Factors Associated with Post-Natal Care Utilization among the Women of Reproductive age Group: Evidence from Bangladesh Demographic and Health Survey 2017–18

Dominant predictors of postnatal care utilization among ever-married mothers of reproductive age in Bangladesh

The majority of maternal mortality occurs during the postpartum period worldwide. Therefore, postnatal care (PNC) is crucial for both mother's and newborn's survival. Unfortunately, PNC is underutilized in Bangladesh and well below any admissible level. The purpose of this study is not only to identify the potential factors associated with PNC but also to explore the more intriguing aspect of finding the most important determinants of PNC receipt among mothers in Bangladesh. Binary logistic regression analysis was employed to determine the factors associated with PNC receipt using data from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The BDHS 2017-18 utilized a two-stage stratified sampling method, selecting 675 enumeration areas (EAs) in the first stage with probability proportional to size and then choosing a systematic sample of 30 households from each EA in the second stage. The analysis considered mothers with a most recent child under three years of age at the time of the survey, leading to a total of 4899 women. The response variable of interest is the receipt of PNC from a medically trained provider (MTP) within two days of delivery. It is observed that 52.8% of mothers received PNC from MTP within two days of childbirth. The variables mother's age at birth, birth order, mother's education level, place of residence, wealth index, media exposure, antenatal care (ANC) visits, working status, and region are all found to be significantly associated with PNC seeking behavior. General dominance (GD) analysis was employed to assess variable importance because complete, and conditional dominances rarely occur. GD is the simplest among the three dominances and can be computed without computing the other two by using a simpler subset model structure. Considering the two-stage stratified sampling design, the analysis reveals that ANC visits, family wealth status, and the mother's education level were the three most dominant predictors of PNC visits, explaining approximately 68% of the total variance. The results suggest that policymakers and stakeholders should intensify the existing facilities to increase awareness of taking ANC visits, which would eventually encourage women to take PNC. Additionally, efforts should be made to help economically disadvantaged women overcome the barriers that prevent them from accessing maternal health care. Finally, the government of Bangladesh should stimulate women to complete at least their secondary education.

Non-utilisation of postpartum services in northwestern Nigeria: analyses of trend and social determinants from 2003 to 2018

OBJECTIVE

To assess the prevalence of non-utilisation of postpartum services in northwestern Nigeria from 2003 to 2018 and to identify and estimate the influence of social determinants, a crucial step in improving maternal and child health in the region.

DESIGN

The 2003, 2008, 2013 and 2018 Nigeria Demographic and Health Survey rounds were used. Descriptive, trend and multivariable logistic regression analyses were used to show the trend and assess the influence of social determinants. The sample consisted of 17 294 women aged 15-49 who responded to questions on postpartum attendance during the period.

SETTING

Northwestern geographical subregion of Nigeria.

OUTCOME

The non-use of postpartum services.

RESULTS

The non-utilisation of postpartum services has increased from 77% in 2003 to 87% in 2018, with an overall prevalence of 88% of all women not using the services. The odds of not using postpartum services were higher for women with no education (adjusted OR (AOR): 1.27; CI: 1.03 to 1.58), those with no knowledge of contraceptives (AOR: 1.72; CI: 1.35 to 2.19), those who never used contraceptives (AOR: 1.71; CI: 1.39 to 2.09), those with parity of four or more births (AOR: 1.58; CI: 1.34 to 1.86), those in polygynous marriage (AOR: 1.16; CI: 1.03 to 1.30) and those from the poorest (AOR: 2.34; CI: 1.67 to 3.28) and poorer (AOR: 2.05; CI: 1.50 to 2.78) households. The odds were lower for women who wanted to delay pregnancy (AOR: 0.74; CI: 0.55 to 0.99) and those with full (AOR: 0.56; CI: 0.42 to 0.75) or joint (AOR: 0.67; CI: 0.53 to 0.83) autonomy in healthcare decisions.

CONCLUSION

The findings are crucial for understanding and addressing the non-utilisation of postpartum services in northwestern Nigeria. Policymakers should aim to address the impacts of the identified social determinants to promote the use of postpartum services, prevent maternal deaths and meet the SDG-3.1 target.

Spatial distribution and determinants of early postnatal discharge among vaginally delivered mothers in Ethiopia: spatial and multilevel analysis of Ethiopian demographic survey data

Background

Postnatal hospital care is aimed to detect any complications for both mother and child. Postnatal care should start as early as possible, especially during the first 24 hours. No study assessed the hotspot areas of early postnatal discharge and its community and individual level determinants in Ethiopia. Therefore this study aimed to fill the mentioned gap.

Methods

This study used the Ethiopian demographic and health survey 2016. A total of 2443 delivered mothers were included in the analysis. The non-spatial analysis was conducted using Stata V.14. A mixed-effect multilevel logistic regression model was fitted. Model comparison was done using Akaike's information criterion and log-likelihood ratio. Global Moran's index, spatial autocorrelations and spatial scan statistics were conducted. Multicollinearity was checked. P values <0.25 and 0.05 were used as a cut-off point to declare statistical significance for the bivariable and multivariable regression models, respectively.

Results

The early postnatal discharge was spatially clustered (Moran's index=0.077, p<0.05). Hotspots of early postnatal discharge were detected in most parts of Benishangul Gumuz, central Amhara, north east Southern Nations, Nationalities, and Peoples' Region (SNNPR) and western Oromiya. Being literate, no media exposure, having three to four antenatal care visits, size of child and history of abortion were statistical significant determinants of early postnatal discharge.

Conclusions

Hotspot areas of early postnatal discharge were detected in parts of central Amhara region, Benishangul gumz, the northeastern parts of SNNPR and western Oromiya. Sociodemographic and reproductive related factors determine early postnatal discharge.

Early postnatal care uptake and its associated factors following childbirth in East Africa-a Bayesian hierarchical modeling approach

Background

The postnatal period is a critical period for both mothers and their newborns for their health. Lack of early postnatal care (PNC) services during a 2-day period is a life-threatening situation for both the mother and the babies. However, no data have been examined for PNCs in East Africa. Hence, using the more flexible Bayesian multilevel modeling approach, this study aims to investigate the pooled prevalence and potential factors for PNC utilization among women after delivery in East African countries.

Methods

We retrieved secondary data from the Kids Record (KR) demographic and health surveys (DHS) data from 2015 to 2022 from 10 East African countries. A total of 77,052 weighted women were included in the study. We used R 4.3.2 software for analysis. We fitted Bayesian multilevel logistic regression models. Techniques such as Rhat, effective sample size, density, time series, autocorrelation plots, widely applicable information criterion (WAIC), deviance information criterion (DIC), and Markov Chain Monte-Carlo (MCMC) simulation were used to estimate the model parameters using Hamiltonian Monte-Carlo (HMC) and its extensions, No-U-Turn Sampler (NUTS) techniques. An adjusted odds ratio (AOR) with a 95% credible interval (CrI) in the multivariable model to select variables that have a significant association with PNC was used.

Results

The overall pooled prevalence of PNC within 48 hrs. of delivery was about 52% (95% CrI: 39, 66). A higher rate of PNC usage was observed among women aged 25-34 years (AOR = 1.21; 95% CrI: 1.15, 1.27) and 35-49-years (AOR = 1.61; 95% CrI: 1.5, 1.72) as compared to women aged 15-24 years; similarly, women who had achieved primary education (AOR = 1.96; 95% CrI: 1.88, 2.05) and secondary/higher education (AOR = 3.19; 95% CrI: 3.03, 3.36) as compared to uneducated women; divorced or widowed women (AOR = 0.83; 95% CrI: 0.77, 0.89); women who had currently working status (AOR = 0.9; 95% CrI: 0.87, 0.93); poorer women (AOR = 0.88; 95% CrI: 0.84, 0.92), middle-class women (AOR = 0.83; 95% CrI: 0.79, 0.87), richer women (AOR = 0.77; 95% CrI: 0.73, 0.81), and richest women (AOR = 0.59; 95% CrI: 0.55, 0.63) as compared to the poorest women; women who had media exposure (AOR = 1.32; 95% CrI: 1.27, 1.36), were having 3-5 children (AOR = 0.89; 95% CrI: 0.84, 0.94), had >5 children (AOR = 0.69; 95% CrI: 0.64, 0.75), had first birth at age < 20 years (AOR = 0.82; 95% CrI: 0.79, 0.84), had at least one ANC visit (AOR = 1.93; 95% CrI: 1.8, 2.08), delivered at health facilities (AOR = 2.57; 95% CrI: 2.46, 2.68), had average birth size (AOR = 0.94; 95% CrI: 0.91, 0.98) and small birth size child (AOR = 0.88; 95% CrI: 0.84, 0.92), had twin newborns (AOR = 1.15; 95% CrI: 1.02, 1.3), and fourth and above birth order (AOR = 0.88; 95% CrI: 0.82, 0.95) were individual-driven women who have been independently associated with PNC, respectively. Regarding community-level variables, rural women (AOR = 0.76; 95% CrI: 0.72, 0.79), high media exposure communities (AOR = 1.1; 95% CrI: 1.04, 1.18), communities with high wealth levels (AOR = 0.88 95% CrI: 0.83, 0.94), communities with high antenatal care (ANC) utilization (AOR = 1.13, 95% CrI: 1.07, 1.19), and long distance to health facilities (AOR = 1.5; 95% CrI: 1.38, 1.63) were among the community factors associated with PNC, respectively.

