥2 days 

p-value

None PNC within 2 days PNC ≥2 days 

p-value % CI % CI % CI % CI % CI % CI 

Mother’s age at birth 

<20 57.6 [49.1,65.7] 5.8 [3.2,10.2] 36.6 [28.8,45.1] 

0.314 

43.8 [39.0,48.7] 18.7 [15.3,22.8] 37.5 [33.1,42.1] 

0.687 20-34 50.3 [46.5,54.2] 9.3 [7.3,11.8] 40.4 [36.8,44.0] 41.1 [37.9,44.3] 19.5 [17.4,21.9] 39.4 [36.4,42.5] 

35+ 52.3 [45.4,59.2] 6.6 [4.0,10.8] 41.0 [34.7,47.7] 44.2 [38.2,50.4] 17.0 [13.1,22.0] 38.8 [33.0,44.9] 

Birth Order

1st 50.8 [42.1,59.5] 10.4 [5.9,17.7] 38.8 [30.7,47.5] 

0.922 

42.0 [37.5,46.5] 21.4 [17.9,25.3] 36.7 [32.6,40.9] 

0.628 2nd 54.6 [46.6,62.4] 6.4 [3.6,11.2] 39.0 [31.4,47.1] 41.1 [36.1,46.4] 19.9 [16.4,24.0] 38.9 [34.0,44.1] 3rd 50.6 [42.9,58.3] 9.2 [5.7,14.6] 40.2 [33.0,47.8] 41.9 [36.7,47.3] 17.5 [13.6,22.3] 40.6 [35.1,46.3] 

4th or more 51.4 [46.8,56.0] 8.1 [6.3,10.5] 40.4 [36.1,44.9] 42.5 [38.8,46.4] 17.8 [15.3,20.6] 39.7 [36.2,43.2] 

Perceived Size at 

Birth Small 57.4 [49.4,65.0] 5.3 [2.6,10.5] 37.3 [29.9,45.3] 

0.358 

42.6 [36.7,48.7] 25.8 [20.2,32.3] 31.6 [26.1,37.8] 

0.076 Average 49.4 [44.7,54.2] 9.0 [6.9,11.6] 41.6 [37.3,46.0] 42.2 [38.9,45.5] 17.8 [15.5,20.5] 40.0 [36.9,43.1] 

Large 54.1 [47.5,60.6] 8.1 [5.4,12.1] 37.8 [31.9,44.0] 41.6 [37.1,46.2] 19.1 [15.8,22.9] 39.3 [34.7,44.1] 

Province 

Central 30.1 [22.4,39.1] 16.0 [11.3,22.2] 53.9 [46.2,61.4] 

<0.001 

25.0 [18.3,33.0] 27.9 [19.3,38.6] 47.1 [33.7,61.0] 

<0.001 

Copperbelt 49.3 [35.8,62.9] 19.5 [11.7,30.8] 31.2 [19.9,45.4] 44.2 [36.1,52.6] 25.5 [19.3,32.9] 30.3 [24.0,37.3] 

Eastern 41.1 [30.9,52.3] 18.3 [11.4,27.9] 40.6 [31.0,50.9] 37.8 [31.7,44.3] 31.7 [26.9,37.0] 30.5 [24.8,36.8] 

Luapula 71.0 [61.6,78.9] 2.2 [0.6,7.7] 26.8 [19.5,35.6] 55.6 [48.8,62.2] 5.1 [2.9,8.8] 39.3 [33.1,46.0] 

Lusaka 38.5 [23.9,55.4] 10.0 [2.8,30.1] 51.6 [35.9,66.9] 29.0 [21.5,37.9] 22.2 [16.8,28.6] 48.8 [41.2,56.4] 

Muchinga 49.2 [38.7,59.7] 3.1 [1.2,8.1] 47.7 [37.1,58.5] 27.5 [21.8,34.2] 16.4 [9.5,26.7] 56.1 [45.3,66.3] 

