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

Postpartum Women's Experiences of Postnatal Care in Sub‐Saharan Africa: A Qualitative Evidence Synthesis

Background

Postnatal care (PNC) is a critical service for the health and well‐being of new mothers and newborns. However, in sub‐Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA.

Methods

This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer‐reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co‐ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data.

Results

Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed‐method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high.

Conclusion

Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.

Postpartum Women's Experiences of Postnatal Care in Sub-Saharan Africa: A Qualitative Evidence Synthesis

BACKGROUND

Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA.

METHODS

This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer-reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data.

RESULTS

Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed-method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high.

CONCLUSION

Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.

Factors influencing early postnatal care use among postpartum women in Afghanistan

Using postnatal care (PNC) within the first week following childbirth is crucial, as both the mother and her baby are particularly vulnerable to infections and mortality during this period. In this study, we examined the factors associated with early postnatal care (EPNC) use in Afghanistan. We used data from the multiple indicator cluster survey (MICS) 2022-2023. The study population was ever-married women who delivered a live child during their recent pregnancy within the 2 years preceding MICS 2022-23. The outcome was EPNC and defined as the first check of the mother within the first week of delivery. A binary logistic regression was used, and odds ratio (OR) and 95% CI were obtained. Out of 12,578 women, 16.0% received EPNC. EPNC was lower in women who delivered at home [AOR 0.35 (95% CI 0.28-0.44)] compared with women who delivered at public clinics. EPNC was higher in women with ≥ 4 antenatal care (ANC) visits [1.29 (1.02-162)], in women in the highest quintile of wealth status [1.70 (1.25-2.32)], and in women with access to radio [1.76 (1.45-2.15)]. EPNC use among Afghan women remains low (16.0%). Key factors associated with ENPC utilization include place of delivery, ANC utilization, wealth status, and radio access.

Sociodemographic disparities in postnatal care coverage at comprehensive health centers in Hamedan City

Background

Postnatal care (PNC) is a crucial component of continuous healthcare and can be influenced by sociodemographic factors. This study aimed to examine the sociodemographic disparities in PNC coverage in Hamedan City.

Methods

In this cross-sectional study, we utilized existing data recorded in the Health Integrated System of Hamedan City, located in Iran, from 2020 to 2021. The study population consisted of 853 women who were over 15 years old and had given birth within the past 42 days. The Health Equity Assessment Toolkit (HEAT) software was used to evaluate the socioeconomic inequalities in PNC coverage.

Results

Overall, 531 (62.3%) of the women received three postnatal visits. The absolute concentration index (ACI) indicates that women aged 20-35 years, illiterate women, housewives, insured individuals, and urban residents experience a higher magnitude of inequality in PNC coverage. The negative values of the ACI suggest that the health index is concentrated among disadvantaged groups, with educational level inequalities being more pronounced than those related to age.

Conclusion

Postnatal care coverage among mothers was relatively adequate; however, sociodemographic inequalities existed in the utilization of PNC services. It is recommended that policymakers make efforts to increase access to PNC services for mothers from low socio-economic groups.

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.

Factors Influencing Women's Attendance to Postnatal Clinics in the Primary Healthcare Centers in the Kingdom of Bahrain, 2023

BACKGROUND

Despite the significance of postnatal care for maternal health, the attendance rate of mothers at postnatal clinics (PNCs) in primary healthcare (PHC) centers in Bahrain is low. This study aims to identify factors influencing women's attendance at PNC in PHC centers in the Kingdom of Bahrain and to propose strategies for service improvement.

METHODS

 In January 2023, we conducted a cross-sectional study. We selected mothers who gave birth between six and 12 months before the survey and met inclusion criteria using systematic simple random sampling and obtained consent (n = 319). Data collection utilized an electronic, structured, interviewer-administered questionnaire, and analysis was carried out using SPSS version 28 (IBM Corp., Armonk, NY).

RESULTS

Out of the 319 participants, 31% were unaware of the existence of PNC, 42% were aware but did not attend, and 27% were aware and had attended the clinic. Mother and child department clerks, doctors, health education boards, and midwives served as the primary sources of information about the PNC for only 34%, 16%, 16%, and 11% of participants, respectively. Understanding the importance of PNC, the services offered by a healthcare worker, the booking process, having a vaginal delivery, and prior experience with a PNC visit were significantly associated with PNC attendance (p = 0.0046, p = 0.027, p < 0.001, p = 0.028, and p < 0.001, respectively). The attendance of 81 mothers, representing 94% of the total women who attended the clinic, was driven by their acknowledgment of the service's importance. Childcare responsibilities, perception of the visit as unimportant, and reluctance to undergo a pelvic examination were the top reasons for not attending the clinic, despite 41%, 38%, and 37% of participants being aware of it.

CONCLUSION

 Postnatal care attendance remains suboptimal for mothers in Bahrain. Awareness of the clinic's presence, counseling by healthcare providers, and prior experience with PNC visits were found to be significant determinants of attendance.

Early Post-natal Care Services Utilization and its associated factors among mothers Systemic Review and Meta-Analysis

Background

Early Post-natal Care Services are defined as the care given to the mother and the newborn baby after childbirth of a few weeks. This time is the most life-threatening time since most maternal and neonatal mortality takes place.

