Postnatal Services Research Articles

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<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.

Effect of household couple counselling for male involvement on the utilization of postnatal services at 1 week in Ibanda district, Uganda; A cluster randomized community trial

Introduction: Prompt and Skilled postnatal care attendance coupled with skilled Antenatal and delivery care can drastically reduce maternal morbidity and mortality and also improve newborn outcomes. Research shows that men are decision makers in the home but they may also restrict resources, hence preventing women and children from health care seeking. But however if involved men may lead to better health care seeking behavior and better utilization of Antenatal care, delivery and postnatal care services. The postnatal care attendance at 1 week is low in Uganda, Ibanda district reported 4% in 2018. The aim of this study was to innovate, implement and document an intervention of house hold couple counseling for male involvement and compare the intervention and control clusters on the utilization of postnatal care services at 1 week. Methods: This was a two arm cluster randomized Community trial with a parallel design with the aim of comparing utilization of postnatal care services. It was carried out in two intervention parishes and two control parishes and was a superiority trial to test if the intervention of household couple counseling would improve utilization of postnatal care services. Results: The intervention arm had 200 respondents while the control had 213. The mean age was 27.3years (SD 6.8). Ninety one point five percent of mother had used skilled delivery services in the intervention compared to 78.4% in the control. Seventy Five percent attended postnatal care at 1week in the intervention as compared to 21.1% in the control (OR 11.2, P<0.001). The activity that are statistically significantly associated with utilization of postnatal services utilization is providing transport to the postnatal clinic (AOR 30.8, P<0.001) comparing the intervention and control clusters. The others included; accompanying to antenatal clinic, partner attending antenatal clinic, providing transport for delivery, escorting partner for delivery, providing psychological support during delivery and providing necessary drugs during delivery and PNC period but these were not statistically significant. Conclusion: The study demonstrated that the intervention of household couple counseling for increased male partner involvement improved significantly utilization of postnatal care services. Interventions to improve utilization of postnatal care services should focus on involving male partners to do the supportive activities which help their partners utilize the health care services.

Veracity of universal health coverage of maternal and neonatal health care among slum dwellers in a metropolitan city of India – Factors aiding access to and cost of availing these services to the poorest household

BackgroundMaternal, newborn and child essential health services are used as tracer indicators for monitoring universal health coverage among countries. This study aims to measure accessibility, factors aiding access, its associated cost of maternal and neonatal health services (M&NHS) among slum dwellers of Chennai. MethodologyCross sectional study design with cluster sampling using Probability Proportion Sampling. The study participants were mothers with at least one child delivered alive in the preceding one year. ResultMost women availed antenatal and intranatal services (99% had ten antenatal visits, institutional delivery, immunization, 88.5% had two USG) while Postnatal services was low (34%). Women preferred combination of public and private facility for antenatal out-patient (80%), private for postnatal in-patient (66.7%) and public facilities for intranatal (90%) services. Influencing factor for public facility was free services and claiming cash benefit, for private it was perceived good care and physical proximity. Out of pocket expenditure was highest among users of private facility. Households with catastrophic expenditure were 54.2% (95% CI: 50.03%–58.37%). Use of exclusive private facility had highest risk (OR 60.7 and 73.8) of catastrophic expenditure. ConclusionAlthough every woman availed M&NHS, proportion of households facing catastrophic health expenditure was high especially among those using private health facilities. This gap in provision of financial risk protection may push households into eternal poverty and fails the effort to achieve Universal Health Coverage for the poorest.

Health-related quality of life among postpartum women with preeclampsia, southern Ethiopia: a prospective cohort study

