Postnatal Care Utilization Research Articles

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

BackgroundAdolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in...

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

BackgroundPostnatal 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.MethodsSecondary 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.ResultsIn 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.ConclusionA 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.

Colostrum avoidance practice and associated factors among mothers of infants less than six months in Chencha District: cross-sectional study

BackgroundColostrum avoidance is failure to feed first breast milk to a newborn baby for the first 2 to 3 days after delivery. The problem of avoiding colostrum is prevalent in Ethiopia. But it is not adequately addressed yet. Therefore, the purpose of this study was to assess prevalence of colostrum avoidance practices and associated factors among mothers of infants aged less than six months; and to explore barriers for colostrum feeding in ChenchaZuria District.MethodsA community-based cross-sectional study supplemented with a qualitative study was conducted in August 2020. The quantitative data were collected from 674 mothers selected by systematic sampling using a structured questionnaire. Both bi-variable and multi-variable binary logistic regression analysis was used to identify factors associated with the colostrum avoidance practices. The statistical significance was declared at a p-value < 0.05. The qualitative data were collected using in-depth interviews from breastfeeding mothers and thematic analysis was done manually.ResultThe prevalence of the colostrum avoidance practice was 15.3% (95% CI: 11.4%- 18.2%). Late initiation of breastfeeding (AOR 4.15 95% CI 2.51–6.84), giving pre-lacteal feeding (AOR 3.16 95% CI 1.93–5.15), not using of postnatal care (PNC) service (AOR 1.79 95% CI 1.05–3.04), and having poor maternal knowledge regarding colostrum. (AOR 1.88 95% CI 1.14–3.08) were factors significantly associated with the colostrum avoidance practices. And in the qualitative part, cultural beliefs and misconceptions, community influence, and complementary feeding practices were found to be facilitators for the colostrum avoidance.ConclusionAbout one in seven mothers practiced colostrum avoidance. Factors that contributed to the colostrum avoidance practices were breastfeeding initiation, pre-lacteal feeding, PNC utilization, and maternal knowledge regarding colostrum. Thus, efforts to prevent colostrum avoidance practices should focus on strengthening and promoting PNC services utilization, timely initiation of breastfeeding, and improving awareness creation activities on the importance of colostrum feeding and risks of pre-lacteal feeding.

Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming

BackgroundCompleting maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria.MethodsA cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p < 0.10), multivariable binary logistic regression and complementary-log–log model quantifies association at a 95% confidence interval (α = 0.05).ResultsCoverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR = 1.27, 95%CI = 1.01–1.62), average wealth index (AOR = 1.83, 95%CI = 1.48 –2.25), southern geopolitical zone (AOR = 1.61, 95%CI = 1.29–2.01), making health decision alone (AOR = 1.39, 95%CI = 1.16–1.66), having nurse as ANC provider (AOR = 3.53, 95%CI = 2.01–6.17) and taking at least two dose of tetanus toxoid vaccine (AOR = 1.25, 95%CI = 1.06–1.62) while women in rural residence (AOR = 0.78, 95%CI = 0.68–0.90) and initiation of ANC as late as third trimester (AOR = 0.44, 95%CI = 0.34–0.58) negatively influenced continuation and completion.Conclusions6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.

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

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

Effect of Perceived Factors on the Utilisation of Postnatal Care Services by Nursing and Postpartum Mothers in Gwer-East Local Government Area of Benue State, Nigeria.

Introduction: This study assessed the effect of perceived factors on the utilisation of postnatal care services by nursing and postpartum mothers in Gwer-East Local Government Area of Benue State. Five objectives were set in the study. Five research questions and five hypotheses were postulated to guide the study. Methodology: The study employed a descriptive survey research design. The population of the study comprised all the nursing mothers attending routine immunisation or other healthcare services with their children in Gwer-East Local Government Area. Total Population Sampling technique was used in the study to sample 198 nursing mothers for the study. The instrument used for data collection was a structured questionnaire designed by the researcher and titled Utilisation of Postnatal Care Services Questionnaire (UPCSQ). Data for this research was obtained through the administration of the questionnaire on respondents. Hand delivery method was used for both the distribution and collection of the questionnaires. The researcher used binary logistic regression to analyse the data at 0.05 level of significance. Results: age [15 – 25 yrs (aOR:8.0, 95%CI: 4.2 – 44.2, p&lt;0.05); 26 – 35 yrs (aOR:6.7, 95%CI: 4.5 – 16.9, p&lt;0.05); 36 – 45 yrs (aOR:2.8, 95%CI: 0.8 – 10.2, p&lt;0.05)]; place of residence [Rural (aOR:0.36, 95%CI: 0.01 – 0.12, p&lt;0.05)]; employment status [unemployed (aOR:0.192, 95%CI: 0.079 –.465, p&lt;0.05); Employed (aOR: 1.117, 95%CI: 0.525 – 2.378, p&gt;0.05); Contract Worker (aOR: 1.203, 95%CI: 0.481 – 3.012, p&gt;0.05)]; level of education [No Formal (aOR:0.001, 95%CI: 0.00 – , p&gt;0.05); Primary (aOR:0.85, 95%CI: 019 – .379, p&lt;0.05); Secondary (aOR:0.220, 95%CI: 0. 084 – .576, p&lt;0.05)]; level of income [Low (aOR:0.032, 95%CI: 0.010 – 0.105, p&lt;0.05); Middle (aOR:0.66, 95%CI: 0.029 – 1.151, p&lt;0.05)] have a significant effect on utilisation of postnatal care services by postpartum mothers. Recommendations: Government effort to strengthen postnatal care utilisation should focus on universal coverage by addressing financial barriers to vulnerable groups, quality improvement to increase women’s satisfaction and carry the less privilege along and integration programmes to maximize the contact between women and health care services during and after delivery and to enhance economic development. Index Terms: Utilisation, Postnatal Care Services, Nursing Mothers, Postpartum Mothers, Perception.

