Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal demographic and health survey 2011

Factors affecting postnatal care service utilization in Pyuthan district: A mixed method study

The first hours, days, and weeks following childbirth are critical for the well-being of both the mother and newborn. Despite this significance, the postnatal period often receives inadequate attention in terms of quality care provision. In Nepal, the utilization of postnatal care (PNC) services remains a challenging issue. Employing a facility-based concurrent triangulation mixed-method approach, this study aimed to identify factors associated with PNC service utilization, as well as its facilitators and barriers. A quantitative survey involved 243 mothers who had given birth in the six months preceding the survey, selected using a multistage sampling technique from six health facilities of two randomly selected local levels of the Pyuthan district. Weighted multivariate logistic regression was employed to identify predictors of PNC service utilization. Additionally, qualitative analysis using Braun and Clarke's six-step thematic analysis elucidated facilitators and barriers. The study revealed a weighted prevalence of PNC service utilization as per protocol at 38.43% (95% CI: 32.48-44.74). Notably, Socioeconomic status (AOR-3.84, 95% CI: 2.40-6.15), place of delivery (AOR-1.86, 95% CI: 1.16-3.00), possessing knowledge of postnatal care (AOR = 6.75, 95% CI: 3.39-13.45) and access to a motorable road (AOR = 6.30, 95% CI: 3.94-10.08) were identified as predictors of PNC service utilization. Triangulation revealed knowledge on PNC, transportation facilities, PNC home visits, and postpartum weaknesses to visit health facility as areas of convergence. Conversely, divergent areas included the proximity of health facilities and the effect of COVID-19. The study identified a low prevalence of PNC service utilization in the district. To enhance utilization, targeted interventions to increase awareness about postnatal care, appropriate revision of existing policies, addressing wider determinants of service utilization, and ensuring effective implementation of PNC home-visit programs are of utmost importance.

Urban-rural disparities and change in postnatal care use from 2016 to 2019 in Ethiopia: Multivariate decomposition analysis

BACKGROUND

Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia.

METHODS

We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.

RESULTS

The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC.

CONCLUSIONS

There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.

Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey

BACKGROUND

Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya.

METHODS

A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05.

RESULTS

Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10-74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47-6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34-5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19-5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68-133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99-6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43-350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88-14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77-3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35-21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively).

CONCLUSION

In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.

Factors associated with postnatal care utilization in Afghanistan

Afghanistan has one of the highest maternal mortality rates in the world. Inadequate postnatal care (PNC) increases the risk of maternal mortality. This study aimed to analyze the socioeconomic and demographic factors that affect postnatal care utilization. A secondary analysis was conducted in 2019 based on the data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 married women aged 15-49 interviewed during the survey. This was a cross-sectional study in which a frequency distribution of independent variables for the study sample was carried out, Pearson's chi-square test was conducted for association, and the strength of association was measured using binary logistic regression. The study found that 39.9% of married women used postnatal care services. The findings of this study suggest that place of delivery and women who gave birth at health facilities were more likely to use PNC than women who delivered at home. Women age 30-39 and 20-29 positively associated with PNC use compared with mothers aged < 20 years. Each level of women's educational attainment increased their use of PNC, and women with higher education were more likely to use PNC than those without education. Furthermore, women who visited 1-3 and more than four ANC visits were more likely to use PNC than women who did not visited ANC. Moreover, women exposed to mass media were more likely to use PNC than those who were not exposed to mass media. Finally, women who lived in the northern and western regions were more likely to use PNC than those who lived in the central region, while women who lived in the southern and southeastern regions were less likely to use PNC than those who lived in the central region. Therefore, strengthening the provision of information, education, and communication could be a communication channel to further improve PNC utilization. Meanwhile further studies are needed to focus on the quality of maternal health care and PNC services in Afghanistan in order to obtain more precise information.

Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries

BACKGROUND

Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs).

METHODS AND FINDINGS

We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes.

CONCLUSIONS

Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.

Early Postnatal Care Utilization and Associated Factors Among Women Who Give Birth in the Last Six Weeks in Hosanna Town, Southern Ethiopia, 2022

Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7-30.0). No formal and primary educational level of husband (AOR = 0.05, 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13, 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (AOR = 0.3, 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08, 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication.

Assessing postnatal care for newborns in Sub-Saharan Africa: A multinational analysis

BACKGROUND

No doubt providing optimal postnatal care (PNC) prevents both maternal and neonatal deaths, in addition to the prevention of long-term complications. Sub-Saharan Africa (SSA) had the highest neonatal mortality rate, despite this adequate content of PNC for the newborn is not explored in SSA, therefore, it is important to identify the factors affecting adequate content of PNC for the newborn in the region. This may assist the program and policymakers to give an intervention based on the findings of the study.

METHODS

A secondary data analysis was performed using 21 SSA countries' Demographic and Health Surveys. A total weighted sample of 105,904 respondents were included in this study. A multilevel binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to determine the individual and community-level factors of adequate PNC for the newborn. A p-value less than 0.05 was declared as statistical significance.

RESULTS

Adequate PNC for newborns in sub-Saharan Africa was 23.51% (95% CI: 23.26, 23.77). Mothers age ≥ 35(AOR  =  1.21,95% CI: 1.06,1.16), mothers' primary education (AOR  = 1.18, 95% CI: 1.13, 1.23), secondary education (AOR  = 1.58, 95% CI:1.51,1.66), higher education (AOR  = 1.61,95% CI:1.49,1.75), rich wealth status (AOR  = 1.05,95% CI = 1.01,1.10), ANC visits 1-7 (AOR  = 1.61,95% CI:1.51, 1.73), antenatal care (ANC) visit 8 and above (AOR  = 2.54,95% CI: 2.32, 2.77), health facility delivery (AOR  = 4.37, 95% CI:4.16,4.58), lived in east (AOR = 0.23,95% CI = (0.20,0.26), central(AOR = 0.21,95% CI = 0.19,0.24), west African sub-regions (AOR = 0.23,95% CI = 0.21, 0.27), Urban dwellers (AOR = 1.22,95% CI: 1.17,1.27), and low community poverty (AOR = 1.21 (95% CI = 1.11,1.31) were associated with adequate content of PNC for the newborn.