BackgroundPreeclampsia affects the health of the mother and the fetus during pregnancy and childbirth. To date, little is known about the impact of preeclampsia on postpartum health-related to quality of life (HRQoL) in the Sidama region of southern Ethiopia. This study aimed to measure the HRQoL and its contributing factors among postpartum women with preeclampsia in the Sidama region.MethodsA prospective cohort study was conducted by enrolling pregnant women at ≥20 weeks of gestation up until the 37th week of gestation. We then followed them until 12 weeks after delivery. A locally validated, World Health Organization Quality-of-Life-BREF (WHOQOL-BREF) tool was used to assess participants’ HRQoL at two time points; the 6th and 12th weeks postpartum. Assessment of HRQoL of participants was based on total scores on the WHOQoL-BREF. Higher scores on the WHOQoL-BREF reflected a higher HRQoL. Multiple linear regression analyses were performed to evaluate the contributing factors to HRQoL. The level of significance was determined at a p-value of < 0.05.ResultsThe HRQoL of postpartum women with preeclampsia significantly improved over time from 6 (151 ± 17) to 12 weeks (167 ± 18), p < 0.001). However, the overall HRQoL scores were lower (156 ± 16, p < 0.001) among women with preeclampsia compared to normotensive women (181 ± 21). An experience of early neonatal death was found to have a significant negative effect on the HRQoL of women with preeclampsia [β = − 2.1, 95% CI: − 3.43– − 0.85] compared to normotensive women who did not have early neonatal death. At 6 weeks of the postpartum period, the physical domain was found to have a significantly higher contribution to the lower HRQoL [β = 1.04, 95% CI: 0.88–1.12] compared to normotensive women, while other factors were constant.ConclusionsThe HRQoL of women with preeclampsia improved over time from 6 to 12 weeks in the postpartum period. Lower HRQoL was observed among postpartum women with preeclampsia, especially among those who experienced preterm birth or early neonatal death. The effects of preeclampsia on the HRQoL of postpartum women should be considered in redesigning postnatal care intervention services.

Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life.

COVID-19 was declared 'a global pandemic' by the World Health Organization in March 2020. India's lockdown, one of the harshest in the world, came with additional challenges for women. This paper aims to assess the impact of COVID-19 pandemic-related pathways on the first thousand days of life in the Integrated Child Development Scheme and the public distribution ecosystem in India. Using Cochrane guidelines, electronic databases, namely Google Scholar and PubMed-NCBI, were searched for evidence between 1 March 2020 and 1 May 2022. A total of 73 studies were identified in initial search; 20 met the inclusion criteria and, thus, were included in the research analysis. Primary studies were conducted throughout pan-India in rural, urban, and semi-urban areas to study the impact of COVID-19 pandemic-related pathways on the first 1000 days of life. The impact of social security, food insecurity, service delivery, nutrition of pregnant and nursing mothers (P&NMs), and infant and young child feeding (IYCF) varied between geographies and within geographies. Most of the primary studies were conducted at small scale, while only three studies were pan-Indian. The majority of studies were conducted on the mental health of P&NMs and pre-natal and post-natal service delivery disruption. The paucity of the available literature highlights the need to undertake research on the impact of the COVID-19 pandemic-related pathways on 1000 days of life in India and worldwide. The best implementation practices were observed where cross-sectional programs were carried out in relation to health services and social security for P&NMs and children.

Trend Analysis of Maternal Health Care Services in Nepal

This study attempts to analyze the trend in maternal health care utilization: antenatal care, delivery care, and postnatal care in Nepal. Maternal health remains a major challenge in developing countries despite improvements in medical technology and several efforts to improve maternal health care services. This study is based on Nepal Demographic and Health Survey data from 2006, 2011, and 2016. It covers 4,066 women in 2006, 4,148 in 2011 and 3,998 in 2016 for antenatal care. In the study, this analysis is confined to women aged (15-49) who had a live birth in the five years preceding the survey. Data on delivery care were obtained for all births that occurred in the five or two years preceding the survey. This study comprises 2030 women in 2011 and 1,978 women in 2016 aged 15–49 years who had a live birth in the two years preceding the survey on childbirth, and postnatal care. Especially, the study deals with antenatal, delivery care, and postnatal care. There is a substantial increase in the utilization of antenatal care (ANC) by skilled health providers from, 44 percent in 2006 to 84 percent in 2016 respectively. Still, six percent percentage do not seek even one-time ANC care and the percentage of women who seek 4 or more ANC care from a skilled service provider is low. Still, two fifth percent of delivery take place at home. postnatal service is still very low in Nepal. This study’s results suggest the need for efforts to be addressed to improve the use of maternal health care services in Nepal. There is a need to increase the use of postnatal checkup as well as delivery assisted by skilled attendants.

