Utilization Of Postnatal Services Research Articles

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.

Assessing the Utilization of Postnatal Services Among Mothers: A Cross-Sectional Study

Assessing the Utilization of Postnatal Services Among Mothers: A Cross-Sectional Study

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.

Impact of mobile health on maternal and child health service utilization and continuum of care in Northern Ghana

Maternal and child mortality are of public health concern. Most of these deaths occur in rural communities of developing countries. Technology for maternal and child health (T4MCH) is an intervention introduced to increase Maternal and Child Health (MCH) services utilization and continuum of care in some health facilities across Ghana. The objective of this study is to assess the impact of T4MCH intervention on MCH services utilization and continuum of care in the Sawla-Tuna-Kalba District in the Savannah Region of Ghana. This is a quasi-experimental study with a retrospective review of records of MCH services of women who attended antenatal services in some selected health centers in the Bole (comparison district) and Sawla-Tuna-Kalba (intervention district) of the Savannah region, Ghana. A total of 469 records were reviewed, 263 in Bole and 206 in Sawla-Tuna-Kalba. A multivariable modified Poisson and logistic regression models with augmented inverse-probability weighted regression adjustment based on propensity scores were used to quantify the impact of the intervention on service utilization and continuum of care. The implementation of T4MCH intervention increased antenatal care attendance, facility delivery, postnatal care and continuum of care by 18 percentage points (ppts) [95% CI - 17.0, 52.0], 14 ppts [95% CI 6.0%, 21.0%], 27 ppts [95% CI 15.0, 26.0] and 15.0 ppts [95% CI 8.0, 23.0] respectively compared to the control districts. The study showed that T4MCH intervention improved antenatal care, skilled delivery, postnatal services utilization, and continuum of care in health facilities in the intervention district. The intervention is recommended for a scale-up in other rural areas of Northern Ghana and the West-African sub-region.

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.

The Impact of Mobile Health Interventions on Antenatal and Postnatal Care Utilization in Low- and Middle-Income Countries: A Meta-Analysis.

Despite many efforts, the utilization of full antenatal and postnatal care remains a significant concern in low- and middle-income countries (LMICs). We planned to retrieve the relevant literature and pooled the data for meta-analysis to evaluate the impact of mobile health (mHealth) intervention on antenatal and postnatal care utilization in low- and middle-income countries. We searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, and Ovid with selected keywords and explored the reference list of articles. Meta-analysis was performed using the RevMan software version 5.4; p-value < 0.05 was considered statistically significant. The effect of variables was measured in odds ratio (OR) with a fixed-effects model. Six published interventional studies were selected as per the eligibility and participants, intervention, comparison, and outcome (PICO) framed for systematic review and meta-analysis. The search was restricted to articles in the English language, articles published online, and preprinted articles until September 2020. Outcome variables include antenatal and postnatal care utilization by pregnant and delivered mothers. The results have been presented in the form of a forest plot. The findings of this meta-analysis depicted the significant increase in four or more antenatal care (ANC) attendance (OR = 1.81, 95% confidence interval (CI) = 1.49-2.19), tetanus toxoid (TT) immunization (OR = 1.63, 95% CI = 1.17-2.27), compliance to iron supplementation (OR = 1.88, 95% CI = 1.18-3.00), and postnatal care attendance (OR = 2.54, 95% CI = 2.15-2.99) among those pregnant mothers who received mHealth intervention compared with the control group. This meta-analysis creates evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes. Technology is changing, but even with limited support such as short messaging service (SMS), there was an improvement in antenatal and postnatal service utilization. This meta-analysis concluded that mHealth has the potential to increase the utilization of antenatal and postnatal care compared to standard care, although the level of evidence is moderate.

Barriers to Utilization of Postnatal Care Services: Mothers and Health Providers Perspective.