Northern 32.1 [25.2,39.8] 1.7 [0.6,4.4] 66.3 [58.3,73.4] 30.2 [23.2,38.2] 18.0 [12.3,25.5] 51.8 [44.0,59.6] North Western 37.8 [27.7,49.0] 12.8 [7.6,20.8] 49.4 [39.3,59.5] 37.0 [30.2,44.4] 2.9 [1.6,5.3] 60.0 [52.6,67.0] Southern 88.3 [82.5,92.4] 1.8 [0.7,4.9] 9.9 [6.0,15.7] 87.3 [82.1,91.1] 5.0 [2.6,9.2] 7.8 [4.8,12.3] 

Western 57.8 [48.2,66.8] 5.1 [2.3,10.9] 37.2 [27.7,47.7] 29.0 [21.9,37.2] 20.7 [15.6,26.8] 50.4 [43.0,57.6] 

Type of Residence 

Urban 43.3 [34.9,52.1] 15.0 [8.9,24.1] 41.7 [33.7,50.2] 0.019 38.0 [33.2,43.1] 21.2 [17.8,25.1] 40.7 [36.3,45.3] 0.046 Rural 52.6 [48.9,56.3] 7.6 [6.0,9.5] 39.8 [36.4,43.3] 45.0 [41.6,48.4] 17.5 [15.2,20.0] 37.6 [34.3,41.0] 

Highest Educational 

Level 

None 52.0 [44.7,59.2] 8.2 [5.0,13.2] 39.8 [32.5,47.7] 

0.011 

38.9 [32.7,45.6] 23.8 [18.4,30.2] 37.3 [30.9,44.2] 

0.091 Primary 52.8 [48.4,57.1] 6.6 [5.0,8.7] 40.7 [36.6,44.8] 40.9 [37.5,44.3] 17.9 [15.7,20.3] 41.2 [37.9,44.7] 

Secondary + 47.4 [40.4,54.5] 14.9 [10.5,20.7] 37.6 [30.8,45.0] 44.1 [39.7,48.5] 19.5 [16.6,22.8] 36.4 [32.9,40.1] 

(Continues...) 
14 

Table 3—Continued 

Variable 

Home births Facility births 

None PNC within 2 days PNC ≥2 days 

p-value

None PNC within 2 days PNC ≥2 days 

p-value % CI % CI % CI % CI % CI % CI 

Wealth Index 

Poor 52.3 [48.3,56.3] 6.5 [5.0,8.5] 41.1 [37.4,45.0] 

0.037 

43.6 [40.1,47.1] 17.2 [14.8,20.0] 39.2 [35.8,42.7] 

0.323 Middle 49.2 [41.6,56.9] 11.6 [8.0,16.5] 39.2 [32.4,46.5] 44.1 [39.0,49.3] 18.7 [15.1,22.8] 37.2 [32.2,42.5] 

Rich 53.4 [43.4,63.1] 13.9 [7.8,23.4] 32.8 [24.7,42.0] 39.4 [34.5,44.6] 21.0 [17.6,25.0] 39.5 [35.2,44.0] 

Women’s 

Employment Status 

Unemployed 50.7 [44.5,56.9] 10.9 [8.0,14.6] 38.4 [33.1,44.0] 0.142 40.7 [36.6,45.0] 18.3 [15.7,21.3] 41.0 [37.1,44.9] 0.270 Employed 52.5 [48.0,56.9] 6.8 [5.1,9.0] 40.7 [36.4,45.2] 43.1 [39.7,46.5] 19.7 [17.2,22.5] 37.2 [34.0,40.5] 

Media Access 

No access 57.8 [52.8,62.7] 5.5 [3.8,7.9] 36.7 [32.1,41.7] 0.001 46.7 [42.7,50.8] 16.5 [13.6,19.8] 36.8 [33.0,40.9] 0.020 Access to media 46.6 [42.0,51.3] 10.6 [8.3,13.5] 42.7 [38.4,47.2] 40.3 [36.9,43.8] 20.0 [17.7,22.5] 39.7 [36.6,42.9] 