Protocol for a multicentre prospective observational study of families with full-term infants on postnatal wards and in the community to capture feeding practices across the first year of life: the Mother Infant Lactation Questionnaire (MILQ) study

IntroductionBreastmilk is considered the gold standard for infant nutrition. Breast feeding is recommended as the sole source of nutrition between birth until around 6 months of age and should be...

A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa.

BackgroundThe factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities.AimThis study compared the prevalence of PND and associated factors among women attending postnatal services facilities.SettingThe study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa.MethodsA total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children’s characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates.ResultsThe overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14–0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05–0.40; p ≤ 0.001]). Significant associations of probable PND with several factors – planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events – were more common in the FSP than in the GP.ConclusionThe prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings.ContributionThe results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.

Understanding Your Baby: protocol for a controlled parallel group study of a universal home-based educational program for first time parents

BackgroundInfant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver’s ability to notice and interpret the child’s behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant’s behavioral cues. MethodsThis study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants’ behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors’ register.DiscussionResults will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population.Trial registrationhttps://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416

Pengaruh Vulva Hygiene Terhadap Penyembuhan Luka Perineum Pada Ibu Nifas Di Polindes Marengan Laok Kecamatan Kalianget

The process of childbirth often results in tearing of the birth canal which causes bleeding in varying amounts. One source of bleeding that comes from perineal wounds that require optimal care. Based on data obtained from the Polindes Marengan Laok, it showed that 7 postpartum mothers (70%) had their perineal wounds in 1 week still wet, moist, some even had pus. The purpose of this study was to determine the effect of vulvar hygiene on the healing of perineal wounds on the 7th day of postpartum women.&#x0D; This type of research is correlation analytic. Based on the time this research uses cross sectional. The independent variable is vulva hygiene and the dependent variable is perineal wound healing. The population is 30 postpartum mothers in Marengan Laok Village with a total sampling technique. Data collection techniques using questionnaires and checklists.&#x0D; Based on the cross tabulation, almost all respondents who performed vulvar hygiene well (88.2%) had their perineal wounds healed as many as 15 respondents, and respondents who lacked vulva hygiene mostly (62.5%) did not heal perineal wounds as many as 5 respondents. From the statistical test of the contingency coefficient using SPSS 18, it was found that 2 count &gt; 2 table (7,297 &gt; 5,991). Based on the coefficient value (0.442) there is a moderate relationship between vulva hygiene and healing of perineal of postpartum women in the Marengan Laok Village.&#x0D; Based on these conclusions, the solution that can be done is that health workers should further improve postnatal services, especially in conducting home visits to prevent, detect, and treat problems in the perineal wound healing process.&#x0D; &#x0D; Keywords: Vulva hygiene, perineal wound, postpartum mother.

P5 - Expectant and new fathers’ health literacy and engagement in maternity and early infant health services

Fathers’ participation in antenatal and postnatal (perinatal) health services is widely recommended, yet rarely achieved at desired levels. One barrier may be health services’ poor understanding of fathers’ health literacy. This study aimed to investigate (a) health literacy strengths and barriers, and (b) associations between health literacy and health service engagement, among expectant and new fathers, to inform the development of more father-inclusive health services. Cross-sectional study. Expectant and new fathers (infants born since 2020) were recruited in August 2021 through Prolific, an international paid online survey platform. The survey included the Health Literacy Questionnaire (HLQ) which encompasses nine conceptually distinct dimensions of health literacy, and questions about fathers’ engagement with perinatal health visits. Surveys were completed by 889 men (46.8% with pregnant partners, 53.2% with infants up to 18mnths). Respondents resided in the USA (30.9%), UK (27%), South Africa (17.5%) and other countries (24.7%). Highest HLQ scores among respondents were in Scale 9: ‘Understanding health information enough to know what to do’ (Mean 4.13, scale range 1-5) and Scale 8 ‘Ability to find good health information’ (Mean 4.05, scale range 1-5). Lowest HLQ scores were seen for Scale 3 ‘Actively managing my health’ (Mean 2.94, scale range 1-4), and Scale 1: ‘Feeling understood and supported by health care providers’ (Mean 2.96, scale range 1-4). Most fathers (81.8%) attended at least half of health visits with their partners/infants; regular attendance was associated (p<0.01) with higher scores on seven HLQ subscales. Expectant and new fathers report good basic, functional health literacy skills but face barriers to engaging actively in their healthcare. Health services should consider ways to improve their support for fathers. These data can inform tailored health information and engagement strategies for fathers, with potential long-term benefits for fathers, partners and infants.