Access to and utilization of post-natal care services is a major challenge as the majority of maternal deaths occur during post-natal period. Although geographical factors and access to health facilities in urban area are feasible as compared to rural area the utilization of all three postnatal visits remains low. Hence, this study aims to explore the barriers in utilization of postnatal care services by mothers from the perspective of mother's and health service providers as well. A qualitative study was done using community- based exploratory design in urban area of Kathmandu district. In-depth interview with mothers with infants above 45 days to 1 year of age and key informant interviews with health care providers were done using interview guidelines. Thematic analysis was done. Seven themes emerged through thematic analysis, which were further classified into category and sub categories. Poor recording and reporting system, poor health communication, postnatal care visits less prioritized among maternal health services, prerequisites to construction, and postnatal care services/information dependent on female community health volunteer, less utilization of mass media, and perception of people were identified as barrier for utilization of postnatal services. The common reason for non-utilization of postnatal care service is identified as poor health communication that resulted in lack of knowledge on the benefit and timing of postnatal care. Lack of awareness among women on postnatal care services shows lack of effort in making postnatal care related information easily available and accessible. Hence, education and awareness on postnatal care services along with proper therapeutic communication is seen essential to complete the continuum of care in maternal health services.

Postnatal Service Utilization and AssociatedFactors among Women Who Gave Birth in thelast 12 Months prior to Study Period in JimmaTown, Southwest Ethiopia

Background: Postnatal care is care (PNC) given to mother and new born within first 42 days of delivery. Lack of care in this period may result in disability even death of either of mother or newborn or both. The aim of this study was to determine postnatal service utilization and associated factors among women, who gave birth in the last 12 months prior to May, 2019. Methods: Community based cross-sectional study was conducted on 420 women who had given birth prior to May 1 to June 30, 2019 (study period). The 17 kebeles of Jimma town is grouped into three similar groups based on occupation of majority of population. Three kebeles were randomly selected from each group. Data was collected using a pretested structured questionnaire. Descriptive statistic, such as frequencies, proportions and means were calculated. In bivariate logistic regression variables with p-value less than 0.25 were selected for multiple logistic analyses and multiple logistic regression was conducted. Finally significantly associated variables were declared at p value less than 0.05. Result: This study showed that prevalence of postnatal care utilization was 59.5%. Mothers who knew at least one danger signs which comes after delivery (AOR=11.5, (95%CI:5.56,22.7), who attended ANC (AOR=5.4, 95%CI:2.7,11.3 ), who get counseled to attend PNC (AOR=14.9%CI:6.1,31.4), who attended at least primary school (AOR=2.3, 95%CI:1.75,7.0), who did not travel more than 30 minutes to reach health facility (AOR=6.8,95% CI 3.4, 13.6 and those having more family size were more likely utilized postnatal service than their counterpart Conclusions: In this study utilization of postnatal care service was very far behind national target (which is 95% at the end of 2020, health sector transformational plan). Awareness about danger signs, educational status of the mother, counseling to attend to attend postnatal care, distance from health facility and family size were strongly associated with PNC utilization.

A cross sectional study on utilization of postnatal services in rural health training centre, Chandragiri, Andhra Pradesh

Introduction: Majority of maternal deaths can be prevented through appropriate maternal health services. According to NHFS-3 postnatal care tends to be low at 36%, percentage of deliveries with a post natal checkup in India is 41.2% and in Andhra Pradesh it is 73.3%. Percentage of deliveries with a post natal checkup within 2 days of birth is 37.3% in India and 64.1% in Andhra Pradesh.1 In developing countries like India; the utilization of basic health services has remained poor. Materials and Methods: A community based cross sectional study conducted among 211 women at rural health training centre, Chandragiri. Women who had delivered more than six weeks ago (completed puerperal period) and within six months after delivery were included in the study. Results: The mean age of study subjects was 23.1±2.1 years. Of the total study subjects, majority (90.1%) were aware about postnatal services and 186 (88.2%) utilized postnatal services. Conclusion: Knowledge and utilization of post natal services are good in the present study area especially at peripheral level. Health education programmes should be implemented to further increase the utilization. Keywords: Post natal care, Post natal services, Utilization, Maternal health.

