Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey

Abstract

Introduction Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. Methods This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. Result In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. Conclusion Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

“…Mothers who had at least one visit by a health eld worker had higher odds of PNC utilisation, a nding similar to that of other studies done in similar contexts [35,36]. The repeated contact with health workers during pregnancy through ANC services and visits by health eld workers promote con dence and familiarity with the health system leading to increased trust in the health system [24]. This emphasizes the need to build capacity among eld health workers, so that they are empowered to counsel women to seek PNC services at the community level in addition to strengthening the services in the health facilities.…”

“…Several studies conducted in Uganda, Ethiopia, Malawi, Zambia and Tanzania, have shown that increased frequency of ANC contacts is associated with higher odds of PNC utilisation [24,27,28,32,33]. Similarly, in this study the odds of PNC utilisation were two times higher among woman who had eight or more ANC contacts compared to their counterparts who had fewer.…”

“…Majority of the women had less than eight ANC contacts (78.0%), had skilled birth attendance (88.3%) were residing in rural areas (61.9%), were Muslims (78.7%), had no education (52.7%), resided in male headed households (75.3%), were married (81.9%), working (77%) and aged between 20 and 34 years (65.9%). Mass media exposure was limited with 57.7% of women not exposed to radio, We found that 42.8% of the participants had at least one PNC contact, which is slightly higher than that recorded in Ethiopia, Rwanda and Ghana [21][22][23][24][25]. On the other hand, it is lower than the reported prevalence of 48.4% for Malawi, 63% for Zambia and 78.4 % for Indonesia [26][27][28].…”

“…Factors associated with PNC utilisation in Sierra Leone as per the 2019 SLDHS We found that 42.8% of the participants had at least one PNC contact, which is slightly higher than that recorded in Ethiopia, Rwanda and Ghana[21][22][23][24][25]. On the other hand, it is lower than the reported prevalence of 48.4% for Malawi, 63% for Zambia and 78.4 % for Indonesia[26][27][28].…”

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

“…Poverty has been associated with poor postpartum nutritional status [37,38], incidence of SSIs [17,39], and poor post-natal care [40]. A study in Ethiopia reported that irrespective of mode of delivery, women with low income were almost half as likely to seek postpartum care [41], and a study in Iran found that rural women who did not received enhanced postpartum follow-up reported poor functional status at six weeks postpartum [41]. Financial hardship faced by poor women in our study could affect post-discharge follow-up and care, and in turn could impede their ability to recover fully.…”