Magnitude and associated factors of postnatal care service utilization among postpartum mothers in Banke district, Nepal

Background: Postnatal care is a care provided to postpartum mothers after the delivery of child for at least 42 days. Postnatal care services play an important role in improving maternal and newborn health and prevent long- term complications. Objectives: The study aimed to assess the utilization of postnatal care services among postpartum mothers in Janaki rural municipality of Banke district. Methods: A community-based cross-sectional study was conducted among 203 postpartum mothers who had children less than 12 months. Proportionate stratified random sampling method was used to reach the sample. Interview schedule as structured questionnaire was used as a data collection tool. Data was entered and analyzed in SPSS v.16. Descriptive statistics was computed to describe socio-demographic profile of participants and factors related to postnatal care utilization. Univariate logistic regression analysis was done to identify the most independent factors related postnatal care utilization. Result: A total of 203 postpartum mothers who had child less than 12 months were enrolled in the study. The prevalence of the low postnatal service utilization was 82%. The mean age with standard deviation of the respondents was 24.55+ 3.95. There was no statistical association between postnatal care utilization and sociodemographic variables. No health service received after delivery (p&lt;0.001) was found statistically significant with low utilization of postnatal care services. Conclusion: The study concluded that low utilization of the postnatal care services was high. Providing awareness on importance of postnatal care services during antenatal care visit and increasing the availability and accessibility of health care to postnatal women is crucial. Strengthening the health services and empowering the mother’s groups to increase postnatal care services is a key intervention to increase services.

Mothers’ experiences with mHealth intervention for postnatal care utilisation in Nigeria: a qualitative study

BackgroundThe postnatal period implies a crucial and delicate time for both the mother and the newborn. There is a growing body of evidence that is increasingly pointing to mHealth interventions as a potential tool for improved utilisation of maternal and child health services, including postnatal care. This can promote the health of mother and baby during this delicate period. However, the success of the interventions must be explored to validate their usefulness and reliability. Hence, this study explored the experiences of postpartum women on the usefulness of the mHealth intervention (postnatal care assistant) they received.MethodsTwenty women, who were involved in mHealth intervention were interviewed using a semi-structured interview guide. They were recruited from the intervention group of a quasi-experimental study that evaluated the effect of a mHealth intervention on the uptake of postnatal care services. Thematic analysis of data was done using NVivo software version 10.ResultsFive major themes emerged from data shared by the participants. They are general feelings about the messages, benefits derived from the messages about pregnancy and hospital delivery, increased knowledge about baby care, facilitation of PNC utilisation and involvement of significant others in decision making. They affirmed that the information and reminder messages gave them the impetus to utilise postnatal care services.ConclusionMothers reported that mHealth intervention provided immense support and assistance during pregnancy and the reminder messages encouraged them to utilise postnatal care services. This study suggests that improved education and reminder messages via mobile phones are needed during pregnancy and after childbirth to promote mother and child health through the utilization of postnatal care services, and efforts to put this approach to action should be pursued.

Factors associated with age-specific maternal health-seeking behaviours among women: A Multiple Indicator Cluster Survey-based study in 10 African countries.