Changes in Maternal Care During the Healthcare Reforms in the Republic of Georgia

Since 1991, the health system of the Republic of Georgia has passed through several phases of reform. Privatization and marketization of the healthcare system are among the major reforms. The aim of this study was to analyze the changes in the utilization of, and access to maternal care services during the period 1999–2010. Secondary analysis was done using data from three national reproductive health surveys (RHS). From three RHSs we selected 7,684 women who experienced childbirth/s during 5-years prior to each survey. We analyzed data on pregnancy outcome, type of childbirth, access and utilization of prenatal, natal and immediate postnatal care, and looked at associations with maternal age, ethnicity, educational level, employment status, residence, religion, and economic status. Binary and multinomial regressions were the main statistical models used along with descriptive statistics. We found that the overall utilization of prenatal care services was quite high; in the first wave, it was 92.1% then increased to 95.1% and 98.1% in the second wave and in the third wave respectively. However, utilization of postnatal services was quite low. According to RHS 1999–2000 only 10.7% of mothers utilized postnatal services, which increased to 23.3% in 2010. Women of age group 30–34 were more likely not to use prenatal care services than the other age groups. Rural dwellers, women with lower education level, and women with lower income were less likely to utilize prenatal check-ups. According to the findings from the survey, there were improvements in access to prenatal and natal care as well as utilization of maternal care services over the years. Overall, the use of maternal care has improved during the reforms.

An assessment of utilization of postnatal care services in urban area Jabalpur district

Background: Postnatal period is a vulnerable time, because most maternal and new born deaths occur during this period, especially immediately after childbirth. Postnatal care in the first hours and days after childbirth could prevent the great majority of these deaths. The objective of study was to assess the utilization of post-natal care and associated factors for low utilization in urban area of Jabalpur district.Methods: A community based cross-sectional study was carried 360 mothers who delivered in last one year in urban area of Jabalpur district. Sampling method was multistage sampling method. A total 36 wards with 10 mothers from each ward was selected. The questionnaire included information related to mode of delivery, post-natal checkups and visits of health care providers.Results: Among 360 mothers, 93.9% mothers received first postnatal check-up within 24 hrs. 1.11% of mothers between 2-3 days and 1.67% of mothers received first postnatal check-up between 4-7 days while 3.33% of mothers didn’t receive any postnatal check-up. Regarding number of post-natal visits, 58.33% mothers received 3 or more postnatal visits, 35% of mother received 2 PNC visits, while 3.3% did not receive a single postnatal visit. The education of mothers, joint type of family, high socioeconomic status, early registration of pregnancy, minimum 4 ANC visits and institutional deliveries were found significantly associated with utilization of postnatal check-up.Conclusions: Utilization of postnatal services is still poor in the urban areas even though the physical accessibility was adequate. In the present study, it was concluded that the role of education, especially of female education, is important contributing factor associated with utilization of postnatal care.

Determinants of postnatal care utilization in Tigray, Northern Ethiopia: A community based cross-sectional study.