ANC visits 

<4 54.4 [50.0,58.8] 7.2 [5.2,10.0] 38.3 [34.2,42.6] 0.135 42.2 [38.6,45.8] 18.6 [16.1,21.4] 39.3 [35.8,42.9] 0.878 4+ 48.6 [43.8,53.3] 9.5 [7.3,12.2] 41.9 [37.4,46.6] 41.9 [38.4,45.5] 19.4 [16.9,22.3] 38.6 [35.4,42.0] 

Total 51.7 [48.3,55.2] 8.3 [6.7,10.1] 40.0 [36.8,43.3] 42.0 [39.2,44.9] 19.0 [17.1,21.2] 38.9 [36.2,41.7]
15 

3.5. Binary Logistic Regression Results for Postnatal Care 

Table 4 presents the adjusted odds ratios of the association between PNC coverage and 

demographic and socioeconomic characteristics, separately for newborns delivered at home and 

in a health facility. Among home births, newborns whose mothers perceived their size at birth to 

be average had 90% higher odds of having a PNC visit compared with newborns perceived to be 

small. The odds of home-born newborns having a PNC visit were 80% and 90% lower in Luapula 

and Southern regions, respectively, compared with Lusaka province. Home-born newborns whose 

mothers had access to media had 40% higher odds of having a PNC visit compared with newborns 

whose mothers did not have access to media. Among home births, newborns whose mothers had 

four or more ANC visits during pregnancy had 50% higher odds of having a PNC visit compared 

with newborns whose mothers had fewer than four ANC visits. 

Among newborns delivered in a health facility, there is no evidence of association between 

perceived size at birth, access to media, or number of ANC visits during pregnancy and the odds 

of the newborn having any postnatal care. However, the odds of having PNC were 50%, 60%, and 

90% lower, respectively, for newborns delivered in a health facility in the Copperbelt, Luapula, 

and Southern provinces compared with Lusaka province. 

Table 4: Adjusted regression results on the demographic and socioeconomic factors associated 

with receipt of any postnatal care among the most recent newborns by place of delivery, 2013-14 

ZDHS 

Variable 

Home births (Model 1) Facility births (Model 2) 

AOR CI AOR CI 

Mother’s Age at birth 

<20 1 1

20-34 1.4 0.7 - 2.9 1.1 0.8 - 1.5

35+ 1.6 0.7 - 3.5 0.9 0.6 - 1.4

Birth Order

1 1 1 

2 0.9 0.5 - 1.8 1.0 0.8 - 1.4

3 0.8 0.4 - 1.6 0.9 0.7 - 1.2

4 or more 0.8 0.4 - 1.6 1.0 0.7 - 1.4

Perceived Size at Birth 

Small 1 1

Average 1.9** 1.2 - 2.9 1.1 0.8 - 1.4

Large 1.5 1.0 - 2.3 1.1 0.9 - 1.5

Province 

Central 1.4 0.5 - 3.6 1.3 0.8 - 2.4

Copperbelt 0.6 0.2 - 1.5 0.5 0.3 - 0.9

Eastern 0.7 0.3 - 1.9 0.7 0.4 - 1.2

Luapula 0.2** 0.1 - 0.6 0.4*** 0.2 - 0.6

Lusaka 1 1

Muchinga 0.7 0.3 - 1.8 1.2 0.7 - 2.0

Northern 1.4 0.5 - 3.8 1.1 0.6 - 1.8

North Western 1.1 0.4 - 2.9 0.8 0.5 - 1.3

Southern 0.1*** 0.0 – 0.2 0.1*** 0.0 - 0.1

Western 0.5 0.2 - 1.3 1.1 0.6 - 2.0

(Continues...)
16 

Table 4—Continued 

Variable 

Home births (Model 1) Facility births (Model 2) 

