Maternal Postnatal Care Research Articles

Maternal postnatal care in general practice: steps forward.

Maternal postnatal care in general practice: steps forward.

Assessing the Quality and Coverage of Maternal Postnatal Care in Bangladesh: A Comparative Analysis of Quality Postnatal Care among Home and Facility Births.

Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. From 2010 to 2016, postnatal care coverage within 48 h of delivery by a qualified provider rose from 23% to 47%. Of the births, 94% were facility births that received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, type of birth attendant, delivery method, and financial readiness. Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. This study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC.

Key factors associated with quality of postnatal care: a pooled analysis of 23 countries

Progress in reducing maternal and neonatal mortality, particularly in low-income and middle-income countries (LMICs) and regions, is insufficient to achieve the Sustainable Developmental Goals by 2030. High-quality postnatal care (PNC) for mothers and neonates is crucial for mothers and babies, yet it remains the most neglected intervention on the continuum of maternal and child care. We aimed to estimate the associations between observable factors and high-quality maternal and neonatal PNC in pooled and country-specific analyses. In this cross-sectional study, we used the most recent (2015-2022) Demographic and Health Surveys from 23 countries across Africa (n=14), Southeast Asia (n=3), Eastern Mediterranean (n=2), Europe (n=2), Americas (n=1), and Western Pacific (n=1). Women who, within the last 5 years, were aged 15-49 years at their last live birth that had delivered a singleton child were included. We identified eleven PNC behaviours recommended by the World Health Organization (WHO) to measure PNC quality, and applied thresholds to create binary outcomes for quality maternal and neonatal PNC. 15 factors were included in our analysis to assess their association with high-quality PNC for mothers and neonates in a series of single-adjusted and mutually adjusted logistic regression models, both in pooled and country-specific analysis. We also conducted two sets of subgroup analyses for place of residence and maternal age at last birth, and two sets of supplementary analyses to test the robustness of the results. Among 172,526 women and their most recent child, 41.42% (40.93-41.91) received quality maternal PNC while 42.34% (41.86-42.83) received quality neonatal PNC. In the pooled analysis, we found that the factors showing the strongest associations with quality maternal PNC were delivery by skilled birth attendants (SBAs) (OR: 4.92; 95% CI: 4.32-5.59), four or more antenatal care (ANC) visits (OR: 1.69, 1.58-1.81), and institutional delivery (OR: 1.61; 1.46-1.78). Consistent results were found for all factors of quality newborn care (e.g., delivery by SBA: OR, 4.25; 3.75-4.81; four or more ANC visits: OR, 1.83; 1.70-1.96) except institutional delivery. The association between these leading factors and PNC quality were broadly consistent across countries. Subgroup analyses and sensitivity analyses showed generally consistent results. Our study demonstrated that institutional delivery and frequent ANC visits had the strongest positive associations with quality PNC for both mothers and neonates. Our findings highlight that improvements to the quality of maternal and neonatal PNC in the LMICs we assessed are urgently needed to achieve ambitious maternal, newborn, and child health goals. China National Natural Science Foundation.

Measuring Coverage of Essential Maternal Postnatal Care Services in the Squatter Settlements of Islamabad Capital Territory in Pakistan.

This study aimed to assess the coverage of essential postnatal maternal care services among women residing in the slums of Islamabad. A community-based, cross-sectional study was conducted to assess the coverage of essential postnatal care (PNC) services. Using random sampling, 416 women living in the squatter settlements of Islamabad Capital Territory were selected as study participants. Data was analyzed by using SPSS version 22. Descriptive statistics were employed to display frequencies for categorical variables, whereas mean, median, and standard deviation were calculated for continuous variables. The analysis of data showed that 93.5 percent of the women utilized postnatal services at least once after delivery. Approximately 9 percent and 4 percent of women received all eight recommended services within 24 h of birth and beyond 24 h of birth, respectively. Effective PNC services were received by only 1 percent of the women. The study revealed that the utilization of effective PNC was very low. The majority of the women delivered in health institutions and received their first PNC checkups, but follow-up for the recommended checkups was very low. These results can help health professionals and policymakers in designing programs and developing efficient strategies that would improve PNC service utilization in Pakistan.

Socioeconomic inequity in coverage and quality of maternal postnatal care in Ethiopia.

