Factors associated with postnatal care utilisation in Rwanda: A secondary analysis of 2010 Demographic and Health Survey data

Abstract

BackgroundPostnatal care (PNC) in the first seven days is important for preventing morbidity and mortality in mothers and new-borns. Sub-Saharan African countries, which account for 62 % of maternal deaths globally, have made major efforts to increase PNC utilisation, but utilisation rates remains low even in countries like Rwanda where PNC services are universally available for free. This study identifies key socio-economic and demographic factors associated with PNC utilisation in Rwanda to inform improved PNC policies and programs.MethodsThis is a secondary analysis of the 2010 Demographic and Health Survey, a national multi-stage, cross-sectional survey. In bivariate analysis, we used chi-square tests to identify demographic and socio-economic factors associated with PNC utilisation at α = 0.1. Pearson’s R statistic (r > 0.5) was used to identify collinear covariates, and to choose which covariate was more strongly associated with PNC utilisation. Manual backward stepwise logistic regression was performed on the remaining covariates to identify key factors associated with PNC utilisation at α = 0.05. All analyses were performed in Stata 13 adjusting for sampling weights, clustering, and stratification.ResultsOf the 2,748 women with a live birth in the last two years who answered question about PNC utilisation, 353 (12.8 %) returned for PNC services within seven days after birth. Three factors were positively associated with PNC use: delivering at a health facility (OR: 2.97; 95 % CI: 2.28–3.87), being married but not involved with one’s own health care decision-making (OR: 1.69; 95 % CI: 1.17, 2.44) compared to being married and involved; and being in the second (OR: 1.46; 95 % CI: 1.01–2.09) or richest wealth quintile (OR: 2.04; 95 % CI: 1.27–3.29) compared to the poorest. Mother’s older age at delivery was negatively associated with PNC use (20–29 – OR: 0.51, 95 % CI: 0.29–0.87; 30–39 – OR: 0.47, 95 % CI: 0.27–0.83; 40–49 – OR: 0.32, 95 % CI: 0.16–0.64).ConclusionsLow PNC utilisation in Rwanda appears to be a universal problem though older age and poverty are further barriers to PNC utilisation. A recent change in the provision of BCG vaccination to new-borns might promote widespread PNC utilisation. We further recommend targeted campaigns to older mothers and poorest mothers, focusing on perceptions of health system quality, cultural beliefs, and pregnancy risks.

Postnatal care utilization and associated factors among women of reproductive age Group in Halaba Kulito Town, Southern Ethiopia

“…The higher tendency of PNC utilization by employed mothers might be due to mothers who are involved in paid employment are more likely to be economically independent and consequently have access to services, and utilize the services when they need or as recommended by their health workers [25]. Evidence showed that having a paid job empowers mothers to utilize maternal health services [26, 29, 30]. …”

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey

“…1). Women who delivered at home were the interest of this analysis for PNC service use because women who delivered at health facility were more likely to receive postnatal care even though the care was likely to be initiated by health care providers and thus does not measure women’s health seeking behavior [29–32].

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Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey

“…From these mothers, 1,055 who delivered at home were studied to identify factors associated with receiving postnatal care ( Figure 2). We focused on women who delivered at home because women who deliver at a health facility are more likely to receive postnatal care, which is initiated by health care providers and thus does not measure women's health seeking behavior [63][64][65][66].…”