Conclusion

One of the significant public health priorities in East Africa continues to be the underutilization of immediate PNC. The government ought to prioritize improving maternity and child health services, collaborating with interested parties in the area, reducing health disparities, educating mothers about child health, and other connected issues that are very beneficial.

Factors Influencing Postnatal Care Utilization Among Women in Sub-Saharan Africa: A Scoping Review

BACKGROUND:Considerable progress has been made globally in improving maternal and child health. However, Sub-Saharan Africa (SSA) and South Asia together accounted for 86% of all maternal deaths in the world during the 2000–2017 period. It is estimated that more than 60% of global maternal deaths occur during the postnatal period. The utilization of postnatal care (PNC) services remains low in SSA. This scoping review aimed to determine factors that influence PNC utilization among women in SSA.

METHODS:Peer-reviewed articles published in English from 2018 to 2023 were searched from Google Scholar, ScienceDirect, MEDLINE, African Journals Online, SCOPUS, and PubMed databases. Two authors independently screened the articles and extracted the data.

RESULTS:Thirty-nine articles were included in this review. Thirty-three of the studies were of a quantitative cross-sectional study design, four were mixed-methods, and two were qualitative studies. The review identified several enablers and barriers to PNC utilization among women, which were categorized into individual, community-level, and healthcare system factors. Some of the individual factors included the place of residence, marital status of the woman, employment status, educational level of both the woman and her partner, and household income. Health system factors included accessibility of healthcare facilities, availability of resources, and the quality of healthcare.

CONCLUSION:To improve PNC utilization in SSA, several strategies should be implemented. These strategies should address issues such as women’s empowerment, accessibility of healthcare facilities, the quality of healthcare services, and healthcare services financing.

Utilisation of postnatal care services among maternal in Maeen District - Sana'a City, Yemen

BACKGROUND

One of the most effective ways to reduce maternal and neonatal mortality is to improve mother and newborn health via the provision of appropriate postnatal care services by qualified healthcare providers. However, there is limited information on the use of postnatal care services in Yemen. This study aimed to determine the utilisation of postnatal care services among mothers in Yemen.

METHODOLOGY

A descriptive cross-sectional study was conducted in the Maeen District of Sana'a City, Yemen from December 2022 to January 2023. Convenience sampling was employed to recruit 321 participants. Semi-structured questionnaires were applied as the study tool in the face-to-face survey.

RESULT

Less than half (45.2%) of the study participants utilised postnatal care services in this study. The mode of delivery, place of delivery, and receiving information about postnatal care during antenatal visits were significantly associated with postnatal care service utilisation.

CONCLUSION

Less than half of the study participants were informed about postnatal care services, contributing to their low utilisation. Thus, it is vital to strengthen the provision of information, education, and communication with regard to postnatal care services among pregnant mothers visiting antenatal clinics.

Comparison of inequality in utilization of postnatal care services between Bangladesh and Pakistan: Evidence from the Demographic and Health Survey 2017-2018

BACKGROUND

Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan.

METHODS

The study used the latest Demographic and Health Survey (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated.

RESULTS

In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women's education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624; and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643; and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595; and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women's education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743).

CONCLUSION

Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.