CONCLUSION

The finding of this study showed that the overall prevalence of adequate content of PNC for a newborn in SSA countries was low. The low prevalence of adequate content of postnatal care for newborns in SSA countries is a concerning issue that requires immediate attention. Age of the respondents, level of education, wealth status, ANC visits, place of delivery, residence, community-level poverty, and sub-region of SSA were the individual-level and the community-level variables significantly associated with adequate PNC for the newborn. Strategies should focus on increasing access to antenatal care services, particularly for vulnerable populations, such as younger mothers, those with lower education levels, and individuals residing in impoverished communities to improve PNC for the newborn.

Utilization of early postnatal care services and associated factors among mothers who gave birth in the last 12 months in South Gondar Zone District, Amhara Regional State, Ethiopia

INTRODUCTION

Postnatal care is care that is provided to mothers and newborn baby after delivery. The care given after childbirth is the most critical time because most maternal and neonatal mortality occurs during this period. Utilization of this service is low in Ethiopia, and no evidence exists to describe the status of early postnatal care service utilization among women in the study area.

OBJECTIVE

This study aimed to assess the utilization of early postnatal care services and associated factors among mothers who gave birth in the last 12 months in the South Gondar Zone District, Amhara Region, Ethiopia, in 2021.

METHOD

This study was conducted in South Gondar Zone Districts from October 1 to 30, 2021. A total of 761 participants were included in this study using a simple random sampling method. The study participants were mothers who gave birth in the last 12 months. The data were collected via interview-guided semistructured questionnaires. The collected data were coded and entered into EPI Info version 7.2 and exported into SPSS version 23 for analysis. Both binary and multivariate logistic regression analyses were applied to identify factors affecting the outcome variables. The results of the final model are presented as the adjusted odds ratio (AOR) and 95% confidence interval (CI). A P value less than 0.05 was considered to indicate statistical significance.

RESULTS

In this study, 761 mothers participated, for a response rate of 100%. The overall prevalence of early utilization of postnatal care services was 20.6%. Mothers who live in urban areas were five times more likely to have early visits than those living in rural areas with adjusted odds ratio [AOR (95% CI) = 5.2 (3.19, 8.54)], a mothers who had a history of more than four parity had more likely to visit than the others at [AOR (95% CI) = 2.25 (1.18, 4.29)], mothers who had a history of pregnancy had two times more likely to visit than the other [AOR (95% CI) = 2.06 (1.05, 4.05)], and mothers who had delivered by instrumental vaginal delivery or cesarean section delivery and those mothers who had mass media exposure were two and five times more likely to visit, respectively [AOR (95% CI) = 2.62 (1.40, 4.91)] and [AOR (95% CI) = 5.18 (2.55, 10.52)].

CONCLUSION AND RECOMMENDATION

Compared with those of other studies, the overall prevalence of early utilization of postnatal care services was low. Improving mothers' knowledge of early postnatal care visits is very important for enhancing quality of life and minimizing neonatal and maternal morbidity and mortality.

Individual and community-level factors associated with women's utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BACKGROUND

Over time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women's utilization of postnatal care services in Uganda.

METHODS

Secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.

RESULTS

The result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78-2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01-1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.

CONCLUSION

This study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Sociodemographic factors associated with immediate puerperal control: A cross-sectional study based on the Peruvian demographic and health survey, 2019

Introduction

Peru is the fifth country in Latin America with the highest maternal mortality. In Peru, immediate puerperal control (IPC) was established in 2013 as a measure to improve postnatal control, with a view in reducing maternal mortality. This study aimed to evaluate the frequency and sociodemographic factors associated with compliance with IPC in Peru, 2019.

Methods

We conducted an analytical cross-sectional study based on the Demographic and Family Health Survey (ENDES, for its acronym in Spanish) of Peru, 2019. The dependent variable was compliance with IPC (control in the first 2 h) in women aged 15-49 years who had delivered within the last five years preceding the survey. To evaluate the associated factors, Poisson family generalized linear models were used to calculate crude (cPR) and adjusted (aPR) prevalence ratios, with their respective 95% confidence intervals (95%CI).

Results

Data from 11,854 women were analyzed. The frequency of IPC was 59.6% (95%CI: 58.3-60.9). We found a lower proportion of IPC in urban areas (58.8%) and in the highlands (57%) and jungle (57.2%) of Peru. Residing in rural areas (aPR:1.13; 95%CI:1.08-1.19), having undergone appropriate antenatal care (ANC) (aPR:1.05; 95%CI:1.01-1.10) and having delivered a low-birth-weight newborn (aPR:1.20; 95%CI:1.12-1.29) were associated with a higher frequency of IPC, while living in the highlands (aPR:0.86; 95%CI:0.80-0.92) or jungle (aPR:0.86; 95%CI:0.80-0.92) was associated with a lower frequency of IPC.

Conclusions

Approximately four out of ten women did not have IPC. There was a lower proportion of IPC in urban areas and in the highland and jungle regions.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis

INTRODUCTION

Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use.

METHODS

We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment.

RESULTS

PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88).

CONCLUSION

Women's decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.

Factors Associated with Maternal Healthcare Utilization Before and After Delivery Among Migrant Pregnant Women in China: An Observational Study

Background

Effective healthcare utilization throughout pregnancy is essential in protecting mother and child health, but the maternal healthcare utilization and its associated factors among migrant women are still underexplored.

Methods

The data came from the 2018 China Migrants Dynamic Survey. Our analysis included 6337 pregnant migrant women. Prenatal healthcare utilization comprises receiving at least 5 antenatal care (ANC) times and establishing the maternal health record within the first 12 weeks of pregnancy. Postnatal healthcare utilization refers to whether an individual received a postpartum visit and a physical health examination within 28 days and 42 days following delivery. A multivariate binary logit model was employed to investigate the factors related to maternal healthcare utilization.