IntroductionGlobally, 289,000 women die from complications related to pregnancy, childbirth, or the postnatal period every year. Two-thirds of all maternal deaths occur during the first six weeks following birth and more than two thirds of newborn deaths occur during the first week of life, These statistics underscore the importance of postnatal care, an often neglected service according to the World Health Organization (WHO). The purpose of this study was to assess the factors associated with postnatal service utilization in the Tigray region of Ethiopia.MethodsThe study was a community-based, cross-sectional study. A multi-stage sampling method was used to select study districts randomly from the entire region. A total of 1,690 participants were selected using systematic random sampling. Participants were 18–49 years old, had given birth within the last six months, and were residents of the district for at least six months. Using SPSS version 20 means, frequencies, and percentages were calculated for the sub-group of participants who did attend postnatal care. Barriers to non-attendance of postatal care were analyzed using descriptive statistics. Bivariate analysis was undertaken to assess the association between demographic, obstetric, and knowledge regarding PNC and attendance at antenatal care. Variables with a P value, <0.05 were included in the multivariate logistic regression analysis to identify the determinant factors of postnatal care utilization.ResultOf the women surveyed, 132 (8%) obtained postnatal care. Women who did not receive postnatal care reported lack of awareness of the services (n = 1110, 73.3%). Most mothers who received postnatal care reported that they were aware of the service prior to the birth of their child (n = 101, 76.5%). Women were more likely to receive postnatal services if they lived in an urban area (odds ratio 1.96, 95% confidence interval 1.07, 3.59), had greater than a secondary education (OR 3.60, 95% CI 1.32,9.83), delivered by cesarean section (OR 2.88 95% CI 1.32,6.29), had four or more antenatal visits (OR 4.84, 95% CI 1.57,14.9), or had a planned pregnancy (OR 6.47, 95% CI 2.04,20.5).ConclusionPostnatal care service utilization is very low in Tigray region. Interventions targeted at increasing women’s awareness of the importance of postnatal services and improving accessibility, particularly in rural areas, is needed.

Utilization of Maternal Health Care Services among Mothers Residing at Slum Area.

Appropriate utilization of maternal health care services is very important tool to reduce the maternal and child morbidity and mortality rate. This study was conducted to assess the utilization of maternal health care services by the women for their last pregnancy in one year period and to find out it's association with selected variables. Descriptive cross sectional study was conducted for one year by using semi-structured questionnaire among 285 mothers residing at slums area of Dharan sub-metropolitan city after taking written consent from them. Ethical clearance was obtained from Institutional Review Committee, BPKIHS and Dharan Sub-metropolitan city office. Simple random sampling followed by snowball sampling method was used to collect the data by interview method. Majority (95.1%) had one Antenatal visit, 60.4% had initiated antenatal visit at first trimester and 78.99% had completed 4 or more antenatal visits. Only 35.8% had taken complete dose of iron and calcium. Majority 262 (91.92%) respondents have taken Tetanus Toxoid immunization and among them only 74.42% had taken 2 dose of TT injection. Women who delivered in health facility accounted for 70.9% but only 28.8% went for postnatal visit. Majority (65.3%) received health advice during postnatal period. Nearly 40% respondents used family planning after post partum period .There was significant association between utilization of antenatal and delivery services with Educational status of respondents and their husbands and number of pregnancy and between utilization of postnatal services with occupation of husband. Utilization of maternal health care services, antenatal services utilization were satisfactory whereas postnatal services and family planning services utilization were very poor. Utilization of maternal health services should be encouraged by conducting public awareness programmes.

Medical Perspective of Childhood Marriage in Nigeria: Body of Evidence from 2013 Nigeria Demographic and Health Survey

Background: Available data from South Asia and sub-Saharan Africa indicates that 12% and 34% of girls were married at age 15years and 18years respectively. This practice of child marriage may debar countries from achieving the Sustainable Development Goals. Objective: To extract and present disaggregated indices in the 2013 Nigeria Demographic and Health Survey (NDHS) on the effect of child marriage on health. Method: This desk review study extracted disaggregated maternal and child health indices on married females aged 15-19 years from the 2013 NDHS. Results: The result showed that married females aged 15-19 years were short, thin, and least likely to receive prophylactic Vitamin A dose postpartum and deworming medication at last pregnancy. Also, while awareness for Family Planning (FP) was high, its utilization was poor at only 1.2%. Their Antenatal clinic attendance, facility delivery, skilled birth attendance at delivery and post natal service utilization were lowest. Similarly, mortality of children under 5 was highest amongst these mothers. Although violence during pregnancy was highest amongst this group, nevertheless more than 20% of them agreed that the practice of female circumcision should be continued. Conclusion: These findings depict some of the negative outcomes of child marriage on maternal and child survival which require integrated multisectoral interventions to ensure that all girls have access to timely sexual reproductive health services and information.&lt;/P&gt;