Maternal health-seeking behaviours (MHSB) are crucial for maintaining maternal health and reducing the maternal mortality ratio (MMR). However, little is known about age-specific MHSB in African countries. This study aims to examine the association between composite indicators of maternal characteristics, household conditions, and socioeconomic factors with MHSB among women from different childbearing age groups in 10 African countries. Based on the responses of 77 303 women and 68 391 households in 10 African countries to a nationally-representative round of the Multiple Indicator Cluster Survey (MICS6), we used age at childbearing to categorize women into groups according to their recent MHSB. In both pooled and age-specific analysis, multivariable logistic regression was applied to identify the predictors associated with MHSB. These factors were ranked with four sets of regression models. This cross-sectional study found a prevalence of 27.69% (95% confidence interval (CI) = 26.93%-28.46%), 45.14% (95% CI = 44.29%-46.00%), and 28.60% (95% CI = 27.82%-29.40%) for four or more antenatal care visits (ANC4), intrapartum care (IPC), and postnatal care (PNC) service utilization, respectively. In the full sample, high household wealth ranked as the strongest determinant for all three MHSB, followed by mass media exposure for ANC4 utilization (odds ratio (OR) = 1.45; 95% CI = 1.20-1.76, P < 0.001), and higher education levels (secondary school education) for IPC and PNC utilization (IPC: OR = 1.49; 95% CI = 1.23-1.79, P < 0.001, PNC: OR = 1.39; 95% CI = 1.20-1.62, P < 0.001). However, higher maternal parity (three births and above) was associated with lower utilization of ANC4 (OR = 0.86; 95% CI = 0.76-0.96, P < 0.007), and residence in rural areas was associated with a lower IPC and PNC utilization (IPC: OR = 0.65; 95% CI = 0.54-0.79, P < 0.001, PNC: OR = 0.70; 95% CI = 0.57-0.85, P < 0.001). Our study provided further information on the direct and indirect factors associated with the utilization of maternal health services by women of different childbearing ages in 10 African countries. Additionally, the heterogeneous results among different childbearing age groups suggest that age-specific programmes and national policies are crucial for improving MHSB, and thus reducing MMR in Africa.

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

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. 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. 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. 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.

Racial and oral health disparity associated with perinatal oral health care utilization among underserved US pregnant women.

The study aims to identify specific determinants of dental care utilization during the perinatal period (prenatal and 1-year postnatal) among underserved US women residing in Upstate New York. The prospective cohort study included 186 low-income US pregnant women. Demographic-socioeconomic parameters and medical-dental conditions were obtained from questionnaires, electronic medical-dental records, and dental examinations. Multivariate regression analyses were used to assess factors associated with perinatal dental care utilization. As an exploratory effort, a separate logistic model assessed factors associated with adverse birth outcomes. The results demonstrated unmet oral health needs among the underserved US pregnant women residing in Upstate New York. Despite an average of 2.7 ± 3.6 untreated decayed teeth per person during pregnancy, only 39.3% and 19.9% utilized prenatal and 1-year postnatal dental care, respectively. Previous dental care utilization was a notable factor contributing to a higher uptake of perinatal dental care at a subsequent period. Prenatal dental care utilization was significantly lower among African American women (odds ratio 0.43 [95% CI 0.19, 0.98], P = .04) and positively associated with dental caries severity (OR 2.40 [1.09, 5.12], P = .03). Postnatal utilization was associated with caries severity (OR 4.70 [1.73, 12.74], P = .002) and prevalent medical conditions (hypertension, diabetes mellitus, and emotional conditions). Pregnant women who achieved prenatal caries-free status had a lower odds of experiencing adverse birth outcomes; however, this was an insignificant finding due to limited adverse birth cases. Racial and oral health disparity is associated with perinatal oral health care utilization among underserved US pregnant women in New York. While both prenatal and postnatal dental care utilization was positively associated with oral health status, specifically, postnatal utilization was driven by existing medical conditions such as emotional condition, hypertension, and diabetes mellitus. The results add to existing information on inherent barriers and postulated needs to improve access to perinatal oral care, thereby informing statewide recommendations to maximize utilization. Considering this is a geographically restricted population, the findings are particularly true to this cohort of underserved pregnant women. However, future more robust studies are warranted to assess effective strategies to further improve perinatal dental care utilization among underserved pregnant women.

Are Ethiopian women getting the recommended maternal health services? The analysis of Ethiopian mini Demographic and Health Survey 2019.

Background and AimsHealth services during pregnancy, childbirth, and the postnatal period play a pivotal role in the survival of both the mother and the baby. We, therefore, analyzed maternal health service utilization and the related drivers among women of childbearing age in Ethiopia.MethodsWe used secondary data from the 2019 Ethiopian mini Demographic and Health Survey. The survey was conducted in 11 regions, and 2 city administrations, in Ethiopia from March 21 to June 28, 2019. Maternal health service utilization was measured in terms of three dimensions including antenatal care (ANC), skilled delivery service, and postnatal care (PNC). Bi‐variable and multivariable logistic regression was used. We then fitted three separate models. Data were analyzed using SPSS version 25; all analysis was adjusted for cluster and sample weight.ResultsA total of 2923, 3924, and 1899 women were included for ANC, delivery, and PNC utilization, respectively. The majority of 1802 (61.7%) women had a “good” antenatal care utilization, and it was explained by the level of maternal education, marital status, and wealth index. Nearly half, of 1899 (48.1%) of the women gave birth in a health facility, and it was associated with age, educational status, wealth index, the timing of first antenatal care, and the number of antenatal care contact. Finally, one third (33.7%) of them had adequate PNC utilization and it was associated with households having a television, the timing of first antenatal care, and the number of antenatal care contacts.ConclusionDespite the due emphasis on maternal health services by the Ethiopian government, the uptake of services is not optimal. Women empowerment and timely and adequate ANC contacts will prepare women for better uptake of services.