Results

67.15% of the 6337 participants established health records within the first 12 weeks of pregnancy, and 88.35% received at least five ANC visits. 76.88% and 84.20% of migrant pregnant women received a postpartum visit and a health examination respectively. Age was positively correlated with receiving at least five ANC visits (OR:1.245, 95% CI: 1.038-1.493), a postpartum visit within 28 days (OR: 1.272, 95% CI: 1.107-1.460) and a physical examination within 42 days after delivery (OR=1.174, 95% CI: 1.002-1.376). Education, household income, health insurance and maternal health education were positively associated with prenatal and postnatal healthcare utilization (P<0.05). Number of Children negatively correlated with ANC times (OR: 0.742, 95% CI: 0.613-0.898) and receiving health examination after delivery (OR: 0.720, 95% CI: 0.610-0.849).

Conclusion

There is still potential for improvement in the maternal healthcare utilization, particularly in postnatal healthcare. Strengthening the follow-up, focusing on those who are younger, have lower socioeconomic status, and are members of ethnic minorities, and continuing to strengthen maternal health education for them can promote the maternal healthcare utilization before and after delivery.

Early postnatal care contact within 24 hours by skilled providers and its determinants among home deliveries in Myanmar: Further analysis of the Myanmar Demographic and Health Survey 2015-16

BACKGROUND

Access and use of early postnatal care (PNC) by skilled providers are crucial for reducing maternal and newborn deaths. However, use of PNC among the deliveries by skilled providers in some developing countries remains unsatisfactory. Furthermore, literature concerning PNC among home deliveries remains limited, particularly in resource-limited countries such as Myanmar. This study aimed to estimate the prevalence of having early PNC contact by skilled providers and its determinants among home deliveries in Myanmar.

METHODS

This cross-sectional study used secondary data from the Myanmar Demographic and Health Survey 2015-16. We included information on all home deliveries in the interviewed mothers aged 15-49 years in the 2 years preceding the survey. Early PNC attendance and its determinants were assessed (using modified Poisson regression with robust variance estimates). All analyses were performed using STATA, Version 15. A p-value <0.05 was considered statistically significant.

RESULTS

Of a total of 2,129 home deliveries, 36.1% (95%CI: 32.4%, 39.9%) did not receive PNC from any providers. Among all home deliveries included in this study, 468 (22.0%, 95%CI: 19.1%, 25.1%) received early postnatal checkup within 24 hours by skilled providers (doctors/nurses/midwives/Lady Health Visitors). Factors associated with early PNC contact among home deliveries by skilled providers included possessing higher education (adjusted Prevalence Ratio (aPR: 1.40, 95%CI: 1.01, 1.94), resident from coastal regions (aPR:1.37, 95%CI: 1.04, 1.80), currently married (aPR: 1.87, 95%CI: 1.01, 3.49), attaining antenatal care (ANC) at least four times (aPR:1.47, 95%CI: 1.22, 1.77), giving birth by a skilled birth attendant (aPR:8.80, 95%CI: 6.67, 11.61), and having access to mass media at least once weekly (aPR:1.23, 95%CI: 1.03, 1.46).

CONCLUSION

A high percentage of home deliveries (78%) were not receiving early PNC by skilled providers. To facilitate early and safe PNC, expanding the coverage of skilled birth attendants and promoting the utilization of ANC should be strengthened. Targeted health education should be delivered through mass media especially for those with low education levels residing in delta, lowland, hills and plains.

Comparison of inequality in utilization of postnatal care services between Bangladesh and Pakistan: Evidence from the Demographic and Health Survey 2017-2018

BACKGROUND

Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan.

METHODS

The study used the latest Demographic and Health Survey (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated.

RESULTS

In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women's education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624; and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643; and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595; and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women's education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743).

CONCLUSION

Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.

Matters of Gender and Social Disparities Regarding Postnatal Care Use Among Nepalese Women: A Cross-Sectional Study in Morang District

Objective

The study compares the uses of postnatal care (PNC) and women's autonomy gradients across social caste and used intersectionality concepts to estimate odds ratio of women's autonomy and social caste on complete PNC.

Methods

A community-based cross-sectional study among 600 women aged 15-49 years who had at least one child younger than the age of 2 years in Morang District, Nepal, was conducted from April to July 2019. PNC, women's autonomy (decision-making power, freedom of movement, and control over finances) and social caste were collected by both methods. Multivariable logistic regressions were used to determine associations between women's autonomy, social caste, and complete PNC.

Results

Complete PNC totaled 13.5% of respondents. About one-fourth of respondents reported poor overall autonomy; however, non-Dalit demonstrated higher autonomy than Dalit. Non-Dalit exhibited greater odds of complete PNC by four times. Women exhibited high women's autonomy in decision-making power, control over finance, and freedom of movement and have greater odds of complete PNC than low autonomy by 17, 3, and 7 times, respectively.

Conclusion

The study raises awareness of intersectionality (gender and social caste), relating to maternal health in caste-based system countries. To improve maternal health outcomes, health care personnel should identify and systematically address barriers that women of lower-caste membership face and offer these women appropriate advice or resources to obtain care. A multilevel change program that involves different actors like husbands and community leaders is needed for improving women's autonomy and lessening stigmatized perceptions, attitudes, or practices toward non-Dalit caste-members.

Trend analysis of multi-level determinants of maternal and newborn postnatal care utilization in Pakistan from 2006 to 2018: Evidence from Pakistan Demographic and Health Surveys

BACKGROUND

Postnatal care (PNC) is crucial for maternal and newborn health. Healthcare-seeking practices within the postpartum period help healthcare providers in early detection of complications related to childbirth and post-delivery period. This study aims to investigate trends of PNC utilization from 2006 to 2018, and to explore the effects of multi-level determinants of both maternal and newborn PNC in Pakistan.

METHODS

Secondary data analysis of the last three waves of the nationally representative Pakistan Demographic and Health Surveys (PDHSs) was conducted Analysis was limited to all those women who had delivered a child during the last 5 years preceding each wave of PDHS Bivariate and multivariate logistic regression was applied to determine the association of maternal and newborn PNC utilization with multi-level determinants at individual, community, and institutional levels.