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey

BackgroundPostnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia.MethodsA facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance.ResultsThe prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91–21.86) and (3.35, 95% CI: 1.10–10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06–9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55–27.75) than women who lacked knowledge about the services.ConclusionsPostnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Utilization of Postnatal among Mothers having under Two years Child in Mahalaxmi Municipality, Lalitpur, Nepal

Postnatal care is a critical phase in the lives of mothers and newborn babies as major changes occur during this period which determines the well-being of mothers and newborns. Adequate utilization of postnatal care can help reduce maternal as well as infant morbidity and mortality. Thus, this study generates the information regarding postnatal care utilization in Lubhu of Mahalaxmi Municipality. This was a descriptive cross-sectional study carried out in a Lubhu of Lalitpur district. The study sample comprised of 130 mothers having unser2 year’s children in year 2017. A pre-tested structured questionnaire was used for data collection. The findings showed that majority of mothers fall under age group 20-29, maximum were from Hindu and Newar ethnicity. This study highlighted more than half (67.7%) mothers utilize the postnatal services. One of the important reasons for not utilizing postnatal services is absence of disease condition in child followed by less knowledge about postnatal services. There was a significant (p=0.018) association between mothers’ education status with utilization of postnatal services. This study concludes that maternal education status affects the maternal utilization of postnatal care services. In order to achieve 100% postnatal care utilization, awareness programs, educational package and other various Postnatal women focused program must be conducted to make them aware about the importance of the utilization of Postnatal services and availability of Postnatal services in different level of health facility.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

BackgroundThe Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients’ satisfaction with these services with a focus on quality of care.MethodsWe used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE’s Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women’s socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items.ResultsWe found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women’s use and satisfaction with the perinatal health services received.ConclusionsQuality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Proportion and factors affecting for post-natal care utilization in developing countries: A systematic review

Background: Majority of neonatal and maternal mortalities occur in developing countries. Moreover, around half of both mortalities occur in immediate postnatal period. Postnatal care utilization is aimed to reduce both mortalities and promote their health status.Methods: We searched PubMed, Google Scholar and HINARI between Jan 1, 2006 and Apr 31, 2014. Cross-sectional studies, surveys published in English language with finding of percentage of and factors affecting postnatal care utilization were included in the analysis. Weighted percentage with 95% CI was calculated to summarize the proportion. Odds ratio of minimum and maximum value was used to summarize associated factors. P-value &lt;0.01 was taken as cut-off for significance of associated factors.Results: Of 45 accessed and reviewed full-text articles, nine included in the review. The studies were conducted in seven countries and total postnatal mothers in all samples were 49385. The weighted percentage of postnatal service utilization was 36.0 (95% CI, 22.5-49.5). Mother’s and husband’s higher educational level; higher wealth quintile of the family; occupation; mother's age at last delivery; number of ANC visit; and number of pregnancy were found associated with postnatal care utilization.Conclusion: The data that only around one in every three mothers utilizing post-natal care shows that scaling-up and improving the service is imperative. The education including literacy programs for both mother and husband; scaling-up of 4th ANC visit; creating earning opportunities for mothers and focusing the mothers of 20-30 years age group would be some intervening areas, however, further evaluation and reviews from interventional designs are suggested before reaching the firm conclusion.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.14-19

Implementation and Operational Research: Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results From the SHAIP Cluster-Randomized Controlled Trial in Kenya.

Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. This study aimed to determine whether integration of HIV services into ANC settings improves PMTCT service utilization outcomes. ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or nonintegrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), whereas control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. HIV care enrollment was higher in intervention compared with control clinics [69% versus 36%; odds ratio = 3.94, 95% confidence interval (CI): 1.14 to 13.63]. Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, hazard ratio = 2.20, 95% CI: 1.62 to 3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%; odds ratio = 3.22, 95% CI: 1.81 to 5.72). Infant testing was more common in the intervention arm (25% versus 18%), however, not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions.