Determinants of early postnatal care attendance: analysis of the 2016 Uganda demographic and health survey

Abstract

Background: The first 2 days after childbirth present the highest risk of dying for a mother. Providing postnatal care within the first 2 days after childbirth can help avert maternal mortality because it allows early detection of problems that could result in adverse maternal health outcomes. Unfortunately, knowledge of the uptake of early postnatal care (EPNC), which is imperative for informing policies aimed at reducing maternal mortality, remains low in Uganda. Therefore, the purpose of this study is to investigate the determinants of early postnatal care attendance among Ugandan women. Methods: This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5471 women (age 15-49) who delivered a child in the 2 years preceding the survey. We used logistic regression to identify factors associated with use of early postnatal care. Results: Our findings showed that 50% of mothers used EPNC services for their most recent delivery in the 2 years preceding the survey. Women's residence, education level, religion, wealth status, marital status, occupation, antenatal care attendance, place of delivery, birth order, perceived accessibility of health facilities, and access to mass media messages were associated with greater use of EPNC. The percentage of women receiving EPNC was much higher among women who delivered at a health facility, either a public facility (63%) or private facility (65%), versus only 9% among women who delivered at home. Multivariate analysis showed that delivery at a health facility was the most important determinant of early postnatal care attendance. Conclusions: To increase mothers' use of EPNC services and improve maternal survival in Uganda, programs could promote and strengthen health facility delivery and ensure that EPNC services are provided to all women before discharge. Even so, the fact that only about two-thirds of women who delivered at a health facility received early postpartum care shows substantial room for improvement. Interventions should target women who deliver at home, women who attend fewer than four antenatal care visits, and women with a primary education.

Postnatal care utilisation among women in rural Ghana: analysis of 2014 Ghana demographic and health survey

“…Partner’s education was recoded into no education = 1, primary = 2 and secondary or above = 3; and finally health decision making capacity was recoded into alone = 1 and not alone = 2. These variables were selected because of their theoretical importance and practical significance to maternal healthcare utilisation [ 21 , 22 ]. Frequency of reading newspaper/magazine, listening to radio and watching television were included in the analysis because they have been found as significant predictors of antenatal care utilisation and skilled birth attendance [ 23 , 24 ].…”

Factors influencing early postnatal care utilisation among women: Evidence from the 2014 Ghana Demographic and Health Survey

“…For certainty in responses, women who affirmed 'don't know' were excluded from the analysis. Women who delivered through caesarean section (CS) are likely to spend several days at health facilities to ensure smooth recovery and management of further complications that might arise; hence, they are likely to have early and consistent PNC checks and were excluded in conformity with a previous study [20].…”

“…Ndugga et al [20] assessed determinants to EPNC and found that delivery at a health facility was the most important determinant of EPNC attendance. However, their study was conducted in Uganda, hence their findings might not be wholly applicable in Ghana.…”

“…Anderson's healthcare utilisation model shall be used as a guide for this study in order to address this question appropriately [20][21][22][23]. The model purports that healthcare utilisation is determined by predisposing, enabling and need factors [23,24].…”

“…In this study, it is anticipated that EPNC uptake shall be determined by predisposing factors (including age, level of education, residence, religion, wealth status, ethnicity, marital status, region); enabling factors (such as access to mass media, health decision making, hold a valid NHIS card); and need factors (such as total children ever born and perceive distance to health facility) (Fig 1). The model provided a robust analytical framework for explaining drivers to EPNC uptake [20].…”