High-quality postnatal care is vital for improving maternal health. This study examined the relationship between household socioeconomic status and both coverage and quality of postnatal care in Ethiopia. Cross-sectional household survey data were collected in October-November 2013 from 12 zones in 4 regions of Ethiopia. Women reporting a live birth in the 3-24 months prior to the survey were interviewed about the care they received before, during and after delivery and their demographic characteristics. Using mixed effect logistic and linear regression, the associations between household socioeconomic status and receiving postnatal care, location of postnatal care (health facility vs. non-health facility), cadre of person providing care and the number of seven key services (including physical checks and advice) provided at a postnatal visit, were estimated. A total of 16% (358/2189) of women interviewed reported receiving at least one postnatal care visit within 6 weeks of delivery. Receiving a postnatal care visit was strongly associated with socioeconomic status with women from the highest socioeconomic group having twice the odds of receiving postnatal care compared to women in the poorest quintile (OR [95% CI]: 1.98 [1.29, 3.05]). For each increasing socioeconomic status quintile there was a mean increase of 0.24 postnatal care services provided (95% CI: 0.06-0.43, p= 0.009) among women who did not give birth in a facility. There was no evidence that number of postnatal care services was associated with socioeconomic status for women who gave birth in a facility. There was no evidence that socioeconomic status was associated with the provider or location of postnatal care visits. Postnatal care in Ethiopia shows evidence of socio-economic inequity in both coverage and quality. This demonstrates the need to focus on quality improvement as well as coverage, particularly among the poorest women who did not deliver in a facility.

Reproductive biology of Gazella arabica: Predictors of offspring weight and short- and long-term offspring survival.

Reproductive traits are central to organismal fitness, and so the factors influencing patterns of reproduction and offspring survival are at the heart of biology. Making use of breeding data collected over 16 years at the King Khalid Wildlife Research Centre in Saudi Arabia, we investigated the reproductive biology of Arabian gazelles Gazella arabica. Offspring survival was mainly a function of birth weight, with heavier offspring having higher survival rates than lighter offspring. However, while sons were heavier than daughters, daughters had higher survival rates. We could not find evidence that giving birth to sons negatively impacts offspring weight in the following year. We uncovered large narrow-sense heritability (h2) in offspring weight at birth, while maternal effects (m2) on birth weight were of lesser importance. However, maternal effects on offspring survival were strong until weaning age, while paternal effects dominated survival to sexual maturity and first reproduction. We propose that variation in maternal postnatal care might overshadow the effects of maternal inheritance of birth weights, while the overall strong heritability of weight at birth and the paternal effects on survival illustrates strong variance in sire fitness based on genetic quality, suggesting a role for sexual selection by female mate choice in wild populations.

Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period),...

Bayesian Multilevel Analysis of Postnatal Care Utilization in Ethiopia

The postnatal period is defined as the first six weeks after birth; it is critical to the health and survival. The study was conducted to determine the key factors of maternal postnatal care using Bayesian multilevel analysis using 7,192 mothers aged between 15-49 of EDHS 2016 data. Descriptive statistics revealed that 675 (9.4%) women received postnatal care. The Bayesian multilevel model used to analyze postnatal care utilization of woman. The predictor variables like mother's age, region, place of residence, media exposure, religion, wealth index, parents' education level, and mothers' occupation were found to be significant determinants of variation in women postnatal care utilization in Ethiopia. The Bayesian multilevel logistic regression analysis also estimates the variance of random effect at the regional level. Thus, the value of var (u0j) = δ2= 0.127 is significant at the 5% level of significance. In order to convey policies, it is important not only to comprehend the effect of reforms on the issues, but also on the how it diverges with demographic and economic characteristics.

A Systematic Review and Meta-analysis of Depression in Postpartum Women in a Low-income Country; Ethiopia, 2020

