Postnatal Care Service Utilization Research Articles

Second dose of measles-containing vaccine coverage and associated factors among children aged 24–36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023

BackgroundMeasles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24–36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023.MethodsA community-based cross-sectional study was conducted among 621 children aged 24–36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association.ResultsA total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1–78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43–6.44), first birth order (AOR: 4.45, 95% CI: 1.21–16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62–16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27–5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67–15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15–3.4), and good perception (AOR: 3.6, 95% CI: 2–6.47) about measles vaccination.Conclusion and recommendationsThe coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.

Factors Influencing Postnatal Care Utilization Among Women in Sub-Saharan Africa: A Scoping Review

BACKGROUND:Considerable progress has been made globally in improving maternal and child health. However, Sub-Saharan Africa (SSA) and South Asia together accounted for 86% of all maternal deaths in the world during the 2000–2017 period. It is estimated that more than 60% of global maternal deaths occur during the postnatal period. The utilization of postnatal care (PNC) services remains low in SSA. This scoping review aimed to determine factors that influence PNC utilization among women in SSA.METHODS:Peer-reviewed articles published in English from 2018 to 2023 were searched from Google Scholar, ScienceDirect, MEDLINE, African Journals Online, SCOPUS, and PubMed databases. Two authors independently screened the articles and extracted the data.RESULTS:Thirty-nine articles were included in this review. Thirty-three of the studies were of a quantitative cross-sectional study design, four were mixed-methods, and two were qualitative studies. The review identified several enablers and barriers to PNC utilization among women, which were categorized into individual, community-level, and healthcare system factors. Some of the individual factors included the place of residence, marital status of the woman, employment status, educational level of both the woman and her partner, and household income. Health system factors included accessibility of healthcare facilities, availability of resources, and the quality of healthcare.CONCLUSION:To improve PNC utilization in SSA, several strategies should be implemented. These strategies should address issues such as women’s empowerment, accessibility of healthcare facilities, the quality of healthcare services, and healthcare services financing.

Health professionals’ perspectives on the role of obstetric ultrasonography in maternity care in rural eastern Ethiopia: a qualitative descriptive study

ObjectiveThe purpose of this exploratory study was to assess healthcare providers’ perspectives on maternity care following the introduction of ultrasound services in the area.DesignThe qualitative descriptive study.Study settingThis study was...

Effects of Social Economy, Exclusive Breastfeeding, Complementary Feeding, and Physical Environment on the Stunted Children’s Development

Background: Maternal and infant morbidity and mortality continue to be a challenge today. Most maternal and newborn deaths occur during the early postnatal period. This condition can be caused by low utilization of postnatal care services. This study aims to analyze and estimate the influence of determining factors on the utilization of postnatal care services.
 Subject and Methods: Meta-analysis was conducted using PRISMA guidelines and PICO format. Population: Postpartum Mothers. Intervention: high antenatal care, high maternal education, high family income and delivery in hospital. Comparison: low antenatal care, low maternal education, low family income, home birth. Outcome: postnatal care services. Cross-sectional study articles were collected from Google Scholar, PubMed, and Science Direct databases. The search strategy used the keywords: "Determinant Postnatal Care" AND "Maternal Health Service" AND "Cross-Sectional". The inclusion criteria for this study were full-text, cross-sectional studies published from 2014 to 2023. Data from articles were extracted with RevMan 5.3.
 Result: The meta-analysis included 16 cross-sectional studies from Ethiopia, Ghana, Kenya, and Malawi. The total sample was 29,165 postpartum mothers. Postnatal mothers with high antenatal care visits (aOR= 2.64; 95% CI= 1.87 to 3.71; p = 0.001), high education (aOR= 2.09; 95% CI= 1.67 to 2.63; p = 0.001), high family income ( aOR= 1.63; 95% CI= 1.25 to 2.11; p = 0.002), and hospital delivery (aOR= 1.58; 95% CI= 1.15 to 2.97; p = 0.010) allow the utilization of postnatal care services and these results were statistically significant.
 Conclusion: The results of this study reveal that high antenatal care, high maternal education, high family income and delivery in hospital have a positive effect on the utilization of postnatal care services.
 Keywords: antenatal care, health institutional, maternal education, family income, postnatal care.
 Correspondence: Rahmi Windhy Astari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java 57126, Indonesia. Email: rahmiwindhy@gmail.com. Mobile: 082288­470778.