AOR CI AOR CI 

Type of Residence 

Urban 1

Rural 0.7 0.5 - 1.1 0.8 0.6 - 1.1

Mother’s educational Level 

None 1 1

Primary 1.1 0.8 - 1.6 1.0 0.7 - 1.4

Secondary + 1.3 0.8 - 2.2 0.8 0.6 - 1.1

Wealth status 

Poor 1 1

Middle 1.2 0.8 - 1.7 1.1 0.9 - 1.4

Rich 0.9 0.5 - 1.6 1.0 0.7 - 1.4

Womens Employment Status 

Unemployed 1 1

Employed 0.9 0.6 - 1.3 1.0 0.8 - 1.2

Media Exposure 

No access/exposure 1 1 

Access to media/exposed 1.4* 1.0 - 2.0 1.2 1.0 - 1.5

ANC visits 

<4 1 1 

≤4+ 1.5*** 1.2 - 2.0 1.1 0.9 - 1.3

*p<0.05, **p<0.01, *** p<0.001 

3.6. Multinomial Regression Results for the Timing of the First Postnatal Checkup 

Table 5 presents the adjusted relative risk ratios of the association between timing of first PNC 

and demographic and socioeconomic characteristics. Separate models were run for home 

deliveries and deliveries in a health facility. The results show that among home deliveries the 

relative risk for attending first PNC within 2 days after delivery relative to not attending PNC for 

newborns whose perceived size was average, was 150% higher than for newborns perceived to be 

small. The relative risk for attending first PNC within two days after birth relative to not attending 

PNC was 90% lower for newborns in Southern region compared with Lusaka. Similarly, the 

relative risk for attending first PNC with 2 days after delivery relative to not attending PNC for 

newborns whose mothers had four or more ANC visits was 80% higher than for newborns whose 

mothers had fewer than four ANC visits. Among newborns delivered in a health facility, the 

relative risk for attending first PNC within two days after birth relative to not attending PNC was 

90% lower in Luapula, North Western, and Southern regions than in Lusaka. In addition, the 

relative risk for attending first PNC within two days after delivery relative to not attending PNC 

for newborns whose mothers were employed was 40% higher than for newborns whose mothers 

were unemployed. 

Table 5 further shows that among newborns delivered at home the relative risk for attending first 

PNC at two or more days after delivery to not attending PNC for newborns whose perceived size 

at birth was average was 80% higher than for newborns whose weight was small. The relative risk 
17 

for attending first PNC at 2 or more days after birth relative to not attending PNC for newborns in 

Southern and Luapula regions was, respectively, 90% and 80% lower than in Lusaka region. 

Further, the relative risk for attending first PNC at two or more days after delivery compared with 

not attending PNC for newborns whose mothers had media exposure was 40% higher for newborns 

whose mothers had no media exposure. Similarly, for newborns whose mothers made four or more 

ANC visits the relative risk for attending first PNC at two or more days after delivery versus not 

attending PNC was 50% higher than for newborns whose mothers made fewer than four ANC 

visits. In contrast, among facility-delivered newborns the relative risk for attending first PNC at 

two or more days after delivery relative to not attending PNC was 40% and 50% higher, 

respectively, for newborns whose perceived size at birth was average and larger than for newborns 

whose perceived size was small. Similarly, the relative risk for attending first PNC at ‘ or more 

days after birth relative to not attending PNC for newborns in Copperbelt, Eastern, Luapula, and 

Southern regions was 60%, 50%, 50%, and 90% lower, respectively, than for newborns in Lusaka 

region. 

Table 5: Adjusted relative risk ratios (RRR) results on the demographic and socioeconomic factors 

associated with timing of the first postnatal checkups among the most recent newborns by place of 

delivery, 2013-14 ZDHS 

Variables 

Home births (Model 1) Facility births (Model 2) 