Background: Maternal mental health in the postpartum period is essential for the optimal development of the newborn. Despite this, a shortage of concrete evidence exists regarding it. Methods: PubMed, Scopus, and EMBASE were investigated with no time limitation. A manual search for a reference list of articles was also done. Relevant data were extracted using the Meta XL package and analysis was done using Stata-11 meta-prop package. Heterogeneity was checked with Cochran's Q-statistics and the Higgs I 2 test. Results: Sixteen studies were included. The average prevalence of postpartum depression was 21.9%. The pooled prevalence was found to be higher in studies assessed with SRQ-20, i.e 24.6% than studies assessed using PHQ-9, which was 18.9%. Moreover, the pooled prevalence was slightly higher in southern Ethiopia (22.6%) than Addis Ababa (21.2%). Poor marital relation (pooled aOR= 3.56) (95% CI: 2.50, 4.63), unplanned pregnancy (pooled aOR=3.48) (95% CI: 2.18, 4.79), previous history of depression (pooled aOR= 4.33) (95% CI: 2.26, 6.59), poor social support (pooled aOR= 4.5) (95% CI: 3.34, 5.56), and domestic violence were among the associated factors for postpartum depression. Conclusion: More than one in five women were found to have postpartum depression and factors such as poor marital relations, history of depression, poor social support, domestic violence, and unplanned pregnancy were observed to be associated with it. Therefore, maternal postnatal care services should integrate this essential health concern.

Access to women physicians and uptake of reproductive, maternal and child health services in India

BackgroundLow availability of women physicians in rural areas can compromise women's health care seeking, where need can be greatest. We examined the associations between availability of women physicians and maternal and child health service utilization in India. MethodsWe analyzed cross-sectional district-level data from all 256 districts in 18 states, from India's District-Level Household and Facility Survey (2012–13) and the National Family Health Survey (2015–16). Assessed measures included lady medical officers (LMOs) availability at Primary Health Centers (PHCs, which are largely rural serving), modern contraceptive use, antenatal care (ANC), skilled birth attendance (SBA), maternal postnatal care (PNC), infant PNC, and child immunization. Multilevel regression models nesting districts in states examined associations between LMO availability and health service utilization, adjusting for district-level socioeconomic status (SES) indicators (e.g., women's education, household water access), urbanicity, health insurance coverage and sampled PHCs (15 on average) within districts. FindingsOnly 72 of 256 districts (28.1%) reported >50% of PHCs with LMOs. In multivariable models, LMO availability in PHCs was associated with higher district prevalence (%) of modern contraceptive use [β=0.04 (95% CI: 0.007, 0.08)], 4+ ANC [β =0.07 (95% CI: 0.008, 0.13)], skilled birth attendance [β=0.09 (0.03, 0.14) and maternal PNC [β=0.08 (95% CI: 0.03, 0.12)], but not infant PNC or child immunization. InterpretationHigher district availability of women physicians is associated with higher maternal health care utilization but not child health care utilization. Improving gender parity in the physician workforce and rural women physician access may improve maternal health care use in India.

Postnatal care generates phenotypic behavioural correlations in the Japanese quail

Behavioural phenotypes can be highly constrained by interdependent behavioural traits. Studies in different taxa showed that these behavioural phenotypic correlations are not universal within a species and can differ between populations exposed to different environmental pressures. Empirical studies are required to better understand the relative contributions of long-term adaptive processes and direct ontogenetic mechanisms in the development of these phenotypic behavioural correlations. In the present study, we investigated the role of postnatal nurturing care on the development of behavioural correlations in a precocial bird model, the Japanese quail (Coturnix coturnix japonica). We compared phenotypic correlations between two populations: 41 artificially reared birds (maternally deprived) and 36 birds fostered by unrelated females. Behavioural responses were measured at the age when birds naturally disperse, with three widely used behavioural tests to assess fearfulness and sociality: tonic immobility, open-field and emergence tests. Our results show that when quail chicks are reared by a foster mother, more phenotypic correlations appeared in the population including correlations within and across behavioural functions and between behavioural responses and chick mass. In contrast, chicks reared without a foster mother presented much fewer behavioural correlations and those were limited to functionally linked behaviours. Our results also highlight that the effect of mothering on phenotypic correlations is sex-specific, with a greater effect on males. We discuss the organisational role of parents on the development of behavioural correlations, the mechanisms likely to support this influence, as well as the reasons for sexual dimorphism. Mothers deeply influence the behavioural development of their offspring during the postnatal stage. Whether maternal presence and nurturing behaviour also affect correlations between behavioural responses of their offspring at a population level remains underexplored and unclear. In the current study, we used an adoption procedure to demonstrate the critical role of maternal postnatal care for the development of behavioural correlations in a precocial bird model widely used for the study of behavioural ontogeny: the Japanese quail. Our findings highlight that the presence of a maternally behaving female during early life promotes the development of correlations between behavioural responses both within and across behavioural functions in males but not in females.