RESULTS

In Pakistan, an upward linear trend in maternal PNC utilization was found, with an increase from 43.5 to 63.6% from 2006 to 2018. However, a non-linear trend was observed in newborn PNC utilization, with an upsurge from 20.6 to 50.5% from 2006 to 2013, nonetheless a decrease of 30.7% in 2018. Furthermore, the results highlighted that the likelihood of maternal and newborn PNC utilization was higher amongst older age women, who completed some years of schooling, were employed, had decision-making and emotional autonomy, had caesarean sections, and delivered at health facilities by skilled birth attendants. Multivariate analysis also revealed higher odds for women of older age, who had decision-making and emotional autonomy, and had caesarean section deliveries over the period of 2006-2018 for both maternal and newborn PNC utilization. Further, higher odds for maternal PNC utilization were found with parity and size of newborn, while less for ANC attendance and available means of transportation. Furthermore, increased odds were recorded for newborn PNC utilization with the number of children, ANC attendance, gender of child and mass media exposure from 2006 to 18.

CONCLUSION

A difference in maternal and newborn PNC utilization was found in Pakistan, attributed to multiple individual (socio-demographic and obstetrics), community, and institutional level determinants. Overall, findings suggest the need to promote the benefits of PNC for early diagnosis of postpartum complications and to plan effective public health interventions to enhance women's access to healthcare facilities and skilled birth assistance to save mothers' and newborns' lives.

Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study

Introduction

Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake.

Objective

The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana.

Methods

The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05.

Results

The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%).

Conclusion

All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.

Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis

BACKGROUND

Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia.

OBJECTIVES

This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia.

DESIGN

A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region.

METHODS

Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization.

RESULTS

Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73).

CONCLUSION

Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.

Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu

INTRODUCTION

Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period.

OBJECTIVE

To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria.

METHODS

This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant.

RESULT

The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05).

CONCLUSION

Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

Background

Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district.

Methods

A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02-30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization.

Results

Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization.

Conclusion

Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it.

Contextualizing a framework for improving postnatal care in Ethiopia

Background

Postnatal care is among the major recommended interventions to reduce maternal deaths. To improve the low postnatal care utilization in Ethiopia, the framework developed for this purpose in Kenya was contextualized and adapted for implementation in the Ethiopian context.

Objectives

The objectives of this article are to share the process followed to contextualize Chelagat's framework for improving postnatal care, for the implementation in Ethiopia as well as the finalized contextualized framework.

Methods

A quantitative descriptive research design was adapted. A self-administered questionnaire was used to gather data during November 2018 from 422 postnatal care providers and coordinators, using stratified random sampling. The AGREE II was utilized to assess adaptability and applicability and an open-ended question allowed to assess the challenges and opportunities for utilizing the framework. The data were analyzed using SPSS computer software, Version 23.

Results

The findings revealed that the framework from Chelagat was adaptable to use for the improvement of postnatal care in the Ethiopian context. The results from the analysis of the data using AGREE II indicated an average domain score of 92%, for contextualization possibility.

Conclusion

The framework originally developed by Chelagat was contextualized and refined to be implemented in Ethiopia to improve postnatal care.

Determinants of postnatal care service utilization among married women in rural areas in western Ethiopia

BACKGROUND

Worldwide studies have shown that three-fourths of the total deaths during the neonatal period occur in the first week of the postnatal period. However, most of these deaths can be prevented with care during pregnancy, childbirth, and postnatal care. According to the 2016 Ethiopia Demographic and Health Survey report, 17% of women in Ethiopia had received postnatal care after childbirth. This study aimed to identify determinants of postnatal care service utilization among married women in rural areas in Western Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 798 women who had given birth in the past 2 years prior to the survey between 2 and 31 January 2015. A pre-tested structured questionnaire was used to collect the data. Multivariable logistic regression was employed to determine factors affecting utilization of postnatal care. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to assess the strength of the associations.

RESULTS

The study showed that 188 (23.6%) women utilized postnatal care services during their last pregnancy. Women's educational level (AOR = 3.29, 95%CI = 1.89-5.73), utilization of antenatal care (AOR = 2.07, 95%CI = 1.28-3.36), awareness on the advantage of postnatal care (AOR = 2.10, 95%CI = 1.41-3.13), and knowledge of at least one danger sign during the postnatal period (AOR = 3.04, 95%CI = 2.07-4.46) showed a significant positive association with the utilization of postnatal care.

CONCLUSION

Educating women and creating awareness of maternal health care services during pregnancy increase the utilization of postnatal care services. Health care professionals should provide information on the importance of postnatal care for pregnant women during antenatal care visits.

Challenges in postnatal care provision in Ethiopia

Background

Most maternal deaths occur during the first 48 h after delivery; thus, a critical time for monitoring possible complications arising from the delivery. Quality postnatal care can contribute to a decrease in maternal mortality and morbidity rates. Despite the importance of postnatal care, it is generally a neglected aspect of maternal and child health services in most developing countries, including Ethiopia.

Objectives

The objective of the study was to describe the challenges experienced by postnatal care providers and coordinators in providing postnatal care in the Ethiopian context.

Methods

A quantitative cross-sectional descriptive study was conducted and data were gathered from 422 postnatal care providers and coordinators during November 2018. A simple random sampling technique was used to select the respondents and the data were gathered through a self-administered questionnaire. The data were cleaned, coded and entered into the Statistical Package for Social Sciences (SPSS) version 21 for analysis. Open-ended questions for qualitative enhancement were open-coded and thematically analyzed.

Results

The findings revealed a lack of physical resources; infrastructure problems; cultural concerns; inadequate capacity building; inaccessibility of health services; unavailability of guidelines; a lack of communication with healthcare users and poor monitoring and evaluation as challenges.

Conclusion

To improve postnatal care in Ethiopia and, ultimately, mother and child health, the challenges experienced by postnatal care providers and coordinators have to be dealt with. A strategic action plan with the active involvement of all stakeholders must be developed and implemented to deal with the challenges and improve postnatal care.

Comparing two data collection methods to track vital events in maternal and child health via community health workers in rural Nepal

BACKGROUND

Timely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies-routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal.

METHODS

We linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as 'recorded by both methods,' 'census alone,' or 'programmatic alone.' We further assessed whether vital events data recorded by both methods were classified consistently.

RESULTS

From June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal 'post-delivery' data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic 'child registry' data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal 'post-delivery' and 'child registry' combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as 'living,' while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data.

CONCLUSIONS

Our findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.