Methods

The preferred reporting elements for the Systematic Review and Meta-analysis (PRISMA) checklist methodology were used to build the current systematic review and meta-analysis. A systematic literature search was done at the electronic database using the Pub Med database, PubMed/MED-LINE, CINAHL, Google Scholar, Google, Web of Sciences, and Google Scholar to identify potential research. The retrieved author/year, study region, design, and sample size of all the authors. A standardized data-gathering measuring tool was used to obtain the data. I2 test statics were used to verify the heterogeneity among the investigations. The statistical program STATA 17 was used to analyze the data. Analysis of sensitivity was verified. The asymmetry of the funnel plot and statistically significant Egger's test at a 5 % significant level indicated the presence of publication bias. The pooled prevalence of mothers' use of early postnatal care services and the factors associated with it were determined using a random effect model.

Result

A total of 4498 mothers were involved in 10 studies. The pooled prevalence of Early Postnatal Care Services Utilization and Its Associated Factors among Mothers in Ethiopia was (28.51 % (95%CI, [20.95, 36.06]). According to the pooled effect, utilizing postnatal care services early was associated with formal education four points, or seven times (OR = 4.73 (95%CI, 3.12, 7.18)) higher likelihood. An early postnatal care service user is three times more likely to know early post-care visits (OR = 3.63 (95%CI, 1.25, and 10.50)).Early postnatal care service consumption is five times more likely to be associated with birth complications (OR = 4.93 (95%CI, 2.62, 9.27)). Being three times more likely to use early post-natal care services if an ANC is present (OR = 3.56 (95%CI, 2.03, 6.26)). Women who had traveled fewer than 2 h were three times as likely to have used early post-natal care services (OR = 3.47 (95%CI, 2.32, 5.20)). Early Post-natal care services utilization history ((OR = 2.26 (95%CI, 1.68, 3.04)) women who had previously used early post-natal care services.

Conclusion and recommendation

In comparison to national guidelines, the WHO, and other research, Ethiopia's pooled prevalence of accessing early postnatal care services is low. Prenatal care service use and birth complications also have a significant impact on the use of early postnatal care services. Improving early postnatal care service usage requires expanding the availability of antenatal care services on a national scale. Strengthening prenatal care services, increasing the number of health centers and health posts, increasing delivery at health facilities, and emphasizing or improving mothers' knowledge of and attitudes toward early post-natal care contact are all critical to improving quality of life and lowering neonatal and maternal morbidity and mortality. Future studies and the Ethiopian Ministry of Health should concentrate on improving the use of prenatal care services, minimizing and managing birth complications, and enhancing the use of early postnatal care services.

Postnatal care services availability and utilization during the COVID-19 era in sub-Saharan Africa: A rapid review

BACKGROUND

Considerable progress has been made globally in improving maternal and newborn babies' health. The COVID-19 pandemic has posed considerable challenges for countries to maintain the provision of high-quality, essential maternal and newborn healthcare services.

METHODS

A rapid review was carried out on 20 March 2022 on postnatal care (PNC) services availability and utilization during the COVID-19 era in sub-Saharan Africa. PubMed, Google Scholar, and Africa Journals Online (AJOL) databases were searched for relevant studies. Studies included in the review utilized both primary data and secondary data.

FINDINGS

Nineteen studies met the inclusion criteria. The review revealed that there were significant declines in the availability and utilization of PNC services during and after the COVID-19 lockdown. Several reasons were found to contribute to the decline.

DISCUSSION

New, innovative strategies are therefore required to ensure that mothers and their newborn babies receive essential PNC to reduce maternal and neonatal morbidity and mortality in sub-Saharan Africa. Some of the strategies that can be used include home-based PNC visits, the use of telemedicine, phone-based referral networks, social media, and community radios.

Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study

INTRODUCTION

Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake.

OBJECTIVE

The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana.

METHODS

The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05.

RESULTS

The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%).

CONCLUSION

All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.

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

Background

Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone.

Methods

We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25.

Results

Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC.

Conclusion

Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12494-5.

Association between antenatal care utilization pattern and timely initiation of postnatal care checkup: Analysis of 2016 Ethiopian Demographic and Health Survey

BACKGROUND

Despite significant public health intervention, maternal mortality remains high in low- and middle-income countries, including Ethiopia. Effective postnatal care is a critical service to reduce maternal mortality. In Ethiopia, only 17% of mothers received postnatal care services in 2016.

OBJECTIVE

This study examined the association between antenatal care and timely postnatal care checkup among reproductive-age women in Ethiopia.

METHODS

The study used the 2016 Ethiopian Demographic and Health Survey data. The current study included 4,081 women who give birth in the two years preceding the survey. Chi-square test and multivariable logistic regression analyses were used to examine the association between antenatal care and timely initiation of postnatal care.

RESULTS

Postnatal care services within 2 days of delivery were received by 16.5% of women. Women who had at least four timely antenatal care visits had higher odds of timely postnatal checkups compared to women who had no antenatal care [adjusted Odds Ratio (aOR): 2.50; 95% CI 1.42-4.42]. Women who had at least four antennal care visits without timely initiation also had higher odds of postnatal check-up than their counterparts (aOR: 2.46; 95%CI: 1.22-4.97). Other factors significantly associated with timely initiation of PNC were secondary and above education (aOR: 1.64; 95%CI: 1.03-2.60), perceived distance to the nearby health facility as a significant barrier (aOR: 1.55; 95%CI: 1.15-2.09), primiparous (aOR: 0.34; 95%CI: 0.19-0.61) and institutional delivery (aOR: 14.55; 95%CI: 2.21-95.77).

CONCLUSION

The prevalence of timely initiation of postnatal care in Ethiopia is very low. Women who received recommended antenatal care services had higher odds of timely initiation of postnatal care. Thus, strengthening the existing maternal and child health programs to adhere to the recommended ANC care guidelines may improve the timely initiation of postnatal care.