Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey

Abstract

BackgroundPostnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health facilities in Tanzania.MethodsThis study examined the role of individual and community-level variables on the use of postnatal health services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression analysis. We analyzed data of 1931 women, who had delivered in the preceding 2–14 months, from a two-stage household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received. Community level variables included community levels of family planning, health service utilization, trust, poverty and education, and distance to health facility.ResultsLess than one in four women in Morogoro reported having visited a health facility for postnatal care. Individual-level attributes positively associated with postnatal care use were women’s education of primary level or higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04–1.81], having had a caesarean section or forceps delivery (2.95, 1.8–4.81), and being counseled by a community health worker to go for postnatal care at a health facility (2.3, 1.36–3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19–3.15), and whose partners tested for HIV (1.41, 1.07–1.86). High community levels of postpartum family planning usage (2.48, 1.15–5.37) and high level of trust in health system (1.77, 1.12–2.79) were two significant community-level predictors. Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33–0.76), health center (0.57, 0.38–0.85), or dispensary (0.48, 0.33–0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43–0.97).ConclusionsIn the context of low postnatal care use in a rural setting, programs should direct efforts towards reaching women who do not avail themselves of postnatal care as identified in our study.

Factors associated with the compliance of recommended first postnatal care services utilization among reproductive age women in Benin Republic: an analysis of 2011/2012 BDHS data

“…27 In addition to the place of residence, differences in terms of PNC services utilization across areas where noticed as found in Tanzania. 9,18 Ethnicity had an independent influence on PNC utilization in this study area as shown also in previous studies on PNC utilization and maternal health services utilization in general. 18,25 This could be explained by underlying cultural beliefs and values systems of different ethnic groups which influence health perceptions, needs, and behaviour of their group members.…”

“…16,26 Increasing household income increases women's chances for PNC services seeking in Benin Republic as showed elsewhere. 18 Other studies 9,17 found weak or no relationship. In many sub-Saharan African countries, financial hardships on one hand and the cost of medical treatments on the other hand are among the leading means preventing people from modern health systems utilization.…”

“…They were: household wealth status; maternal education attainment; ANC utilization; desire of pregnancy; ethnic; distance to health facilities; place of residence; place of delivery; newborn's health status after delivery. 9,[16][17][18] Despite such findings, evidences are inconsistent. While study from Kanté et al found significant association with ANC attendance and household income, Mohan and colleagues found no or weak association.…”

“…While study from Kanté et al found significant association with ANC attendance and household income, Mohan and colleagues found no or weak association. 9 In addition, factors pertaining to supply and demand side of health services, attitudes towards maternal PNC services and perception on quality of health services in health facilities, and the state of roads (routes), the availability of transport for emergencies were found to be strong predictors for PNC seeking. 17,19 Benin Republic is one of the countries where high maternal and child mortality persist.…”

“…4,7,9 Global estimates showed that over two third of newborns deaths could be saved through existing maternal and child health programmes. 6,10 PNC coverage at 90%, could allow avert up to 10 to 27% of newborns deaths.…”