Abstract
Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson’s total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level.
Highlights
Each year, approximately 60 million women worldwide experience pregnancy complications, and up to 20 million experience postpartum illnesses [1]
60% of maternal deaths happen during the postpartum period around the world [3], few studies focus on the occurrence and severity of postpartum illnesses in developing countries [4,5]
A prospective cohort study of 784 women who had recently given birth and their 772 neonates was conducted from May 2017 to July 2018 in three randomly selected kebeles (i.e., Mekonisa, Hase-Haro, and Tumata-Chiricha) in the Wonago district of southern Ethiopia, which is Incidence of postpartum and neonatal illnesses and utilization of healthcare services located 420 km from the city of Addis Ababa
Summary
Approximately 60 million women worldwide experience pregnancy complications, and up to 20 million experience postpartum illnesses [1]. 60% of maternal deaths happen during the postpartum period around the world [3], few studies focus on the occurrence and severity of postpartum illnesses in developing countries [4,5]. A small body of emerging literature suggests a high incidence of postpartum illnesses in these countries. In Pakistan, about 40% of women experience at least one type of postpartum illness [4]. The most common symptoms of postpartum illnesses are high fever (21%), heavy vaginal bleeding (14%), foulsmelling vaginal discharge (10%) [8], and breast problems (18%) [6]. In 2018, a review from Ethiopia indicated that the prevalence of hypertensive disorders during pregnancy is high (6%) [10]. Multiple socioeconomic and demographic factors, such as the cost of healthcare services and poverty, are linked with increased risk of postpartum illnesses [11]
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