The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study

ObjectiveTo examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria.DesignIndividual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the...

The impact of monetary incentives on referrals by traditional birth attendants for postnatal care in Nigeria

BackgroundGaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA’s advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria.MethodsWe conducted a non-blinded, individually-randomized, controlled study of 207 TBAs in Ebonyi State, Nigeria between August and December 2016. TBAs were randomly assigned with a 50–50 probability to receive $2.00 for every maternal client that attended postnatal care within 48 h of delivery (treatment group) or to receive no monetary incentive (control group). We compared the probabilities of maternal and neonatal postnatal care use within 48 h of delivery in treatment and control groups in an intention-to-treat analysis. We also ascertained if the care received by mothers and newborns during these visits followed World Health Organization guidelines.ResultsOverall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9–22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9–19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits.ConclusionsWe show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance.Trial registrationThe trial was retrospectively registered in clinicaltrials.gov (NCT02936869) on October 18, 2016.

Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providers.

The first 48 hours after birth is a critical window of time for the survival for both mothers and their newborns. Timely and adequate postnatal care (PNC) is being promoted as a strategy to reduce both maternal and newborn mortality. Whether or not a woman has received a postnatal check within 48 hours has been well studied, however, specific content and type of provider are also important for understanding the quality of the check. The objective of this paper is to understand who receives specific PNC interventions by type of provider in Bangladesh. Data from the 2014 Bangladesh Demographic and Health Survey (DHS) were used to study receipt of specific PNC interventions - breast exam, vaginal discharge exam, temperature check and counseling on danger signs - within 2 days of birth. Descriptive bivariate analyses and regression analyses using generalized estimating equations (GEE) were used to understand if receipt of an intervention differed by socio-economic and health-related factors. A key factor studied was the type of provider of the PNC. The proportion of women receiving specific interventions during maternal PNC was mostly low (41.81% for breast exam, 39.72% for vaginal discharge, 82.22% for temperature check, 55.56% for counseling on danger signs and 16.95% for all four interventions). Findings from the regression analyses indicated that compared to having postnatal contact with formal providers (doctors, nurses, midwives and paramedics), having postnatal contact with village doctors was significantly associated with lower probabilities of receiving a breast exam, vaginal discharge exam and receiving all four interventions. PNC provided by NGO workers and other community attendants was significantly associated with a lower probability of receiving a vaginal discharge exam but a higher probability of receiving counseling on danger signs. During PNC, women were much more likely to receive a temperature check than counseling on danger signs, breast exams or vaginal discharge exams. Very few women received all four interventions. In the situation where Bangladesh is experiencing a shortage of high-level providers, training more types of providers, particularly informal village doctors, may be an important strategy for improving the quality of PNC.

Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providers

Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providers

Timely initiation of complementary feeding to children aged 6\u201323\xa0months in rural Soro district of Southwest Ethiopia: a cross-sectional study

BackgroundPoor complementary feeding practice to infants is one of risk factors for child undernutrition in Ethiopia. This would vary across the culturally and socioeconomically diverse settings in this country. Thus, this study was aimed to determine the proportion of timely initiated complementary feeding practice of women to their children aged 6–23 months in rural Soro district in Southwest Ethiopia.MethodsA community based crossectional survey was conducted in Soro district from August to September in 2015. Randomly selected 543 women having children aged 6–23 months were the final sampling units for this study. First, local administrative units (kebeles) of residents were randomly selected from such lists in the district. Secondly, the sample size was proportionally allocated to each selected kebele by population sizes. Individual households were selected by systematic random technique. Data was collected by using a structured questionnaire through face to face interview. Descriptive statistics was done for univariate results, and we applied bivariate logistic regression to look for crude association, and multivariate logistic regression to model predictors with effect measures and 95% confidence intervals (CI). Statistical significance was decaled at P < 0.05.ResultsThe proportion of timely initiated complementary feeding was 34.3% at 95%CI: (30.31, 38.29) in this study. Secondary and above education levels of respondents (AOR = 2.25 95%CI: 1.17, 4.30) and husbands (AOR = 2.33 at 95% CI: 1.06, 5.14), and maternal Postnatal Care visits (AOR = 1.94 at 95% CI: 1.19, 3.16) were found independent predictors for timely initiated complementary feeding practice in this study.ConclusionsTimely complementary feeding practice in the study area was low compared to the standard recommends for it. Education in general and equipping child bearing women with specific messages on Infant and Child Feeding Practices may improve infant and child feeding practice in the area. Optimizing utilization of Postnatal Care by post partum women and including specific advices on complementary feeding are recommended.