PNC within 2 days PNC ≥2 days PNC within 2 days PNC ≥ 2 days 

RRR 95% CI RRR 95% CI RRR 95% CI RRR 95% CI 

Mothers Age at Birth 

<20 1 1 1 1 

20 – 34 2.9 0.8 - 11.1 1.3 0.6 - 2.6 1.3 0.8 - 1.9 1.0 0.8 - 1.4 

35+ 2.7 0.6 - 12.6 1.4 0.6 - 3.2 1.1 0.6 - 1.9 0.9 0.6 - 1.4 

Birth Order

1 1 1 1 1 

2 0.4 0.1 - 1.5 1.1 0.5 - 2.2 0.9 0.6 - 1.3 1.1 0.8 - 1.6 

3 0.5 0.1 - 2.0 0.9 0.4 - 1.9 0.7 0.4 - 1.0 1.1 0.8 - 1.5 

4 or more 0.6 0.2 - 2.1 0.9 0.4 - 1.8 0.7 0.5 - 1.2 1.1 0.8 - 1.6 

Perceived Size at 

Birth 

Small 1 1 1 1 

Average 2.5* 1.0 - 6.0 1.8* 1.1 - 2.8 0.7 0.5 - 1.1 1.4* 1.0 - 1.9 

Large 1.7 0.6 - 4.6 1.5 0.9 - 2.3 0.8 0.5 - 1.2 1.5* 1.0 - 2.1 

Region 

Central 2.3 0.5 - 11.0 1.2 0.5 - 3.1 1.5 0.8 - 2.8 1.2 0.6 - 2.4 

Copperbelt 1.5 0.3 - 7.2 0.4 0.1 - 1.1 0.7 0.4 - 1.4 0.4** 0.2 - 0.7

Eastern 1.7 0.4 - 8.3 0.5 0.2 - 1.5 1.2 0.7 - 2.1 0.5* 0.3 - 0.9 

Luapula 0.1 0.0 - 1.1 0.2** 0.1 - 0.7 0.1*** 0.1 - 0.3 0.5** 0.3 - 0.8 

Lusaka 1 1 1 1 

Muchinga 0.3 0.1 - 2.0 0.7 0.3 - 1.9 0.8 0.4 - 1.7 1.4 0.8 - 2.4 

Northern 0.3 0.1 - 1.7 1.5 0.6 - 4.0 0.8 0.4 - 1.6 1.2 0.7 - 2.1 

North Western 1.6 0.3 - 8.8 0.9 0.3 - 2.6 0.1 0.0 - 0.2 1.1 0.7 - 1.9 

Southern 0.1** 0.0 - 0.4 0.1*** 0.0 - 0.2 0.1*** 0.0 - 0.2 0.1*** 0.0 - 0.1 

Western 0.5 0.1 - 2.9 0.5 0.2 - 1.3 0.9 0.5 - 1.8 1.2 0.7 - 2.2 

(Continues...)

 
18 

Table 5—Continued

Variables 

Home births (Model 1) Facility births (Model 2) 

PNC within 2 days PNC ≥2 days PNC within 2 days PNC ≥ 2 days 

RRR 95% CI RRR 95% CI RRR 95% CI RRR 95% CI 

Type of Place of 

Residence 

Urban 1 1 1 1 

Rural 0.5 0.2 - 1.0 0.8 0.5 - 1.3 0.8 0.5 - 1.1 0.8 0.6 - 1.2 

Highest Educational 

Level 

None 1 1 1 1 

Primary 1.0 0.5 - 2.0 1.1 0.8 - 1.6 0.8 0.5 - 1.2 1.1 0.8 - 1.6 

Secondary + 2.0 0.9 - 4.6 1.2 0.7 - 2.0 0.7 0.4 - 1.1 0.9 0.6 - 1.3 

Wealth Index 

Poor 1 1 1 1 

Middle 1.3 0.7 - 2.4 1.1 0.7 - 1.7 1.1 0.8 - 1.6 1.1 0.8 - 1.5 

Rich 1.0 0.4 - 2.6 0.8 0.4 - 1.5 1.0 0.6 - 1.5 1.1 0.7 - 1.5 

Mothers Employment 

Status 

Unemployed 1 1 1 1 

Employed 0.8 0.5 - 1.4 0.9 0.6 - 1.4 1.4* 1.1 - 1.8 0.9 0.7 - 1.1

Media Exposure 

No Access/Exposure 1 1 1 1 

Access/Exposed to 

Media 1.5 0.8 - 2.8 1.4* 1.0 - 1.9 1.2 0.9 - 1.6 1.2 1.0 - 1.6 

Number of ANC 

visits 

< 4 1 1 1 1 

4+ 1.8* 1.1 - 3.1 1.5** 1.1 - 1.9 1.1 0.9 - 1.4 1.1 0.9 - 1.4 

*p<0.05, **p<0.01, *** p<0.001
19 

4. Discussion, Conclusion, and Policy Implications 

4.1. Discussion 

The objectives of this study were to assess the demographic and socioeconomic characteristic 

associated with PNC coverage and also to examine the factors associated with the timing of first 

