Patterns and determinants of postpartum physical activity among women attending postnatal care in Lusaka, Zambia: A cross-sectional study.

Jane Chela Singoyi; Geoffrey  Moyo; Loveness Anila Nkhata

doi:10.51168/sjhrafrica.v7i3.2453

Authors

Jane Chela-Singoyi Department of Physiotherapy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia
Mr. Geoffrey Moyo Department of Physiotherapy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia
Dr. Loveness A. Nkhata Department of Physiotherapy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2453

Keywords:

Postpartum physical activity, Knowledge, Attitudes, Practices, maternal health, Zambia, Sub-Saharan Africa

Abstract

Background:

Postpartum physical activity is vital for maternal recovery and long-term health, but participation rates are low, particularly in low- and middle-income countries like Zambia. This study focused on assessing the knowledge, attitudes, practices, and factors influencing postpartum physical activity among women receiving postnatal care in Lusaka, highlighting the need for more quantitative evidence in this area.

Methods:

A facility-based cross-sectional study involving 420 postpartum women at four public health facilities in Lusaka District, assessed their sociodemographic characteristics, obstetric history, knowledge, attitudes, physical activity practices, barriers, and healthcare provider counselling. Data was collected through a structured questionnaire, and multivariable logistic regression was utilized to identify factors associated with adherence to World Health Organization physical activity recommendations.

Results:

The mean age of participants was 28.4±5.6 years. Only 24.3% (n=102) of women met recommended levels of postpartum physical activity. Although 38.6% (n=162) demonstrated good knowledge and 45.7% (n=192) reported positive attitudes towards physical activity, a substantial knowledge-practice gap existed. Multivariable analysis revealed that vaginal delivery (AOR=2.34, 95%CI: 1.45-3.78, p<0.001), tertiary education (AOR=2.87, 95%CI: 1.52-5.41, p=0.001), good knowledge (AOR=2.15, 95%CI: 1.18-3.92, p=0.012), positive attitudes (AOR=1.98, 95%CI: 1.05-3.74, p=0.035), primiparity (AOR=1.76, 95%CI: 1.09-2.84, p=0.020), and receipt of healthcare provider counselling (AOR=3.21, 95%CI: 2.01-5.13, p<0.001) were independently associated with higher physical activity participation. Major barriers included lack of time (68.3%), fatigue (62.1%), cultural beliefs about postpartum rest (54.8%), and absence of healthcare provider guidance (55.7%).

Conclusion:

Postpartum physical activity among women in Lusaka is low, indicating a knowledge-practice gap. The strongest modifiable predictor is healthcare provider counselling. Enhancing counselling in routine postnatal care, particularly for women recovering from caesarean sections, could effectively improve maternal physical activity engagement. Future nationwide longitudinal studies should assess pregnancy-to-postpartum physical activity trends.

Author Biographies

Mr. Geoffrey Moyo, Department of Physiotherapy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia

is a senior lecturer and researcher at the University of Zambia, Department of Physiotherapy, School of Health Sciences

Dr. Loveness A. Nkhata, Department of Physiotherapy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia

is a lecturer and seasoned researcher at the University of Zambia, School of HEalth Sciences, Department of Physiotherapy

References

World Health Organization. WHO recommendations on postnatal care of the mother and newborn. Geneva: WHO; 2013.

https://iris.who.int/server/api/core/bitstreams/de085c59-2f77-44ff-831c-f50da6fa52c5/content

Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv. 2014;69(7):407-414. https://doi.org/10.1097/OGX.0000000000000077 PMid:25112589 PMCid:PMC4134098

Davenport MH, McCurdy AP, Mottola MF, et al. Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1376-1385. https://doi.org/10.1136/bjsports-2018-099697

World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. https://iris.who.int/server/api/core/bitstreams/faa83413-d89e-4be9-bb01-b24671aef7ca/content

Saligheh M, McNamara B, Rooney R. Perceived barriers and enablers of physical activity in postpartum women: a qualitative approach. BMC Pregnancy Childbirth. 2016;16(1):131. https://doi.org/10.1186/s12884-016-0908-x PMid:27256279 PMCid:PMC4890285

Albright CL, Maddock JE, Nigg CR. Physical activity before pregnancy and following childbirth in a multiethnic sample of healthy women in Hawaii. Women's Health. 2006;42(3):95-110.https://doi.org/10.1300/J013v42n03_06 PMid:16901890

Haakstad LAH, Voldner N, Henriksen T, Bø K. Physical activity level and weight retention in the postpartum period: a prospective study. Acta Obstet Gynecol Scand. 2007;86(12):1427-1434.https://doi.org/10.1080/00016340601185301 PMid:17464584

Gaston A, Cramp A. Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport. 2011;14(4):299-305.https://doi.org/10.1016/j.jsams.2011.02.006 PMid:21420359

Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health. 2009;18(12):1925-1934.https://doi.org/10.1089/jwh.2008.1309 PMid:20044854 PMCid:PMC2828187

Albright C, Maddock JE, Nigg CR. Increasing physical activity in postpartum multiethnic women in Hawaii: results from a pilot study. BMC Women's Health. 2009;9:4. https://doi.org/10.1186/1472-6874-9-4 PMid:19254387 PMCid:PMC2662815

Cramp AG, Bray SR. Understanding exercise self-efficacy and barriers to leisure-time physical activity among postnatal women. Matern Child Health J. 2011;15(5):642-651.https://doi.org/10.1007/s10995-010-0617-4 PMid:20495858

Nkhata LA, Munalula-Nkandu E, Shula H. Exercise practice among women attending antenatal care at the University Teaching Hospital in Lusaka, Zambia. Science Journal Public Health. 2015;3(3):361-365.https://doi.org/10.11648/j.sjph.20150303.19

Nkhata L, Nkandu E, Shula H. The knowledge, attitudes, and practices towards exercise among women attending antenatal care at the University Teaching Hospital in Lusaka, Zambia. Journal of Scientific Research and Reports. 2014;3(15):1986-1992. https://doi.org/10.9734/JSRR/2014/10693

Phiri M, Likwa RN, Mweshi MM, Nkhata LA. Knowledge and practice of exercise during pregnancy among pregnant women receiving antenatal care in selected public health facilities in Lusaka, Zambia. American Journal of Nursing and Health Sciences. 2024;5(1):17-22. https://doi.org/10.11648/j.ajnhs.20240501.13

Jukic AMZ, Evenson KR, Daniels JL, Herring AH, Wilcox AJ, Hartmann KE. A prospective study of the association between vigorous physical activity during pregnancy and length of gestation and birthweight. Matern Child Health J. 2012;16(5):1031-1044. https://doi.org/10.1007/s10995-011-0831-8 PMid:21674218 PMCid:PMC3386423

Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-395. https://cpb-eu-w2.wpmucdn.com/mypad.northampton.ac.uk/dist/5/6345/files/2016/05/Stages-of-Change-Prochaska-1983-typs6q.pdf

https://doi.org/10.1037/0022-006X.51.3.390 PMid:6863699

Adeniyi AF, Ogwumike OO, Osinike CI. Physical activity and energy expenditure: findings from the Ibadan Pregnant Women's Survey. Afr J Reprod Health. 2014;18(2):117-126.

Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346. https://doi.org/10.1136/bjsports-2018-100056 PMid:30337460

Connelly M, Brown H, van der Pligt P, Teychenne M. Modifiable barriers to leisure-time physical activity during pregnancy: a qualitative study investigating first-time mothers' views and experiences. BMC Pregnancy Childbirth. 2015;15:100. https://doi.org/10.1186/s12884-015-0529-9 PMid:25896111 PMCid:PMC4409747

Hartman MA, Hosper K, Stronks K. Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health. 2008;8:70.https://doi.org/10.1186/1471-2458-8-172 PMid:18498623 PMCid:PMC2412873

Wilcox S, Dowda M, Leviton LC, et al. Active for Life: final results from the translation of two physical activity programs. Am J Prev Med. 2008;35(4):340-351. https://doi.org/10.1016/j.amepre.2008.07.001 PMid:18779028

Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007;370(9595):1358-1369.https://doi.org/10.1016/S0140-6736(07)61578-5 PMid:17933651

Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth. 2008;35(1):16-24. https://doi.org/10.1111/j.1523-536X.2007.00207.x PMid:18307483

Gimovsky AC, Guarente J, Berghella V. Prolonged second stage in nulliparous with epidurals: a systematic review. J Matern Fetal Neonatal Med. 2017;30(4):461-465.https://doi.org/10.1080/14767058.2016.1174999 PMid:27050812

Dennis CL, Fung K, Grigoriadis S, et al. Traditional postpartum practices and rituals: a qualitative systematic review. Women's Health. 2007;3(4):487-502.https://doi.org/10.2217/17455057.3.4.487 PMid:19804024

Kaewsarn P, Moyle W, Creedy D. Traditional postpartum practices among Thai women. J Adv Nurs. 2003;41(4):358-366.https://doi.org/10.1046/j.1365-2648.2003.02534.x PMid:12581101

Lovelady CA, Lonnerdal B, Dewey KG. Lactation performance of exercising women. Am J Clin Nutr. 1990;52(1):103-109.https://doi.org/10.1093/ajcn/52.1.103 PMid:2360539

Dewey KG, Lovelady CA, Nommsen-Rivers LA, McCrory MA, Lonnerdal B. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med. 1994;330(7):449-453. https://doi.org/10.1056/NEJM199402173300701 PMid:8289849