High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

BACKGROUND

Antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visits are vital to improve the health of mothers and newborns. Despite improved access to these routine maternal and newborn health (MNH) services in Nepal, little is known about the cascade of health service coverage, particularly contact coverage, intervention-specific coverage, and quality-adjusted coverage of MNH services. This study examined the cascade of MNH services coverage, as well as social determinants associated with uptake of quality MNH services in Nepal.

METHODS

We conducted a secondary analysis of data derived from the Nepal Demographic and Health Survey (NDHS) 2016, taking 1978 women aged 15-49 years who had a live birth in the 2 years preceding the survey. Three outcome variables were (i) four or more (4⁺) ANC visits, (ii) institutional delivery, and (iii) first PNC visit for mothers and newborns within 48 h of childbirth. We applied a cascade of health services coverage, including contact coverage, intervention-specific and quality-adjusted coverage, using a list of specific intervention components for each outcome variable. Several social determinants of health were included as independent variables to identify determinants of uptake of quality MNH services. We generated a quality score for each outcome variable and dichotomised the scores into two categories of "poor" and "optimal" quality, considering > 0.8 as a cut-off point. Binomial logistic regression was conducted and odds ratios (OR) were reported with 95% confidence intervals (CIs) at the significance level of p < 0.05 (two-tailed).

RESULTS

Contact coverage was higher than intervention-specific coverage and quality-adjusted coverage across all MNH services. Women with advantaged ethnicities or who had access to bank accounts had higher odds of receiving optimal quality MNH services, while women who speak the Maithili language and who had high birth order (≥ 4) had lower odds of receiving optimal quality ANC services. Women who received better quality ANC services had higher odds of receiving optimal quality institutional delivery. Women received poor quality PNC services if they were from remote provinces, had higher birth order and perceived problems when not having access to female providers.

CONCLUSIONS

Women experiencing ethnic and social disadvantages, and from remote provinces received poor quality MNH services. The quality-adjusted coverage can be estimated using household survey data, such as demographic and health surveys, especially in countries with limited routine data. Policies and programs should focus on increasing quality of MNH services and targeting disadvantaged populations and those living in remote areas. Ensuring access to female health providers and improving the quality of earlier maternity visits could improve the quality of health care during the pregnancy-delivery-postnatal period.

Level of Postnatal Checkup in Ethiopia - Implications for Child Health Services

Background

High neonatal mortality rates continue to be a major public health issue in Ethiopia. Despite different maternal and neonatal care interventions, neonatal mortality in Ethiopia is at a steady state. This could be due to the low utilization of neonatal checkups. Thus, nationally assessing the level and predictors of postnatal checkups could provide important information for further improving neonatal healthcare services.

Materials and Methods

A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) was performed on 7,586 women who had live births in the 2 years before the survey. All variables with a p-value of ≤0.25 in the bivariable analysis were entered into the final model for multivariable analysis, and the level of statistical significance was declared at a P-value of <0.05.

Results

According to the national survey, only 8.3% [95% CI: 8.19, 8.41] of neonates received postnatal checkups. About two-thirds of women, 62.8% had antenatal care visits, 67.9%, gave birth at home, and 95.7% were unaware of neonatal danger signs. Distance from health care institutions [AOR = 1.42; 95% CI: 1.06, 1.89], giving birth in a healthcare facility [AOR = 1.55; 95% CI: 1.12, 2.15], antenatal care visit [AOR = 3.0; 95% CI: 1.99, 4.53], and neonatal danger signs awareness [AOR = 3.06; 95% CI: 2.09, 4.5] were all associated with postnatal care visits.

Conclusion

The number of neonates who had a postnatal checkup was low. Increasing antenatal care visit utilization, improving institutional delivery, raising awareness about neonatal danger signs, increasing access to health care facilities, and implementing home-based neonatal care visits by healthcare providers could all help to improve postnatal checkups.

Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa

BACKGROUND

Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa.

METHODS

We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval.

RESULTS

Young women who experienced child marriage were less likely to have  ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors.

CONCLUSION

Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.

Gender, nutritional disparities, and child survival in Nepal

BACKGROUND

This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five.

METHODS

We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender.

RESULTS

We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged.

CONCLUSION

While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.

Experiences of Postnatal Mothers with Healthcare Providers in Rural Kenya: Insights from Applying the Mmogo Method

PURPOSE

To explore the experiences of postnatal mothers with health care providers during postnatal care in rural Kenya.

DESIGN

This was a visual-based narrative inquiry study that applied the Mmogo method® - a visual projective data-collection method.

METHODS

The participants were women (n=26) receiving postnatal care at purposively sampled rural health facilities (n=4) in Laikipia County Kenya.

FINDINGS

Two themes emerged from this study. First, the mothers had positive experiences with health care providers. Secondly, the mothers expressed expectations to enhance future experiences with health care providers.

CONCLUSIONS

Mothers had positive experiences and various expectations to enhance future experiences with health care providers that related to their postnatal needs. The mothers proposed the possible use of mobile phones by health care providers to meet their health education needs as well as receive psychological support.

CLINICAL EVIDENCE

Health care providers can use mobile phone devices to call and address some of the postnatal needs during the postnatal period.

Inequalities in women's utilization of postnatal care services in Bangladesh from 2004 to 2017

Postnatal care (PNC) is an essential component of maternity care. Appropriate and timely care immediately after childbirth can save lives and help to prevent or treat comorbidities resulting from pregnancy and childbirth. Despite its importance, PNC coverage is still low in Bangladesh. The aim of this study was to analyse the trends, inequalities, and factors associated with PNC for mothers in Bangladesh. Data from the last five Bangladesh Demographic and Health Surveys (BDHS) were used. Descriptive statistics were used to report PNC outcome rates and trends across six inequality indicators. Modified Poisson regression analyses were used to identify factors associated with PNC use in the most recent BDHS. A total of 21,240 women were included for the analysis. The rate of PNC by ‘medically trained provider’ within 2 days of birth increased between 2004 and 2017, from 16 to 52%. There were wide inequalities across socio-demographic factors. The regression analyses found women giving birth at home, women from the poorest wealth quintile and women receiving no antenatal care (ANC) were least likely to receive PNC. The findings emphasize the need to improve public health programs supporting women who have the least access to PNC. The identified inequalities can inform policy formulation to ensure more equitable provision of PNC to women in Bangladesh.

Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data

Objective

The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women’s empowerment indicators to provide evidence for the need for policy change.

Methods

Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women’s empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women’s empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design.

Results

The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women’s knowledge level were associated with any PNC, but the association between women’s knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women’s knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant’s gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant’s size at birth.

Conclusions for Practice

PNC coverage after discharge in Indonesia needs improvement. Women’s empowerment indicators need to be addressed in improving PNC coverage.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-021-03324-y.

Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis

Introduction

Maternal mortality remains a global public health issue, more predominantly in developing countries, and is associated with poor maternal health services utilization. Antenatal care (ANC) visits are positively associated with facility delivery and postnatal care (PNC) utilization. However, ANC in itself may not lead to such association but due to differences that exist among users (women). The purpose of this study, therefore, is to examine the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC using Propensity Score Matched Analysis (PSMA).

Methods

The present study utilized the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Women aged 15 – 49 years who had given birth three years preceding the survey were considered for this study. Propensity score-matched analysis was used to analyze the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC.

Results

The results revealed a significant and positive effect of four or more ANC visits on facility delivery [ATT (Average Treatment Effect of the Treated) = 0.118, 95% CI: 0.063 – 0.173] and early PNC [ATT = 0.099, 95% CI: 0.076 – 0.121]. It also found a positive and significant effect of facility-based delivery on early PNC [ATT = 0.518, 95% CI: 0.489 – 0.547].

Conclusion

Policies geared towards the provision of four or more ANC visits are an effective intervention towards improved facility-based delivery and early PNC utilisation in Uganda.

Factors Associated with Post-Natal Care Utilization among the Women of Reproductive age Group: Evidence from Bangladesh Demographic and Health Survey 2017–18

Introduction

Postnatal period is a crucial stage of illness for mothers and their newborn children. Lack of post-natal care (PNC) services during this period is lifethreatening for both the mother and the babies. This study aims at examining the associated factors of PNC utilization among the mothers to explore the opportunities to accelerate it.

Methods

This study utilized the latest data from Bangladesh Demographic and Health Survey (BDHS) 2017–18, a nationally representative survey. A weighted sample of 5043 Bangladeshi women who gave birth three years prior to the survey was studied. Bivariate and multivariate analyses were performed to identify the underlying factors associated with the utilization of PNC.

Results

Around 63% women sought PNC from any kind of provider within 24 h to 42 days of the delivery among whom more than 48% received it from medically trained providers. Together with several sociodemographic factors- administrative division, place of residence, educational level, employment status, wealth status, some maternal factors such as- antenatal care (ANC) visits, place and mode of delivery- played a significant role in utilizing PNC services from trained providers.

Conclusion

To further improve utilization of post-natal care, national and local level action plans should be introduced to promote health facility delivery irrespective of their place of residence. In the meantime, PNC awareness campaigns, intervention and economic empowerment programs targeting mothers from the poorest quintile needs to be implemented, particularly those who are unable to attend at least four ANC visits, and have accessibility issues to education.

Determinants of Postnatal Care and Timing of the First Postnatal Care for Newborns in Ethiopia: Further Analysis of 2019 Ethiopian Demographic and Health Survey

BACKGROUND

Neonatal mortality remains a persisting public health challenge in Ethiopia. Most of the factors that lead to neonatal deaths could be prevented through postnatal checkups. However, in Ethiopia, the provision of postnatal care (PNC) continues to be low. This study aims to assess the socioeconomic and demographic factors associated with PNC visits and the timing of PNC among newborns in Ethiopia.

METHODS

Using the Ethiopia Mini Demographic and Health Survey (EMDHS) 2019, a total weighted sample of 2,105 women aged 15-49 giving birth in the 2 years preceding the survey were included in the study. The generalized linear mixed models were separately fitted to identify factors associated with any PNC for newborns delivered at home and health facilities. Multinomial logistic regression was used to assess the timing of PNC with their associated factors.

RESULTS

Overall, only 13% (95% CI: 11.2, 14.0) of the newborns received PNC in Ethiopia. Among newborns delivered at home, utilization of any PNC was determined by region, maternal educational status, and birth order. On the other hand, among newborns delivered in a health facility, region, number of antenatal care (ANC) visits, and religion were determinants of any PNC. Furthermore, utilization of the first PNC within 48 h after the delivery was determined by region and religion. On the other hand, utilization of the first PNC after 48 h after the delivery was determined by region number of ANC visits, maternal educational status, and religion.

CONCLUSION

The finding of the current study revealed low coverage of PNC among newborns regardless of the place of delivery in Ethiopia. The study makes the following recommendation: increase community health education on PNC, encourage delivery at health facilities, and link community home birth with PNC. It will be more valuable if there is sharing good practice.

Utilisation of Skilled Birth Attendant in Low- and Middle-Income Countries: Trajectories and Key Sociodemographic Factors

Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24–1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31–1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.

Association between antenatal care utilization pattern and timely initiation of postnatal care checkup: Analysis of 2016 Ethiopian Demographic and Health Survey

BACKGROUND

Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016.

OBJECTIVE

This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia.

METHODS

The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care.

RESULTS

Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42-4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22-4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03-2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15-2.09), primiparous (aOR: 0.34; 95%CI: 0.19-0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21-95.77).

CONCLUSION

The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.

Determinants of postnatal care service utilization among mothers of Mangochi district, Malawi: a community-based cross-sectional study

Background

Postnatal care (PNC) service is a neglected yet an essential service that can reduce maternal, neonatal and infant morbidity and mortality rates in low and middle-income countries. In Malawi, maternal and infant mortality rates remain high despite numerous efforts by the government and its partners to improve maternal health service coverage across the country. This study examined the determinants of PNC utilization among mothers in Mangochi District, Malawi.

Methods

A community based cross-sectional study was conducted among 600 mothers who gave birth in the past 2 years preceding January 1–31; 2016. A multistage sampling technique was employed to select respondents from nine randomly selected villages in Mangochi district. A transcribed semi-structured questionnaire was pre-tested, modified and used to collect data on socio-demographic characteristics and maternal related factors. Data was coded in EpiData version 3.1 and analysed in Stata version 12. A multivariable logistic regression adjusted for confounding factors was used to identify predictors of PNC utilization using odds ratio with 95% confidence interval and p-value of 0.05.