Continuum of maternal health care services among peri-urban women- a community-based cross-sectional study in North India

Background: Low level of utilization of continuum of maternal health services (CMHS) is a major factor responsible for high maternal mortality and morbidity. This study was conducted to assess status of utilization, determinants and satisfaction of /about CMHS in peri-urban women of north India.Methods: A community based, cross-sectional study of 310 recently delivered women (RDWs) was conducted. Data were collected using a structured interviewer administered questionnaire and analysed using SPSS 26.0.Results: 158 (51%), 228 (73.5%) and 92 (29.7%) of RDWs had full utilization of antenatal care (ANC), intra natal care (INC) and post-natal care (PNC) respectively. Birth order, education of husband, complications in previous pregnancies, type of family, first ANC visit and place of ANC were significant (p&lt;0.05) predictor of full utilization of ANC. Education of RDW and husband, complications in previous pregnancies were significant (p&lt;0.05) predictor of full utilization of INC. Age, birth order and education of husband were significant predictors (p&lt;0.05) of full utilization of PNC. Full utilization of overall CMHS was only 60 (19.4%). &gt;70% RDWs expressed satisfaction with the quality of CMHS while 28.5% were not satisfied.Conclusions: Utilization of all the three aspects of CMHS still lagging behind with regards to required goals with full utilization of PNC, as limiting factor. Comprehensive approach to increase utilization of CMHS is need of hour, to address the issue of drop out with special emphasis on PNC.

Contextualizing a framework for improving postnatal care in Ethiopia.

BackgroundPostnatal 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.ObjectivesThe 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.MethodsA 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.ResultsThe 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.ConclusionThe framework originally developed by Chelagat was contextualized and refined to be implemented in Ethiopia to improve postnatal care.

Community Health Educators and Maternal Health: Experimental Evidence from Northern Nigeria

The slow pace of improvement in service delivery and health outcomes for pregnant women and newborns in developing countries has been a major concern for policy makers in recent decades. This paper presents the results from a randomized controlled trial of a community health worker program designed to enhance uptake of child and maternal health services in Northern Nigeria. Three interventions were evaluated: the deployment of community health educators, health educators with the provision of safe birth kits, and health educators with community dramas. The results suggest that the interventions increased utilization of antenatal, postnatal, and infant care. Maternal and newborn health practices improved as well as health knowledge. In addition, the community health worker program was more effective when supplemented with additional program components.

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

BackgroundWorldwide 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.MethodsA 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.ResultsThe 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.ConclusionEducating 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.

Factors that influence uptake of routine postnatal care: Findings on women's perspectives from a qualitative evidence synthesis.

BackgroundEffective postnatal care is important for optimal care of women and newborns–to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care.MethodsWe undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach.FindingsOf 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women’s desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care.ConclusionsFactors that influence women’s utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings.RegistrationThis protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.

"Why would I go if the infant was healthy?": Factors Influencing Postnatal Care Utilization in Chiapas, Mexico.

Despite global efforts, postnatal care utilization remains low. There is almost no research on factors influencing postnatal care utilization in Latin America. Chiapas has one of the highest rates of maternal and neonatal mortality in Mexico. In 2014, we conducted 101 interviews with recently delivered women, male partners, traditional birth attendants (TBAs), and health staff, to assess factors influencing postnatal care utilization. Data underwent content analysis and thematic coding. Travel costs, postnatal seclusion practices, and a low perceived need for postnatal care were found to be disincentives to seek care. Providers ascribed low care adherence to cultural beliefs and low health literacy, while families indicated that their decision to seek facility care was mediated by the TBA's recognition of danger signs and perceived ability to manage complications. TBAs should be leveraged as gatekeepers, health literacy programs should emphasize the importance of primary care, and structural barriers to care should be reduced.

Provision of inadequate information on postnatal care and services during antenatal visits in Busega, Northwest Tanzania: a simulated client study

BackgroundMost (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits.MethodsA cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13.ResultsOnly 38.73% (95% CI; 28.18–49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21–12.14).ConclusionThe provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women’s utilization of postnatal care and improve outcomes for mothers and newborns.

Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey

BackgroundFamily planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa.MethodsThirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model.ResultsThe pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2–4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization.ConclusionThe uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.