PNC among newborns delivered at home and newborns delivered in a health facility. Our study 

found that, overall, 55% of newborns received PNC. However, there was a substantial difference 

by place of delivery. Newborns delivered at home were less likely than newborns delivered at a 

health facility to receive PNC, at 48% versus 58%. This finding is supported by similar studies 

elsewhere (Singh et al. 2012; Fadel et al. 2015; Yunus et al. 2013. The difference may be attributed 

to the fact that births delivered in a health facility are attended by skilled personnel, who may 

encourage and educate mothers on the importance of PNC. In addition, only 16% of the newborns 

received PNC within the first two days, according to the 2013-14 ZDHS (CSO 2014). 

Disaggregated by place of delivery, our study found that the timing of PNC within the first 2days 

after birth was more than twice as high among newborns delivered in a health facility compared 

with newborns delivered at home (19% versus 8%). 

Newborns delivered at home whose size at birth was average as perceived by their mothers had 

higher odds of having a PNC visit, and having it within the first days after birth compared with 

newborns perceived as small. This finding agrees with other studies (Titaley et al. 2009). The 

finding is counterintuitive, because studies also show that small-sized newborns need extra care 

after birth compared with newborns of average size (Lawn et al. 2005). Various factors may help 

to explain this finding; for example, women in rural areas and women with little education may 

not know the problems that having a low birth-weight child could bring in the immediate or near 

future and thus do not see the need for the newborn to be taken for PNC. 

Region of residence is an important factor that has been cited as influencing whether newborns 

receive PNC and the timing of their first PNC. Studies show that in poorer regions of a country 

lower odds of early PNC after delivery may be attributable to high levels of early neonatal deaths, 

and these deaths are much more common among newborns delivered at home (Fadel et al. 2015). 

In addition, according to a study in Nigeria by Dahiru and Oche (2015), newborns in regions that 

were predominantly rural in nature had lower odds of having PNC compared with those in 

predominantly urban regions. A recent study in Rwanda by Rwabufigiri (2016) also found that the 

Western Province (a poorer region) had lower odds of having PNC than Kigali, the capital city. 

Similarly, in Bangladesh Yunus et al. (2013) found that the region of residence had a significant 

relationship with newborns’ receipt of PNC and also the timing of first PNC. These studies agree 

with the results of our study, which found that some regions of Zambia had lower odds of newborns 
20 

having PNC and the timing of first PNC regardless of whether the births were delivered at home 

or in a health facility. 

Besides, among newborns delivered at home, only in Luapula and Southern regions were there 

significantly lower odds of PNC than in Lusaka region. Among newborns delivered in a health 

facility, Copperbelt, Luapula, and Southern regions exhibited lower odds than Lusaka region. 

Further, with regard to timing of first PNC within two days of delivery, only Southern region had 

lower odds for newborns delivered at home compared with Lusaka region. Among newborns 

delivered in a health facility, Luapula, North Western, and Southern regions had lower odds of 

PNC than Lusaka region. The reason for the observed lower odds in receiving PNC and timing of 

the first PNC may be rooted deeply in the cultural practices in these regions, which may be beyond 

the data used in our study. In addition, this could further be explained by the reference category 

that was used in the analysis, which was Lusaka, the capital city, where almost every mother is 

expected to deliver in a health facility and where ANC is almost universal (99%) (CSO et al., 

2014). 