Contributing Factors on Utilization of Postnatal Care Services among the Mothers of a Rural Municipality

Introduction: The postnatal period is a period of adjustment for both the mother and her new family member. This is a critical stage because a large proportion of maternal and neonatal deaths occur during the postnatal period. This study aimed to identify the factors that influence mothers' use of postnatal care services. Methods: Descriptive cross-sectional study was conducted among 163 mothers with children aged eight days to less than one year. The data was collected through face-to-face interviews using a semi- structured interview schedule using a non-probability purposive sampling technique. SPSS version 20 was used to analyze the data, which was then described using descriptive and inferential statistics. Results: Only 10.4% had received full postnatal care services within seven days following last childbirth. There was a significant association with respondents' education level (p-value = 0.03), history of abortion (p-value = 0.005), importance of PNC at the ANC checkup (p-value = 0.001), place of delivery (p-value = 0.004), duration of hospital stay (p-value &lt;0.001), and health complications during recent childbirth (p value= &lt;0.001). In binary logistic regression analysis, it showed that respondents' education more than secondary 4.6 times than up to secondary and duration of hospital stay more than 24 hours 85.5 times more than less than 24 hours were more likely to fully utilize the postnatal care services. Conclusion: Despite the accessibility and availability of postnatal care services, the level of utilization is low. Respondents fully utilize the first postnatal service but do not use the full package as recommended by protocol.

DETERMINANTS OF POSTNATAL CARE SERVICE UTILIZATION AMONG REPRODUCTIVE AGE WOMEN IN BASSO LIBEN WOREDA, NORTH WEST ETHIOPIA

Objectives: The objective of the study is to assess the determinants of postnatal care service utilization among reproductive age women in Basso Liben woreda. Methods: The data were collected from a representative sample of 374 populations using systematic sampling technique. The major strategy of the study was mixed approach. In quantitative study, the data were collected using structure questionnaires. The study participants were women of reproductive age (15–49 years) who gave birth in the past 2 years before the study. The dependent variable is utilization of at least one postnatal care visit within 6 weeks of delivery. Bivariate and multivariate analyses were employed to determine the association between dependent and independent variables. Results: From the total respondents, 37.7% of the mother and 20.3% of newborn had gotten postnatal checkup within the first 6 weeks, respectively. From PNC users, 51.1% of the mother and 47.4% of the newborn had utilized PNC 1 time, respectively. Based on multivariate analysis maternal education, number of ANC follow-up, PNC information before delivery, monthly income, place of delivery, and attendant during delivery have statistically significance association with postnatal health-care service utilization. Conclusion: The use of postnatal care service utilization is still limited in the study area. Only 37.7% of the mother and 20.3% of newborn had gotten postnatal checkup. Establishing qualified health facility around the area, expanding transport accessibility, and providing vehicles like ambulances that used to take mothers in the health facility are used to improve postnatal care service utilization.

Magnitude and associated factors of suicidal behavior among postpartum mothers attending public health centers of Addis Ababa, Ethiopia

BackgroundIn low-income nations, suicidal conduct increases within the first year following delivery, ranging from 4 to 17.6%, with a three-fold cause of maternal death. Suicidal behavior was also reported to be 14% among postpartum women in Ethiopia.ObjectiveTo assess the magnitude and associated factors of suicidal behavior among postpartum mothers attending public health centers in Addis Ababa, Ethiopia, 2021.MethodsA cross-sectional study was conducted in ten public health facilities of Addis Ababa, Ethiopia with a total sample size of 615 women. The data were entered into Epi data 4.6 and exported to SPSS version 25 for statistical analysis. A logistic regression model with adjusted odds ratio (AOR), 95% confidence interval (CI) and p-value of ≤0.05 was used to identify predictors of the outcome variable.ResultsThe magnitude of suicidal behavior among postnatal mothers attending public health centers in Addis Ababa was 41.46% with 95%CI (35.2-44.5%). Being mother’s literate (adjusted odds ratio (AOR) = 0.64, 95% CI: 0.42-0.97), verbal abuses (AOR = 2.18, 95% CI: 1.38-3.44), history of rape (AOR = 3.03, 95% CI 1.14 -8.05), history of depression (AOR = 4.12, 95% CI 1.21-14.03), women’s having sexually unfaithful husband (AOR = 1.42, 95% CI 1.14-6.23) and khat chewing (AOR = 8.48, 95% CI 2.52-28.50) were significantly associated with suicidal behavior.ConclusionThe magnitude of suicidal behavior among postnatal mothers attending public health centers in Addis Ababa was 41.46% and it was found to be associated with being literate, rape, verbal abuse, having a history of depression, having a sexually unfaithful husband and chewing khat. As a result, women should be screened for suicidal behavior during antenatal and postnatal services for early detection and management.

