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Background: Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 576/100,000 and neonatal mortality rates at 37/1000 live births (NDHS, 2013). While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are limited. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria using the Nigeria Demographic and Health Survey (NDHS) 2013. Methods: For analysis, the postnatal care uptake for 19,418 children born in the 5 years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. A multinomial logistic regression model was applied to examine the adjusted and unadjusted determinants of non-utilization of postnatal care. Results: Results from this study showed that 63 % of the mothers of the 19,418 children did not utilize postnatal care services in the period examined. About 42 % of the study population between 25 and 34 years did not utilize postnatal care and 61 % of the women who did not utilize postnatal care had no education. Results from multinomial logistic regression show that antenatal care use, distance, education, place of delivery, region and wealth status are significantly associated with the non-utilization of postnatal care services. Conclusions: This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers’ utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at women in remote areas who don’t have access to services and developing mobile clinics. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria.
This is a secondary data analysis of a population-based cross-sectional data of the 2013 Nigerian Demographic and Health Survey (NDHS). The child recode dataset was used for this study. This dataset has one record for every child born in the 5 years preceding the survey for interviewed women. It contains the information related to the child’s pregnancy, delivery, postnatal care and immunization among others. The data for the mother of each of these children are included. For this study, only the last child of the women were used to avoid mix-ups in the recalling and reporting of mothers experiences, especially when they have had more than one birth in the last 5 years. Also, women who had experienced child mortality within 42 days were dropped. This amounted to 19,418 live births born to 19,418 women (between 15 and 49 years) in the 5 years preceding the 2013 Nigeria Demographic and Health Survey. The outcome of this study was non-utilization of postnatal care services. The variable was constructed using the WHO definition of postnatal care, which takes into account attendance of PNC services, checked by trained health personnel and timing of care (within 42 days of birth). It was thus derived from the following questions: Qualified health care providers are country specific and variations exist. For the purpose of this study, which draws reference from other studies, qualified health care providers include; doctors, nurses, midwives, community extension health worker, community or village health workers and auxiliary midwives, while unqualified health care providers include traditional birth attendants, and ‘others’. In Nigeria, Community Health Officers (CHOs) and Community Extension Health Workers (CHEW) are trained at the schools of health technology which is why we have included them in the analysis as qualified health care providers. With regards to timing, it is recommended that the mother and baby be assessed within 1 h of birth and again before discharge if the mother is in a facility, and also within first 42 days. For births that occur at home, first visits should target the crucial 24 h after birth, and a further visit within first 42 days. Thus, the categorization of PNC as use and non-use in this study complies with the highest level of PNC (appropriate care). Mothers were considered to have made adequate utilization of PNC services if she and are baby were checked by qualified healthcare personnel within 42 days of child birth. Hence, PNC non-utilization was categorized in this study as “0” if respondent was attended to by a qualified health worker within 42 days; “1” if respondent was not attended to by qualified healthcare personnel within 42 days of birth; and “2” if respondent had one or two of the three essential components of post-natal care (i.e. any one or two of post-natal visit, attendance by skilled health care worker and within 42 days). These are labelled non-utilization, some level of care and appropriate care, respectively. Given the poor uptake of PNC, a study at national level is important as it may help in directing policies that address the issue of PNC non utilization at national level. A geographically broad, quantitative assessment of women’s reasons for non-use can help shed light on general patterns and trends regarding the relative importance of these reasons. The independent variables used in this study include demographic, social and economic variables and were selected based on their documented association with postnatal care utilization [17–20]. These are: Age of mother at last birth, antenatal care use, birth order, birth size, child sex, distance to health facility, pregnancy wantedness, education, marital status, occupation, place of delivery, place of residence, region, religion and household wealth status. A visit to a qualified health care provider for ANC irrespective of timing and frequency was used as a proxy for antenatal care. See Table 3 in Appendix for a summary of all variables used in the study. Variable definition and codes of selected variables Three levels of analysis were employed in this paper. These were bivariate descriptive, unadjusted and adjusted multinomial logistic modelling. At the bivariate descriptive level, the percentage distribution of study sample was presented by the various selected characteristics of mothers and children. Unadjusted and adjusted multinomial logistic regression were then employed to examine the independent and net relationship between all the independent variables and the outcome variable. A p value <0.05 was considered statistically significant. The Nigerian DHS can be downloaded from the website and is free to use by researchers for further analysis. In order to access the data from DHS MEASURE a written request was submitted to the DHS MACRO and permission was granted to use the data for this survey. This study made use of cross-sectional data. As such, the study was unable to conclusively determine the temporal relationship between the independent variables and dependent variable rather, associations were examined. Also, the 2013 Nigeria Demographic and Health Survey data was collected retrospectively. This may be associated with recall bias given that the events took place 5 years following the survey. For instance, women may forget or may not accurately recall during the interview the number of postnatal care visits attended. In addition, the current DHS data for women in Nigeria does not ask questions on PNC non-use, hence results may not reveal up-to-date situation of PNC non-use.
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