Individual and community-level factors associated with women’s utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BackgroundOver time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women’s utilization of postnatal care services in Uganda.MethodsSecondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.ResultsThe result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78–2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01–1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.ConclusionThis study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study

BackgroundPromoting a favorable experience of postpartum care has become increasingly emphasized over recent years. Despite the fact that maternal health care services have improved over the years, postnatal care service utilization is generally low and the health-related quality of life of postpartum women remains overlooked. Furthermore, the health-related quality of life of postpartum women is not well studied. Therefore, this study aimed to assess the health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia, Region, Ethiopia.MethodsA community-based cross-sectional study was conducted among 429 participants. A multistage stratified sampling procedure was used to select the sampling unit and simple random sampling technique was employed to select the study participants from 23 August 2022 to 16 November 2022. A pre-tested standard structured questionnaire was used to collect the data. Data were entered using Epi-Data 3.1 and then exported to Statistical package for social science version 26. Binary logistic regression analysis was computed at p-value < 0.25 were considered candidates for multivariable logistic regression. Adjusted Odds Ratios (AOR) with 95% confidence interval and statistical significance was declared at a p-value < 0.05.ResultsThe study revealed that 73.7% (95% CI: 69.4–77.7) had a low level of health-related quality-of-life with a mean of 44.02 (SD ± 10.4). Urban residing [AOR = 0.27, 95% CI: (0.10–0.74)], no education [AOR = 3.44, 95% CI (1.35–8.74)], received at least four antenatal contact [AOR = 0.56, 95% CI (0.33–0.95)], received at least one postnatal care [AOR = 0.30, 95% CI (0.14–0.62)], poor social support [AOR = 2.23, 95% CI: (1.025–4.893)], having postpartum depression [AOR = 2.99, 95% CI: (1.52–5.56)], cesarean delivery [AOR = 3.18, 95% CI: (1.09–9.26)], and lowest household assets [AOR = 5.68, 95% CI: (2.74–11.76)] were significant associations with low health-related quality of life of postpartum women.ConclusionsThe health-related quality of life among postpartum women was very low. Postpartum women with low socio-economic status and inadequate maternal health service utilization had a low health-related quality of life. Promoting women’s education and postnatal care services is needed to improve the health-related quality of life of postpartum women.

Determinants of Exclusive Breastfeeding Among Mothers of Infants Less Than Six Months of Age in Mogadishu: A Facility-Based Cross-Sectional Study

Background Breastfeeding is a vital practice for infant health and well-being, with exclusive breastfeeding (EBF) during the first six months being particularly crucial. Despite its benefits, EBF is sub-optimally practiced in many low-to-middle income countries. This study focuses on Somalia, a country with historical political instability and poor health indicators, aiming to identify the prevalence and determinants of exclusive breastfeeding among women with infants under six months attending SOS Mother and Child Hospital in Mogadishu. Methods A hospital-based cross-sectional design was used, and data were collected through a structured questionnaire. The study sample consisted of 345 mothers, selected using a systematic sampling technique. Descriptive, bivariate, and multivariate analyses were conducted to assess breastfeeding practices and determine factors influencing exclusive breastfeeding prevalence. Result The study found that the prevalence of exclusive breastfeeding among the study population in Somalia was 44%, influenced by factors such as maternal education, employment, and utilization of antenatal and postnatal care services. Male infants and younger infants had higher odds of being exclusively breastfed. Conclusion and recommendations The study emphasizes the importance of promoting exclusive breastfeeding as the optimal feeding practice for infants in Somalia, highlighting the need for comprehensive health education during antenatal care visits and postnatal counseling. It recommends the development of supportive policies, such as maternity leave and workplace accommodations, along with community-based initiatives and support groups to facilitate and encourage exclusive breastfeeding practices.