An Observational Review Of Determinants Of Perinatal Deaths In Kwahu East, West And South Districts

Background: Perinatal deaths, largely occurring in full-term pregnancy1, are usually of unknown causes even with statutory routine autopsy performance. Autopsies reveal causes in only 40%4. Data paucity remains a major challenge in developing countries.Objective: The study aimed to identify determinants of perinatal deaths in three Kwahu Districts and assess their preventability.Methodology: An observational study with an unmatched case control design using Health Facilitybased data.Results: Most perinatal deaths occurred at term. Mean gestational age at delivery was 37 and 38.8 weeks for cases and controls respectively. Cases were mainly rural residents with informal occupations and comparatively higher gravidity and parity. Controls hadhigher educational backgrounds. Factors associated with perinatal deaths were Rural residence, OR - 2.7 (95% CI = 2.02 - 3.6), grandmultiparity OR - 2.0 (95% CI = 1.3 - 3.2), mal presentation OR - 2.5 (95% CI = 1.4 - 4.4), Low Birth Weight OR - 2.3 (95% CI = 1.4 -3.8), delayed second stage OR - 8.4 (95% CI = 2 - 27), Hypertensive disease OR - 3.0 (95% CI = 1.8 - 3.6), uterine rupture OR - 2.0 (95% CI = 1.8 - 2.1) and prematurity OR - 3.8 (95% CI = 2.7 - 5.3). Formal occupations OR - 0.4 (95% CI = 0.3 - 0.7), referrals OR - 0.6 (95% CI = 0.4 - 0.7), tertiary education OR - 0.3 (95% CI = 0.2 - 0.5) and adequate ANC OR - 0.5 (0.3 - 0.6) significantly reduced odds of deaths.Conclusions: Perinatal deaths remain preventable with accessible quality ANC, delivery and postnatal services supported by comprehensive, sustainably funded surveillance. The Human Rights Based Approach to programming must be prioritized.

Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice.

Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice.

Determinants of Mental Healthcare-Seeking Behavior of Postpartum Women in Ibadan, Nigeria.

The mental healthcare-seeking behavior of postpartum mothers has received little attention in Nigeria. Previous studies in the country have focused on determinants of physical health-seeking behavior, choice of maternal healthcare provider, prevalence, and determinants of maternal mental illness, yet, determinants of maternal mental health-seeking behavior among Nigerian women has been understudied. This study, therefore, examined the determinants of mental health-seeking behavior among postpartum women in Ibadan, Nigeria. Maternal mental illness, which was proxied using postpartum depression, was computed using the Edinburgh Postpartum Depression Scale. Data for the study were obtained through a survey method using a 9-page questionnaire. A 3-stage sampling technique was employed. The first stage was a stratified sampling to disaggregate the health facilities offering postnatal and immunization services on the basis of ownership of public and private healthcare providers. In the second stage, seven healthcare facilities comprising three (3) private and four (4) public healthcare were purposively selected based on the number of attendees. The final stage was a random selection of 390 postpartum mothers attending postnatal and immunization clinics across seven healthcare facilities. The prevalence of depression among the mothers was 20.8%. While only 39.5% of the depressed women sought care, 22.3% of the non-sufferers also sought mental healthcare. This revealed that both sufferers and non-sufferers sought mental healthcare. Also, a higher incidence of postpartum depression among the sufferers increased the likelihood of seeking mental healthcare. Age, family history of postpartum depression, and having the desired gender of child were determinants of mental health-seeking behavior. Among the sufferers of postpartum depression who failed to seek care, a low perceived need for mental healthcare, the perception that the depressive symptoms will go on their own, as well as fear of being stigmatized as a “weak mother”, were reasons for not seeking mental healthcare. Thus, to promote mental healthcare, the non-cost factors, like availability and accessibility to a mental healthcare facility should be addressed. To achieve this, mental healthcare sensitization programs should be integrated into maternal healthcare at all levels, and mothers attending antenatal clinics should be routinely screened for early symptoms of depression in the postpartum period.

