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

Eveline T Konje,Deborah Dewey,Reg Sauve,Moke Magoma,Jennifer Hatfield,Susan Kuhn

doi:10.1186/s12913-021-06695-8

Abstract

BackgroundMaternal 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.MethodsA 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 findingsApproximately, 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.ConclusionsUtilization 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.

Highlights

In the past two decades, significant reductions in maternal and neonatal mortality have been reported globally [1, 2]
Our findings reveal that women who delivered at health facilities, those who experienced birth-related complications, and those who completed at least four antenatal visits were more likely to utilize postnatal care within the first week after delivery
Early initiation of postnatal care remains low in this setting with home delivery commonly practiced, which may act as a barrier to utilization of these services

Summary

Introduction

In the past two decades, significant reductions in maternal and neonatal mortality have been reported globally [1, 2]. Around 5.4 million underfive children died in 2017; 47 % of these deaths occurred during the neonatal period [2]. Conditions such as preterm complications, birth asphyxia, neonatal sepsis, or other neonatal conditions such as pneumonia, diarrhea, and tetanus account for approximately two-thirds of the neonatal deaths that occur in the first week of life [2, 5]. 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

Results

Conclusion