Predictors of Postnatal Care Services Utilisation among Women of Childbearing Age in Kenya: A Facility-Based Study

Globally, approximately 295,000 women die annually as a result of pregnancy and childbirth-related complications. Sub-Saharan Africa accounts for 66 % of the estimated maternal deaths. Maternal death occurs during the first 24-48 hours up to 42 days post-delivery. The major causes are haemorrhage, sepsis, and hypertensive complications, which can be prevented by effective utilisation of postnatal care services. To improve maternal, new-born and infant health and reduce mortality ratio, which reciprocates the quality of services received during the early postnatal period. The objective of the study was to determine the factors influencing the utilisation of postnatal care among mothers attending St. Joseph Mission Hospital, Taita/Taveta County. A descriptive cross-sectional study design was adopted, and a convenient sampling technique was used to sample 145 postnatal mothers. The findings showed that the majority of mothers who utilised postnatal care were between the ages of 21 and 32 years; their parity was between 2(25.2%) and 3(24.4%) children. Inferential analysis revealed that education and occupation p=0.00, religion p=0.008, knowledge p=0.001 when to start PNC p=0.000, decision maker p=0.008 and importance p=0.001 were significantly associated factors in the utilisation of postnatal care. The study concluded that most postnatal mothers attended postnatal care visits at 2 weeks post-delivery and only attended one or two visits during the entire postnatal period. The study recommends that more awareness of postnatal care should be emphasised at a facility level, community level, and the entire county level to ensure that mothers are given updated information on PNC services during the ANC

Utilization of Maternal Health Care Services in Himachal Pradesh: An Empirical Analysis

More than 500,000 maternal deaths during pregnancy, childbirth, or within a few weeks of delivery occur as a result of poor maternal health delivery in developing countries. Along with many other socioeconomic determinants, the persistent lack of accessibility and underuse of antenatal and other healthcare services continues to be a significant contributor to the high rates of maternal death. The main objective of the present study is to examine the utilization of maternal healthcare services, such as antenatal care (ANC), intranatal care (INC), and postnatal care (PNC), in Himachal Pradesh and what are the determinants which influence the utilization of maternal health care services. The cross-sectional design and multistage stratified random sample used in the study covered three administrative zones within Himachal Pradesh. 576 respondents participated in the study sample, and data were gathered using structured questionnaire. The result of the study showed that majority of the respondents had utilized at least one of the maternal healthcare services. A generous percentage of respondents chose public hospitals for ANC, with Mandi having the most significant consumption of ANC services. Normal delivery was predominant and most of the deliveries took place in public hospitals. The rate of PNC service utilization was relatively low. It was concluded from the study that the importance of education and income in improving maternal healthcare outcomes requires focused interventions to raise PNC service utilization.

Post-natal care: a vital chance to save mothers and infants! Exploring barriers and factors associated with it: a mixed study.