Results

The study revealed that the prevalence of PNC service utilization was 84.8%. Mother’s and partner’s secondary education level and above (AOR = 2.42, CI: 1.97–6.04; AOR = 1.45, CI: 1.25–2.49), partner’s occupation in civil service and business (AOR = 3.17, CI: 1.25, 8.01; AOR =3.39, CI:1.40–8.18), household income of at least MK50, 000 (AOR = 14.41, CI: 5.90–35.16), joint decision making (AOR = 2.27, CI: 1.13, 4.57), knowledge of the available PNC services (AOR = 4.06, CI: 2.22–7.41), knowledge of at least one postpartum danger sign (AOR = 4.00, CI: 2.09, 7.50), health facility delivery of last pregnancy (AOR = 6.88, CI: 3.35, 14.14) positively associated with PNC service utilization.

Conclusion

The rate of PNC service utilization among mothers was 85%. The uptake of PNC services among mothers was mainly influenced by mother and partner education level, occupation status of the partner, household income, decision making power, knowledge of available PNC services, knowledge of at least one postpartum danger signs, and place of delivery. Therefore, PNC awareness campaigns, training and economic empowerment programs targeting mothers who delivered at home with primary education background and low economic status are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04061-4.

Postnatal care service utilization and its determinants in East Gojjam Zone, Northwest Ethiopia: A mixed-method study

BACKGROUND

The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia.

METHODS

A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively.

RESULTS

The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization.

CONCLUSION AND RECOMMENDATION

The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.

Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach

Background

Maternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services.

Methods

A sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12.

Study findings

Approximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services.

Conclusions

Utilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06695-8.

Difference in factors associated with continuum of care completion rate from pregnancy to postpartum period in rural Nepal: a community-based, cross-sectional study

OBJECTIVES

This study aimed to investigate the continuum of care (CoC) completion rate in maternal, neonatal and child health and its associated factors among mothers in two ecological regions in Nepal.

DESIGN

This was a community-based, cross-sectional study, for which data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analyses were conducted to determine the associated factors.

SETTING

This was carried out in two rural districts of Nepal, in different regions: one in the hills (Dhading) and another in the flatlands called Terai (Nawalparasi). The data were collected between July and December 2016.

PARTICIPANTS

Mothers who gave birth within a year before this study were included as participants. In total, there were 1803 participants.

AN OUTCOME MEASURE

The outcome of this study was measured by the CoC completion rate when a mother completes four antenatal check-ups, deliver at a health facility and receives postnatal care within 24 hours of delivery.

RESULTS

The CoC completion rates were 41% in Dhading and 28% in Nawalparasi. In Dhading, shorter travel time to a health facility and higher wealth quintiles were associated with a better CoC completion rate. In Nawalparasi, the CoC completion rate was affected by parity and decision-making for pregnancy care.

CONCLUSIONS

The CoC completion rate was low in both districts in Nepal. However, factors associated with the CoC completion rate varied by district. Differences in these factors might be reflected by geographical and socioeconomic conditions and the characteristics of household decision making in these districts.

Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey

Background

Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal.

Methods

A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC.

Results

The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts.

Conclusions

The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11142-8.

Determinants of postnatal care coverage among mothers and new-borns in India: Evidence from a nationally representative survey

Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.

Early Postnatal Care Service Utilization and Its Determinants among Women Who Gave Birth in the Last 6 Months in Wonago District, South Ethiopia: A Community-Based Cross-Sectional Study

Background

Postnatal care is one of the key strategies to reduce maternal and newborn morbidity and mortality. Early postnatal visit is especially the most critical time for survival of mothers and newborns, particularly through early detection and management of postpartum complication. Despite the benefits, most mothers and newborns do not receive postnatal care services from health care providers during the critical first few days after delivery.

Objective

The aim of this study was to assess utilization of early postnatal care service and associated factors among women who gave birth in the last six months in Wonago District, Gedeo Zone, Southern Ethiopia.

Methods

A community-based cross-sectional study design was employed at Wonago District. A total of 612 mothers who gave birth in the last six months were selected by simple random sampling technique. Pretested structured questionnaire was used for data collection. Data were entered into EpiData version 3.1 and then exported into SPSS version 20 for analysis. Principal component analysis (PCA) and bivariate and multivariate logistic regression were used.

Result

In this study, 13.7% of mothers utilized early postnatal care. Educational status of mothers (AOR = 3.7 : 95 CI; 1.3–10.7), place of delivery (AOR: 1.8 : 95 CI; 1.03–3.2), ANC attendance (AOR = 3.4 : 95 CI; 1.1–10.09), development of complication after delivery (AOR: 7.8 : 95 CI; 3.7–16.2), and previous history of postnatal care utilization (AOR: 2.1 : 95 CI; 1.13–3.9) were found to be associated with early postnatal care service utilization. Conclusion and Recommendations. Educational status of mothers, ANC attendance, place of delivery, delivery complication while giving recent birth, and past history of postnatal care utilization were significant predictors for early postnatal care utilization. Considering this, empowering women with education and overall strengthening of health facility to improve maternal health service utilization are necessary measures to be done at different levels to enhance early postnatal care utilization during this critical time.

Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey

Introduction

Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged.

Methods

This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21.

Result

In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility.

Conclusion

Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.

Factors influencing early postnatal care utilisation among women: Evidence from the 2014 Ghana Demographic and Health Survey

INTRODUCTION

Early postnatal care (EPNC) utilisation is crucial for averting maternal deaths as recommended by the World Health Organisation. About 30% of women do not obtain EPNC in Ghana and no national level study have investigated the determinants of EPNC. Therefore, this study aimed at assessing factors associated with EPNC uptake among women aged 15-49 in Ghana.

MATERIALS AND METHODS

The study utilised data from the women's file of the 2014 Ghana Demographic and Health Survey (GDHS) and sampled 1,678 women aged 15-49 who had complete data on EPNC. Descriptive computation of EPNC was done. Since EPNC (which is the main outcome variable for the study) was dichotomous, the binary logistic regression was used to determine factors influencing utilisation of EPNC at 95% two-tailed confidence interval. The results were presented as adjusted odds ratio (AOR). Stata version 14.0 was used for all the analyses.