Further, this study reveals that among newborns delivered in a health facility those whose mothers’ 

were employed at the time of the survey had higher odds of receiving their first PNC within the 

first 2 days compared with those whose mothers were not employed. This finding is comparable 

to the study in Nigeria by Dahiru and Oche, which found that newborns whose mothers were 

employed had higher odds of receiving a PNC within the recommended time period (Dahiru and 

Oche 2015). The finding may be attributed to the fact that women who are employed tend to make 

decisions on the use of their resources and on what health services they can provide for their 

newborns for them to grow as a healthy child. 

Our study shows that newborns, whether delivered at home or in a health facility, were more likely 

to receive PNC if their mothers had access to media. However, logistic regression models reveal 

that only newborns delivered at home and whose mothers had access to media had higher odds of 

having a PNC compared with those whose mothers did not have media access. Access to media 

by mothers to newborns has been found to have a positive association with the use of PNC services 

among newborns. For instance, women who have access to media have been found to have 

increased antenatal care visits, and as such they tend to know the benefits of a child having PNC 

after birth, as they are aware of what problems they encounter if the child does not receive PNC 

(Acharya et al. 2015; Mumtaz et al. 2012; Aqha and Carton 2011; Titaley et al. 2009; WHO 2005). 

Our study found that newborns whose mothers had four or more ANC visits had higher odds of 

having PNC. Similarly, newborns delivered at home and whose mothers had four or more ANC 

visits had higher odds of having first PNC within the first 2 days. This finding is similar to results 
21 

of other studies, where the number of ANC visits is an important determinant of PNC use (Dahiru 

and Oche 2015; Yunus et al. 2013; Titaley et al. 2009). 

4.2. Conclusions 

Based on the nationally representative 2013-14 ZDHS, this study identified differences that exist 

in the factors associated with receipt of PNC and the timing of first PNC among newborns 

delivered at home and newborns delivered in a health facility. The study shows low levels of PNC 

among newborns regardless of place of delivery but some differences by demographic and 

socioeconomic characteristics. For home births, perceived child size at birth by mothers, region of 

residence, access to media, and mothers’ number of ANC visits are the major determinants of 

PNC. For facility births, however, only region of residence is associated with receipt of PNC. 

Regarding timing of PNC within the first two days after birth, for newborns delivered at home the 

major determinants are perceived child size at birth by mothers, region of residence, mothers’ 

access to media, and number of ANC visits. Among newborns delivered in a health facility, region 

of residence and mothers’ employment status are associated with receiving PNC within the first 2 

days. 

4.3. Policy Implications 

This study demonstrates that policies related to newborns and the timing of when newborns receive 

their first PNC are cardinal. Therefore, emphasis should be placed on encouraging women to 

deliver in a health facility, where they will be attended by qualified personnel who know the 

importance of PNC. This may help reduce the high neonatal mortality rate in the future. 

The association between receipt of PNC and access to media implies that Information Education 

and Communication (IEC) programs can play a critical role in encouraging women to take their 

newborns for PNC. Therefore, this calls for coordinated efforts by all stakeholders involved in the 

provision of child health services at all levels of society to include IEC activities in their 

programming and implementation of their activities. 

The study also shows that mothers’ attendance of the recommended number of ANC visits plays 

a fundamental role in ensuring that mothers take their newborns for PNC, especially among those 

delivered at home. As such, emphasis should be placed on ensuring that healthcare services are 

taken as close as possible to the people to stimulate increased use of PNC and the timing of first 

PNC. 

Finally, more research is required to understand the factors that cause low levels of PNC and 

influence its timing in certain regions like Luapula, Southern, North Western, and Copperbelt 

regions and among newborns perceived to be small at birth. 

23 

5. Limitations 

This study had three major limitations: First, the study was limited to only the variables collected 

in the ZDHS. Factors that may affect PNC care but are not available in DHS could not be 

examined. For example, we observed differences in receiving PNC among regions but were not 

able to explore the factors that account for the differences. Second, not only is receipt of PNC 

important; so is the content of PNC. However, content could not be assessed because of data 

unavailability. Third, due to the cross-sectional nature of the survey, it was impossible to infer 

causality in the associations between the covariates in this study and the outcome variables. 

25 

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