The most effective maternal health intervention for enhancing mother and baby survival is postnatal care, yet it is also the most neglected service in Ethiopia. Less is known about postnatal care despite earlier studies concentrating on pregnancy and delivery service utilization. Postnatal care is the subject of few national and local area studies. Therefore this research aims to evaluate postnatal care utilization and barriers and associated characteristics among women in Ilubabor Zone and Buno Bedele Zone. A mixed-methods study involving women who visited immunization clinics was conducted in Southwest Ethiopia. For the quantitative part, a cross-sectional survey was conducted between June 12 and July 12, 2022. The data collected through interviews was analyzed using SPSS version 26. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value was constructed to evaluate the associations between postnatal care service utilization and explanatory variables. The usage of postnatal care services was determined to be significantly correlated with explanatory variables in multivariable logistic regression with a p-value less than 0.05. This qualitative study used two focused group discussions and two in-depth interviews to gather data from purposely selected mothers, and thematic analysis was used to analyze the data. A total of 422 participants with a 100% response rate were included in the analysis. 234 (55.5%) of these underwent postnatal checks. In the quantitative section, postnatal care counseling and appointment setting, counseling on danger signs, and prior postnatal care utilization all demonstrated a statistically significant association with the use of postnatal care services (AOR = 3.6, 95% CI (1.47-7.23)), [AOR = 2, 95% CI (1.05-3.64)], and [AOR = 3, 95% CI (1.36-58), respectively). At the qualitative level, it was determined that the themes of knowledge and access were obstacles to the use of postpartum care services. Generally this study revealed that the Ilubabor Zone and Buno Bedele Zone have a poor total PNC service utilization rate. Furthermore, ignorance, conventional wisdom, religious activity, distance from facilities, environmental exposure, and waiting time were identified as barriers to postnatal care service utilization. To optimize this service, all parties involved should address these factors.

Prenatal and postnatal care in a frozen conflict zone: results from a household survey

Abstract Introduction Maternal and child health are crucial for the well-being of a society. Armed conflicts negatively affect health systems including maternal and child health services. We explored access and utilization of prenatal and postnatal care services in Nagorno-Karabakh: a frozen conflict zone. Methods We applied cluster sampling to draw a sample of 1023 households in Nagorno-Karabakh in 2022. Interviewer-administered surveys were conducted among women of reproductive age (18-49) from the selected households. The instrument captured key reproductive health, and maternal and child health indicators, for the youngest 0-5 y.o. child. Results Out of 1023 women, 299 (29.5%) had at least one 0-5 y.o. child: 54.5% males and 45.5% females. Almost all the respondents received prenatal care (97.7%), the majority of them (95%) starting in the first trimester with frequency of more than 4 visits (90.7%). The visits included blood pressure measurement (99.3%), urine test (99.7%), blood test (99.7%), checking baby's heartbeat (99.3%), ultrasound (98.3%), nutrition education (82.9%) and breastfeeding counseling (79.8%), and asking about vaginal bleeding episodes (58.2%). Less than half of the respondents reported folic acid (49.5%) and iron (46.5%) supplementation during the pregnancy. While in the healthcare facility, mostly doctors checked mothers’ and babies’ health, 78.6% and 90.3%, respectively. Once discharged, less than 50% of the mothers and more than 80% of the babies received follow-up health checks. Conclusions Despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations. Our findings indicate some gaps in breastfeeding counseling, folic-acid supplementation, and utilization of postnatal services. Capacity-building and community-based educational programs have the potential to improve overall prenatal and postnatal care and build sustainable health systems. Key messages • This unique study showed that despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations. • Capacity building, as well as patient-provider and community-based educational programs have the potential to improve overall prenatal and postnatal care in Nagorno-Karabakh.

Gender-based roles, psychosocial variation, and power relations during delivery and postnatal care: a qualitative case study in rural Ethiopia.

The World Health Organization (WHO) strongly encouraged men to support women in receiving maternal healthcare. However, especially in developing countries, maternal healthcare has traditionally been viewed as an issue in women, with men making little or no contribution, even though sexuality and children are shared products. The study aims to understand how gender-based roles, psychosocial variation, and power relations are related to child delivery and postnatal care (PNC) services. The study was conducted in three rural districts of Oromia regional state, Jimma Zone, Ethiopia. An in-depth interview and focus group discussion were held with carefully chosen health professionals, health extension workers, community health development armies, and religious leaders. The data was collected, translated, and transcribed by experienced men and women qualitative researchers. For data analysis, ATLAS.ti version 9 was used. The data were coded and categorized concerning delivery and PNC service utilization. Independent and shared gender-based roles were identified as a means to improve maternal healthcare service delivery. The result obtained three categories, namely, gender-based roles, psychosocial variation, and power relations. Men can persuade pregnant women to use delivery services and PNC. The place of delivery is determined by the levels of gender-based power relations at the household level, but women are usually the last decision-makers. The belief of the community that giving birth in a health facility makes women look clean and neat, as opposed to home delivery, increases their intention to use maternal healthcare services. The study contributes that the role of a man as a husband is crucial in mobilizing others to carry pregnant women to health facilities, contributing to early intervention during labor. The decision-making capacity of women has improved over time, with men accepting their right to make decisions about their health and fetuses. Home delivery and men not being present during delivery are perceived as signs of backwardness, whereas giving birth in health institutes is seen as a sign of modernization and the rights of women.

Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen’s behaviour model

BackgroundPapua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG.MethodsThe study was conducted using the 2016–2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05.ResultsThe prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women’s employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors.ConclusionsThis study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women’s education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.

Factors affecting access to early postnatal care service among women of urban slum in Bangladesh

Background: Postnatal care (PNC) refers to care and attention to the general mental and physical health of the mother and infant during the period beginning after the delivery of the placenta up to the next six weeks. The postnatal period, the hours and days after birth is critical to the health for survival and is the most vulnerable time for a mother and newborn. Majority of maternal death occur after delivery but the postnatal period is the most ignored time for the establishment of quality services yet now in Bangladesh. The aim of the study was to assess the factors affecting access to early postnatal care service among women of urban slum in Bangladesh. Methods: This was a community based cross sectional descriptive quantitative study conducted among the women of reproductive age who gave birth in the last one year prior to the study period in different slums of Dhaka South City Corporation, Dhaka, Bangladesh during the period from September to October 2016. A stratified sampling method was employed to select the total of 382 study participants for this study. Data were collected by means of a pretested structured interviewer administered questionnaire. Chi square and binary logistic regression analysis was carried out by using statistical package for the social sciences (SPSS) version 21.0. Results: In this study, it was found that, 29.1% women and 29.8% of their baby received postnatal care service (PNC) visit after last delivery. The factors that significantly affected the access to postnatal care service utilization in this study were women’s education, household income, residence, husband’s education and occupation, physical violence against women, place of delivery, ANC visit, PNC checkup for baby, postnatal complications, importance of PNC checkup, knowledge in PNC service, perception of postnatal danger sign, sources of information, transport use, and health insurance. In assessing all those factors, the p values were found as &lt;0.001. Conclusions: Among the common factors affecting access to early postnatal care service among women of urban slum, domestic physical violence against women and health insurance emerged as strong predictors. In Bangladesh there is a crucial need for public health interventions to increase the access rate to early postnatal care service that should target women who need this service at the appropriate time.

Barriers to Utilization of Postnatal Care Services within the First 48 Hours of Birth in North West Syria: A Barrier Analysis Study