Factors associated with minimal meal frequency and dietary diversity practices among infants and young children in the predominantly agrarian society of Bale zone, Southeast Ethiopia: a community based cross sectional study

BackgroundPoor infant and young child feeding (IYCF) practices in the first 2 years of age are among major causes of childhood malnutrition, in developing countries including Ethiopia. It results in irreversible outcomes of stunting, poor cognitive development, and significantly increases risks of many chronic and infectious diseases. This study was intended to assess factors associated with minimum meal frequency and minimum dietary diversity practice among children aged 6–23 months in the predominantly agrarian society of Bale zone, Southeast Ethiopia.MethodsA community based cross sectional study was employed from January to June 2016. An interviewer administered, pretested and structured questionnaire was used to collect data. Multi-stage sampling followed by a systematic random sampling technique was used to include study subjects. Data was entered using Epi info version 3.5.3 and analyzed by SPSS version 20. In the logistic regression, both bivariate and multivariate analyses were carried out to identify factors associated with minimum meal frequency and minimum dietary diversity scores. All variables with P-values of <0.2 in the bivariate were earmarked for the multivariate analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) were computed at 95% Confidence Interval (CI) to determine the strength of associations. In the multivariate analysis, variables at P–Values of <0.05 were considered as statistically significant with minimum meal frequency and dietary diversity practice.ResultA total of 801 infants and young children aged 6–23 months and their mothers participated in the study. The overall prevalence of minimum meal frequency and minimum dietary diversity practice was 68.4% [95% CI: 0.652, 0.716] and 28.5% [95% CI: 0.254, 0.316], respectively. Child age (AOR = 0.29; 95% CI: 0.28, 0.94) and parity of mother (AOR = 2.8; 95% CI: 1.11, 7.50) were independently associated with minimal meal frequency. On the other hand, mothers educational level (AOR = 0.52; 95% CI: 0.28, 0.94), child illness in the past 1 week (AOR = 0.44; 95% CI: 0.26, 0.73) and maternal counselling on IYCF practice during postnatal care (PNC) visits (AOR = 2.6; 95% CI: 1.59, 4.45) were factors statistically associated with dietary diversity practice in the study area.Conclusion and recommendationsCompliance to recommended minimum meal frequency and diversified diets was low in this study community. Minimum meal frequency was associated with the age of child and parity of mother. But, mothers’ education, child illness in the past 1 week, and maternal counseling on IYCF during PNC visits were factors associated with minimum dietary diversity practice. Improving the level of maternal and child health care utilization, increasing the educational level of mothers and providing health and nutrition counseling on IYCF during maternal PNC service visits are vital interventions to improve IYCF practices in the predominantly agrarian society of Bale zone, Southeast Ethiopia.

Complementary feeding practices among children in Benishangul Gumuz Region, Ethiopia

BackgroundAppropriate complementary feeding helps to reduces child’s risk of undernutrition, infectious disease and related mortality. However, complementary feeding practices are sub-optimal in Ethiopia. There is, however, also limited evidence in the country, particularly of Pawie District. Therefore, this study aimed to assess timely initiation of complementary feeding and associated factors among mothers who had children aged 6–23 months in Pawie District, Benishangul Gumuz Regional State.MethodsA community based cross-sectional study was conducted in Pawie District from February 01 to March 29, 2015. A multi-stage sampling technique was employed to select 806 mother–child pairs. Multivariable logistic regression analysis was used to investigate factors associated with timely initiation of complementary feeding. Adjusted odds ratio (AOR) with corresponding 95% Confidence Interval was calculated to show the strength of association. A p value of <0.05 was used to declare significance of association.ResultsThe overall prevalence of timely initiation of complementary feeding was 61.8%. One quarter (23.7%) of children had good dietary diversity and 32.7% of children aged 12–23 months were fed with appropriate meal frequency. Mother’s place of residence: urban settlement [AOR = 2.11, 95% CI 1.47, 3.02] and postnatal checkup [AOR = 1.68, 95% CI 1.15, 2.45] were significantly associated with timely initiation of complementary feeding.ConclusionsThe prevalence of timely initiation of complementary feeding was low in Pawie District. Therefore, further strengthening maternal postnatal care utilization is a key to improve timely initiation of complementary feeding. Moreover, attention needs to be given to the rural mothers.

