Abstract
BackgroundIn low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia.MethodsWe conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing the mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression.ResultsOne hundred and two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.49; CI 3.55–15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67–5.99), notified their birth (AOR, 6.16; CI 3.50–10.84) and those members of community health insurance (AOR, 1.87; CI 1.13–3.10) were factors associated with postnatal home visit by a health extension worker.ConclusionThe coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. The existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.
Highlights
In low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits
Despite the fact improvements observed with antenatal care (ANC) and facility delivery, postnatal care (PNC) utilization coverage remains low due to many reasons such as unavailability, inaccessibility, poor quality of health services, socio-cultural beliefs, awareness on danger signs of postnatal period, and distance [3,4,5,6,7,8,9,10]
The results revealed that, mothers who received at least one home visit during pregnancy by HEWs (AOR, 7.49; Confidence Interval (CI) 3.55–15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67–5.99), notified their birth (AOR, 6.16; CI 3.50–10.84) and those members of community health insurance (AOR, 1.87; CI 1.13– 3.10) had statistically significant positive association with postnatal home visits by health extension workers within 3 days after delivery
Summary
In low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. The extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. Despite the fact improvements observed with antenatal care (ANC) and facility delivery, postnatal care (PNC) utilization coverage remains low due to many reasons such as unavailability, inaccessibility, poor quality of health services, socio-cultural beliefs, awareness on danger signs of postnatal period, and distance [3,4,5,6,7,8,9,10]. Studies showed that a significant proportion of mothers prefer to return home or discharged within a few hours after delivery, which makes them not receive the required care [12, 13]
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