Objectives: The objective of this study is to identify barriers to the utilization of postnatal care services among mothers and neonates in a conflict-affected area. Methods: This study involves a cross-sectional survey utilizing the Barrier Analysis (BA) approach, which is based on the Health Belief Model and the Theory of Reasoned Action. It explores up to 12 recognized determinants of behavior adoption. The survey was conducted in six communities located in Idlib and western rural Aleppo, representing both urban and rural areas for host and displaced populations in northwest Syria (Selwa, Abin Samaan, Sahara, Tal Elkaramej, Boz Ghaz, Koknaya). Data collection took place from 7th to 11th November 2021. Initially, screening questions were used to verify participants' eligibility for the survey. The interviewed mothers were then classified into two main groups: the first group consisted of mothers of newborns who attended postnatal care within the first 48 hours after birth (DOERS), while the second group comprised mothers of newborns who did not attend postnatal care within the first 48 hours after birth (NON-DOERS). From both groups, a random sample of 90 mothers of newborns aged 0-6 months was selected (45 DOERS and 45 NON-DOERS) out of a total of 418 respondents. Their answers were analyzed based on the 12 determinants included in the questionnaire. All collected data, including coded qualitative data and closed-ended questions, along with their frequencies, were entered into the Standard Barrier Analysis Tabulation Sheet Excel (SBATS). The odds ratio and P-value were calculated, considering results to be "significant" if the P-value was less than 0.05. Results: All demonstrated significant results are being compared between doers (mothers who attend postnatal care within the first 48 hours after birth) and non-doers (mothers who did not attend postnatal care within the first 48 hours after birth) according to the determinants and based on their recurrence, not their percentage. A total of 90 mothers with newborns aged 0-6 months (45 DOERS and 45 NON-DOERS) were interviewed, the findings revealed that 68% of the interviewed mothers had a normal delivery at health facilities, while 20% had a cesarean delivery, and 12% had a normal delivery at home. The barriers to PNC services included the long distance of the health facilities and the absence of transportation, social norms and traditions that prevent women from leaving home after childbirth, overcrowding at health facilities, fear of COVID-19 infection when visiting health facilities, absence of accompanying people, and the perception among mothers that they were unlikely to experience immediate post-birth problems. On the other hand, the enablers for accessing postnatal care services included community-based health support through community health workers, awareness of the available services, the mother's level of education, and a perceived understanding of the risks associated with medical complications that may arise after birth. Additionally, the availability of transportation and economic resources played a facilitating role in accessing postnatal care services. Conclusion: This study examines the low uptake of postnatal care (PNC) services for mothers and neonates in a conflict-affected area. Findings highlight barriers including limited maternal knowledge, inadequate health service coverage, transportation challenges, and social norms.

Contribution of female community health volunteers on the utilization of ANC and PNC by mothers in two districts of Nepal: a Qualitative study

Background and Objectives: A group that has been credited behind the reduction in child and maternal mortality through programs like immunization, integrated management of childhood illnesses, family planning, and preparing pregnant women for delivery are known as Female Community Health Volunteers (FCHV). FCHVs’ roles have gradually expanded beyond family planning programs and especially are focused on maternal and child health services at a large scale. FCHV is often spoken about or spoken for, but there is little evidence of FCHV's own characterization of their practice. so, this study is designed to explores the roles, practices and experiences of FCHVs in the utilisation of Antenatal care (ANC) and Postnatal Care (PNC) services in two contexts; rural and urban Nepal. Materials and Methods: This is a qualitative study carried out in two districts (one urban and the next rural) viz. Kathmandu and Terathum. Questionnaires leading to  in-depth interviews were carried out with 28 FCHVs and 15 service users and Key- Informant Interview with the 8 health facility staff and 15 service users who were purposely selected Data were analyzed using thematic analysis.  Results: The study found out that the FCHVs have been involved rigorously on screening and counseling pregnant women on nutritious foods, counseling family about the birth preparedness, institutional delivery, ANC and PNC services provided at the health facility in rural Nepal. While in urban Nepal, the referrals on ANC existed only in those places which were outside the ringroad. The PNC services were not that used by the mothers in rural Nepal while the PNC referrals were not made by urban FCHVs as the maternity hospital itself called for a follow-up. The motivating factors for FCHVs were self-identity, social responsibility and social recognition and status that kept them in doing voluntary workers over the years. Conclusion: FCHVs have been contributing a lot of their time and effort to every possible way to make the women of their community survive while being pregnant or after delivery. This study also underlines some of the differences in the real picture of their roles in urban and rural Nepal.

Factors Associated With Utilisation of 4th Postnatal Care among Mothers Seeking Vaccination for Children in Selected Health Facilities in the City of Kigali, Rwanda