Utilization of Maternal Postnatal Care Services Among Women in Selected Villages of Bahi District, Tanzania

Tanzania is among the countries in sub-Saharan Africa with high rate of maternal mortality. Postpartum deaths caused by obstetric factors occur mainly due to limited access and use of maternal health care services. A cross-sectional study was conducted in July, 2014 in Bahi district, Central Tanzania. The objective of the study was to assess the utilization maternal postnatal care (PNC) services and determinants for its utilization. The study involved a random sample of 134 women whose last live child birth occurred within two years preceding the survey. Key issues investigated were awareness to maternal PNC services on health facilities and attitude on the services; timing and frequency of use of maternal PNC services and barriers for utilization of the services. Results show that majority of women (94.8%) were aware of the existence of maternal PNC services in health facilities. Nearly 82% of women had positive attitude towards maternal PNC services. However, only 71.6% of them used the services in their most recent child birth, 70.8% had one to two PNC visits for checkup within 42 days post delivery as opposed to the recommended three visits; and only 41.7, 45.6 and 32.1%, respectively of women that had first, second and third maternal PNC visits, attended the visits timely. Factors associated with non- use of maternal PNC services included low education level, long distance to health facilities, low household income, non-attendance to health facilities for antenatal care service, home delivery, negative attitude towards maternal PNC services and negative perception on quality of maternity health services in health facilities. Women with at least secondary education were more likely to use maternal PNC services compared to those with no formal education (OR = 1.40, p = 0.020). Likewise, women from high income families were more likely to use the services compared to the counterpart (OR = 1.67 p = 0.015). On the other hand, women living in distant areas from health facility i.e., more than 5 km from homestead, were less likely to use the services compared to the counterpart (OR = 0.75, p = 0.033). Non-use of antenatal care services (ANC) also decreased odds for use of maternal PNC services among women (OR = 0.68, p = 0.017). Results further indicate women delivered in health facilities were more likely to report use of maternal PNC services compared to those delivered at home (OR = 2.03, p = 0.004) and women who attached less importance to maternal PNC services were 58% less likely to use the services compared to the counterpart (OR = 0.42, p = 0.003), while those think that quality of maternity health services in health facilities are good were 40% more likely to use maternal PNC services compared to the counterpart (OR = 1.40, p = 0.046). Based on these results, the study recommended that efforts to raise awareness of women in terms of health education and improving their socio-economic conditions should be continued and strengthened. There is also need for continued efforts to improve coverage of health facilities in the rural areas. Capacity of health services should be strengthened both in terms of skilled health attendants and medical supplies.

Effects of a community-based intervention package on postnatal care seeking behavior in rural Bangladesh: a cluster-randomized controlled trial

Background: Community-based Postnatal Care (PNC) initiatives have been found to improve maternal and neonatal health. Objectives: This paper aims at evaluating the effectiveness of a Community-Based Intervention Package in providing ‘limited’ PNC services by Community Support Systems (CmSS) and in increasing maternal PNC visits from Skilled Healthcare Providers (SHPs) in rural Bangladesh as well as identifying the predictors of maternal PNC from SHPs. Methods: A cluster-randomized controlled trial was employed where 6 clusters (each with an average population of about 28,000) of Narsingdi District were randomly assigned to the intervention and the comparison group. Sample sizes for pre- and post-intervention were 675 and 702, respectively, collected in June 2010 and December 2011, respectively, from mothers with a recent live birth. Logistic regression was used in examining the main outcomes and the predictors of maternal PNC from SHPs. Results: The coverage of ‘limited’ PNC services by the CmSS members to the mothers did not increase significantly (p=0.25), nor did the maternal PNC from SHPs (p=0.11). Both delivery at a Healthcare Facility and delivery by SHPs increased the odds of taking at least one PNC from SHPs 10-fold with 95% confidence intervals of 4.52-24.04 (p Conclusion: This intervention was found to be effective neither in providing limited PNC services by the CmSS members, nor in increasing maternal PNC from SHPs in our study. Further research with proper monitoring and sufficient number of clusters is recommended.