RESULTS

Descriptively, the results indicated that 31% of women aged 15-49 sought EPNC. At the inferential level, women aged 40-44 were more likely to seek EPNC compared to those aged 15-19 [AOR = 3.66, CI = 1.25-10.67]. Islam women had higher odds of EPNC as compared with Christians [AOR = 1.70, CI = 1.23-2.35]. Comparatively, women of Mande ethnic group had higher propensity to seek EPNC than the Akan [AOR = 3.22, CI = 1.20-8.69]. Residents of the Greater Accra region were over 11 times probable to utilise EPNC compared with the residents of Western region.

CONCLUSION

The key determinants of EPNC were age, religion, ethnicity, marital status and region. Therefore, the Health Promotion and Education Unit and Reproductive and Child Health Department of the Ghana Health Service need to scale up EPNC sensitisation programmes and should target women aged 15-19, Christians and other category of women with less likelihood of EPNC in order to offset the disparities.

Prevalence and Factors Associated with Immediate Postnatal Care Utilization in Ethiopia: Analysis of Ethiopian Demographic Health Survey 2016

Background

Maternal mortality is unacceptably high in Ethiopia. Most maternal complications are preventable using immediate postnatal care. However, it is not utilized effectively. Hence, this study can assist in formulation of national policies to increase use of immediate postnatal care in Ethiopia.

Objective

To assess the prevalence and factors associated with immediate postnatal care utilization in Ethiopia, in 2016.

Methods

Secondary data analysis was done on Ethiopian Demographic Health Survey 2016 data, in a stratified, two-stage, and cluster sampling study. This analysis was restricted to postnatal women who had given birth at least once in the five years before the survey. Chi-square test of statistics was performed to identify factors associated with immediate postnatal care service uptake. Bi-variable and multi-variable logistic regression analyses were carried out to identify factors associated with immediate postnatal care utilization. Odds ratio with 95% confidence level was computed and P-value < 0.05 was considered as statistically significant in the multivariable logistic regression.

Results

The overall level of immediate postnatal care service utilization was 6.3% in Ethiopia. Urban setting (AOR=2.3, 95% CI, 1.9, 2.9), higher education status (AOR=1.6, 95% CI, 1.3, 2.0), secondary education status (AOR=2.6, 95% CI, 1.9, 3.6), primary education status (AOR=3.1, 95% CI 2.0, 4.6), always listening to the radio (AOR=2.4, 95% CI, 1.7, 3.2), being in a richer wealth quintile (AOR=4.2, 95% CI, 3.0, 5.8), being in a middle wealth quintile (AOR=2.8, 95% CI, 2.0, 3.9), being in a poorer wealth quintile (AOR=1.9, 95% CI, 1.3, 2.8), having fewer than six children (AOR=1.3, 95% CI, 1.1, 2.0), and being told about pregnancy complications (AOR=2.2, 95%CI, 1.7, 2.7) were factors positively associated with utlilization of immediate postnatal care.

Conclusion

Prevalence of immediate postnatal care utilization is still low in Ethiopia. Awareness should be created about immediate postnatal care utilization through the efforts of health extension workers. In addition, the Ethiopian government should design strategies to enhance the socio-economic status of women. Beside these, information about postnatal care and its benefit is critical and can be transmitted through mass media.

Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia

BACKGROUND

Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia.

OBJECTIVES

This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019.

METHODS

A community based cross sectional study was conducted from January 1-30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance.

RESULT

Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4-0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67-8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08-8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4-4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service.

CONCLUSION

Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.

Factors associated with non-utilization of postnatal care among newborns in the first 2 days after birth in Pakistan: a nationwide cross-sectional study

Background

Recent data indicated that approximately four in every ten newborns in Pakistan do not receive postnatal care (PNC) services in the first 48 hours after delivery.

Objectives

This study aimed to identify factors associated with the non-utilization of PNC for newborns in Pakistan using the 2017–18 Pakistan Demographic and Health Survey (PDHS).

Methods

This was a cross-sectional analytical study utilizing data from 3887 live-born newborns recorded in the 2017–18 PDHS. Non-utilization of PNC was assessed against a set of independent factors using multilevel logistic regression analysis, and the population attributable risk estimates of factors associated with non-utilization of PNC were also calculated.

Results

There were 1443 newborns (37%) in Pakistan whose mothers did not utilize PNC check-ups in the first 2 days after delivery. The non-utilization of PNC was largely attributable to newborns delivered at non-health facilities 53% (47% to 59%) and those born to uneducated women 27% (13% to 38%). Adjusted analyses indicated that newborns with higher birth order and with a birth interval of more than 2 years, women who perceived their baby to be small at birth, women with no formal education and those living in regional areas of Khyber Pakhtunkhwa and Federally Administered Tribal Areas were significantly associated with non-utilization of PNC services.

Conclusions

Tailored health messages by community health workers, including door-to-door visits on utilizing health facilities through pregnancy to the postnatal periods, are needed and should target places of low socioeconomic status, including educationally disadvantaged women from regional areas of Pakistan.

＜Editors' Choice＞ Factors influencing utilization of postnatal care visits in Afghanistan

The World Health Organization (WHO) defines the postnatal period as the first six weeks (42 days) after delivery and recommends four postnatal care (PNC) visits for women giving birth to a child to enable early detection and treatment of complications. However, a low utilization of PNC visits by Afghan women has contributed to a relatively high maternal mortality in Afghanistan. This study aimed to identify factors influencing the utilization of PNC visits among Afghan women by sampling nationally representative data from Afghanistan Demographic and Health Survey (AfDHS), 2015. The logistic model was used to measure the adjusted odds of utilizing PNC services among women, with a 95% confidence interval (95% CI) and a p-value of <0.05 for statistical significance. The study found that the utilization of PNC visits in Afghanistan is low; among 8,581 women (44%) who utilized PNC visits and 10,924 women (56%) who didn’t, the women’s age, place of residence, parity, education, occupation, number of antenatal care (ANC) visits, place of delivery, exposure to public media, the woman’s role in decision making and needing a permission to seek healthcare were found to be associated with the level of utilization of PNC visits. Based on the study results, health promotion interventions are recommended to increase the utilization of PNC visits.