Maternal mortality remains a global public health concern. Maternal mortality rate was 211deaths per 100,000 live births in 2017 with sub-Saharan Africa accounting for two third. A strengthened postnatal care can significantly reduce this unacceptable mortality. This study aims at assessing the factors associated with the utilization of 4th postnatal care services among mothers seeking vaccination for their children in selected health centers located in the city of Kigali. A cross-sectional study design was conducted in 10 health centers and 403 mothers were recruited. Data was collected using an interview-administered questionnaire, Chi-square and multivariate analysis were used to examine the relationship between independent variables and PNC4 attendance. Mothers who participated in the study (56.7%) were between the ages of 26 and 35, 47.6% were cohabiting, and 49.6% had completed secondary and TVET school. The attendance of PNC4 was 27%. PNC4 service awareness (AOR = 10.922, 95% CI: 5.869-20.325, P 0.001), ANC attendance (AOR = 2.334, 95% CI, 1.050-5.188, P = 0.038), and religion belief (AOR=0.338, 95% CI, 0.177-0.645, P=0.001) were significantly associated with PNC4 attendance. The utilisation of PNC4 is still low. PNC4 should be strengthened to ensure the well-being of the mothers and children. Keywords: Postnatal care, Vaccination for Children, utilization, Selected Health facilities, Kigali, Rwanda

Factors Associated with Utilization of Postnatal Care Services.

Preventable causes of death accounts for 810 women per day. Care provided during the child-bearing and after the childbirth is of vital importance. Despite of the facts, many women in developing world deprive of this service. Therefore, this study aims to explore the contributing factors for Postnatal care service in urban areas of Chitwan, Nepal. A cross-sectional study was conducted among 212 mothers who delivered within last one year. Data collection was conducted through pre-tested questionnaire in Nepali language after taking ethical approval and informed consent. Descriptive and bi-variate statistics were applied in analysis. Higher number of mothers (39.2%) were in 25-29 years age groups. Hindu were 89.6% and Janajati were 70.7%. Mothers (26.4%) reported to reach nearest health facilities on foot by 30 minutes or more. Nearest health facility had twenty-four hours seven days a week maternal health services for 57.5% of mothers. Antenatal visitors were 83.9% and 96.7% reported institutional delivery. About 27.8% mothers were aware about Postnatal care; 48.1% were aware about maternal complications; 98.1% mothers had at least one PNC visit; and 34.4% reported Postnatal care visit as per protocol. Lack of counseling (52.6%) was one of the main reasons for not completing Postnatal care. Age factor, husband's education, health service-related variables, availability of essential drugs and equipment in health facilities influenced Postnatal care. Fewer mothers reported about complete Postnatal care service. Socio-economic factors, health service-related factors, experience of mothers on their previous childbirth also contributed to complete Postnatal care.

Utilization of Postnatal Care Services among Mothers Residing in Morang District, Nepal

Introduction: Post-natal care is regarded as the care provided to the mother and the baby during first six weeks of childbirth. Large proportion of maternal and neonatal deaths occur during postnatal period. The utilization of postnatal care services helps in preventing maternal and neonatal deaths. The study aim to find out the utilization of postnatal care services among postnatal mothers residing in Morang district, Nepal.Methods: A Cross sectional study was undertaken among 256 postnatal mothers residing in Kanepokhari rural municipality, Belbari and Sundarharaincha municipality of Morang district. Multi stage sampling method was used. Ethical approval was obtained from PUSHS- Institutional review committee (Ref no 041—078/079). Face to face interview was done using self developed semi structure questionnaire to collect the data. Descriptive statistics were performed and chi –square was done. Multivariable logistic regression was doneResults: Nearly half (47.3%) had utilized the postnatal care services. Very few (6.6%) of the respondents were aware about the importance about the PNC utilization. Most (85.2%) of the respondents were unaware about the government protocol of PNC visit. Educational level, duration of stay at hospital parity, danger sign seen in pregnancy, place of delivery and mode of delivery were associated with having utilization of postnatal services. The primi mothers (95% CI: 1.229-0.403) had higher likelihood of having postnatal care utilization.Conclusions: Nearly half postnatal mothers have utilized the postnatal care services. Awareness programme focusing on government protocol for postnatal services should be done to improve the utilization.

Utilization of Postnatal Care Services and Associated Socio-Demographic Factors among Mothers in Sheikhupura

Utilization of Postnatal Care Services and Associated Socio-Demographic Factors among Mothers in Sheikhupura