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.

Magnitude and Determinant Factors of Postpartum Depression Among Mothers Attending Their Postnatal and Vaccination Services at Public Health Institutions of Addis Ababa, Ethiopia.

BackgroundThe postpartum period is known as a high-risk period for the onset of different maternal mental health problems. Globally, 10–20% of postnatal mothers suffer from depressive symptoms. This study aimed to assess the magnitude and determinant factors of postpartum depression among mothers attending their postnatal and vaccination services at public health institutions in Addis Ababa, Ethiopia.MethodologyHealth institution-based cross-sectional study was conducted among 461 postnatal mothers attending public health institutions in Addis Ababa from 15 May 2021 to 15 July 2021. A multistage sampling technique was employed to select the public health institutions and a systematic random sampling method was used to get selected, postnatal mothers. Epidata version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.ResultsFrom total postnatal mothers 91(19.7%) of them had postpartum depression. Occupational status [AOR = 3.39, 95% CI: 1.04, 8.15], marital status [AOR = 2.69, 95% CI =1.33, 5.45], income management [AOR = 3.76, 95% CI: 1.53, 8.21], sex of baby [AOR = 5.07, 95% CI: 1.24, 20.69], history of child death [AOR = 6.93, 95% CI: 2.67, 15.79], unplanned pregnancy [AOR = 3.08, 95% CI: 1.65, 7.93], negative life event [AOR = 2.39, 95% CI: 1.03, 5.39], substance use during pregnancy [AOR = 6.23, 95% CI: 2.72, 20.05], history of depression [AOR = 5.08, 95% CI: 1.79, 14.39], and marriage satisfaction [AOR = 6.37, 95% CI: 2.63, 14.29] were determinant factors of postpartum depression.ConclusionThe prevalence of postpartum depression in this study is high compared to national findings. Occupational status, marital status, income management, sex of baby, history of child death, unplanned pregnancy, negative life event, substance use during pregnancy, history of depression, and marital satisfaction were determinant factors of postpartum depression. The ministry of health should integrate mental health services with existing maternal health care services. It would be better if all healthcare professionals working in the maternal and child health unit will routinely screen postpartum depressive symptoms and link them to mental health services.

Mobile phone use among mothers seeking postnatal services in Kakamega County, Kenya

Background/Aims Mobile phone use is increasing globally, with Kenya having increased use in rural and urban areas. Despite the widespread use of mobile phones, their use in health delivery services, such as to enhance postnatal care attendance, is low. Kenya is exploring interventions such as the use of mobile health to improve uptake. This study aimed to determine mobile phone use among postnatal mothers in Kakamega County, Kenya. Methods This was a descriptive cross-sectional study using quantitative data. It was carried out among 240 postnatal mothers in Kakamega County. Systematic sampling was used to recruit the participants from three hospitals and data were collected using questionnaires. Data were analysed using the Chi squared test to determine associations between sociodemographic characteristics and perceptions of mobile phone use to improve postnatal care attendance. Results The majority of participants (87.0%) owned a mobile phone. Over half (53.0%) used their mobile phone many times a day, with 61.0% sending SMS many times a day and 65.0% making voice calls many times a day. Almost all participants (93.0%) said they would recommend the use of an SMS or voice call service for postnatal care attendance to their friends. Frequency of mobile phone use (P=0.000), SMS use (P=0.042) and voice call use (P=0.007) were all significantly associated with perception of mobile phone use to improve postnatal care attendance, as was antenatal care visits (P=0.005). Conclusions The majority of participants owned mobile phones and felt positive about mobile phone use to improve postnatal care. The county government of Kakamega should integrate mobile phone technology with the delivery of postnatal services to improve attendance.