Prevalence and associated factors of early postnatal care service use among mothers who had given birth within the last 12 months in Adigrat town, Tigray, northern Ethiopia, 2018

International Journal of Women's Health, Volume 12, Year 2020

Interpretation

Background: The care given for the first hours, days, and weeks after childbirth is life-threatening. So far, this period receives less attention from health-care providers than the care given to pregnancy and delivery. This study aimed to determine the prevalence and associated factors of early postnatal care service use among mothers who had given birth in the last 12 months in Adigrat Town, Tigray, Ethiopia. Methods: A community-based cross-sectional study was conducted from March to April 2018 among 481mothers who had given birth in the last 12 months. A systematic random sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect the data. Data analysis was computed using SPSS version 20. An adjusted odds ratio with a 95% confidence interval and p-value less than 0.05 was used to determine the level of significance. Results: The proportion of early postnatal care service utilization was 34.3% (95% CI: 29.9%–38.5%). Mothers’ use of early postnatal care service was predicted by previous early postnatal care use (AOR=2.60, 95% CI: 1.41–4.77), ANC visit (AOR=0.122, 95% CI:0.059– 0.251), delivery complication (AOR=5.57, 95% CI: 2.85–10.89), distance (AOR =5.05, 95% CI: 2.45–10.42), postnatal home visit (AOR=0.21, 95% CI: 0.11–0.40), awareness on early postnatal care (AOR=16.38 95% CI: 6.23–43.07), age (AOR=9.34, 95% CI: 1.73–50.27), (AOR=6.50, 95% CI: 2.29–18.41), (AOR= 6.23, 95% CI: 2.38–16.33) and income (AOR=7.97 95% CI: 2.42–26.26, AOR=3.30 95% CI:1.42–7.67). Conclusion: Our study’s finding revealed that the prevalence of early postnatal care service use was low. Early postnatal care service use was significantly associated with previous early postnatal care use, delivery complication, distance, postnatal home visit, number of ANC visits, awareness on early postnatal care use, age, and income. A community-based cross-sectional study was conducted from March to April 2018 in Adigrat Town Eastern zone of Tigray among 481 mothers who had given birth in the last 12 months. Adigrat town is found 903 km far from the capital of the country Addis Ababa. Adigrat town has 6 Kebeles, 14,443 households. According to the 2007 census population projection, the total population of Adigrat town is 63,548. Out of which 50.8% are females, and 23.5% of them are reproductive-age females. There are one district hospital, two governmental health centers, two private higher clinics, and 351 women development armies. There are about 992 total lists of birth in the town 12 months before the survey. All Mothers who were randomly selected and who has given birth in the last 12 months before our study was considered source populations. All mothers who gave birth in the previous 12 months preceding the survey and resided in the town for at least six months were included in the study. Mothers who had a mental problem and critically ill during data collection were excluded from this study. A single population proportion formula was used to get the required sample size based on the following assumption. Prevalence of early postnatal care (P=0.24).17 Level of confidence=95%. The margin of error=4. Then By adding a 10% non-response rate, the total sample size was becoming 481 mothers. To get the study participants, first four kebeles were selected by lottery method from the six kebeles in Adigrat town. The number of mothers who gave birth in the past 12 months in each kebele was; kebele 01 (200), kebele 02 (170), kebele 04 (220), kebele06 (150). The total sample size of 481 was distributed proportionate allocation to size to each kebele. Finally, the participants were selected by simple random sampling (Figure 1). Schematic presentation of sampling procedure about early post natal care service utilization among mothers given birth in Adigrat town, Tigray, Ethiopia, 2018. To get the study participants, first 4 kebeles were selected by lottery method from the 6 kebeles in Adigrat town. The number of woman who gave birth in the past 12 months in each kebele were; kebele 01 (200), kebele 02 (170), kebele 04 (220), kebele06 (150). The total sample size of 481 was distributed proportionate allocation to size to each kebele. Finally, the participants were selected by simple random sampling. The dependent variable for our study was early postnatal care use. The Independent variables for our study were: Socio-demographic factors include Age, Religion, Ethnicity, Monthly income, marital status, Family size, Occupation, Educational status, partner education, and partner’s occupation; Maternal factors include: Knowledge of mother on the danger sign of post-partumpost-partum, experience on the utilization of early postnatal care, place of delivery, Pregnancy plan, parity, ANC follow up and the number of visits, mode of delivery, and delivery attendant; Health institution related factors include: Access to transportation, distance from the health facility, length of stay at a health facility after delivery, advice by a health professional on early postnatal care after discharge, awareness of postnatal care service. Is defined as healthcare services given after delivery to the end of the first week of delivery for the mothers and newborn babies by health workers. In this study, mothers who had at least one postnatal care check-up for the current delivery within 2–7 days after delivery in a health facility. The coverage of early postnatal care use was defined as the percentage of mothers and newborns that were visited the health facilities at any time within seven days after delivery and after discharged. The visits were measured by mothers/caretakers words.i.e.by yes or no options for a visit (yes = 1, no = 0). Knowledge was measured concerning; Knowledge of the mothers about postnatal maternal danger signs, knowledge of the mothers about newborn danger signs, and knowledge of mothers about early postnatal services provided. Knowledge of mothers about obstetric danger signs was measured by the total number of correct answers to 7 items. And knowledge of mothers on the early postnatal service provided was measured by the total number of correct answers to 8 items. Accordingly, two categories were developed for each item. A mother who answers at least two danger signs of post-partum and early postnatal service was labeled as having Good knowledge. A mother who did not answer at least two danger signs of post-partum and early postnatal service provided was labeled as having no knowledge.17,24 An interviewer-based structured questionnaire was used to collect the data. The questionnaire was developed in English, then translated into the Tigrigna language (the local language of the area), and back to English to ensure its consistency. Additionally, training was given to data collectors and supervisors. A pre-test was conducted on (5%) of the total sample size, then after, a necessary adjustment was made before the questionnaires were used for actual data collection. The data collection procedure was closely supervised, and the collected data were checked for completeness, consistency, and reliability. Data were entered and analyzed using SPSS version 20.0 statistical software package. Descriptive statistics such as frequencies, percentages, means, standard deviations, and crosstabs were computed. In the bivariate logistic regression analysis model, variables with a p-value of less than 0.2526 at binary were taken into multivariable logistic regression. Those variables with a P-value of <0.05 at the final model were considered independent predictors of early postnatal care use. To determine the association between dependent and independent variables, OR with 95% confidence intervals were used. Finally, results were presented using text, tables, and figures.

AI Digest

Study Justification:

The study aimed to determine the prevalence and associated factors of early postnatal care service use among mothers who had given birth in the last 12 months in Adigrat Town, Tigray, Ethiopia. This is important because the care given during the postnatal period is crucial for the health and well-being of both mothers and newborns. However, this period often receives less attention from healthcare providers compared to pregnancy and delivery care. Understanding the prevalence and factors influencing early postnatal care service use can help identify gaps and inform interventions to improve maternal and newborn health outcomes.

Highlights:

– The study found that the prevalence of early postnatal care service use among mothers in Adigrat Town was low, at 34.3%.
– Factors associated with early postnatal care service use included previous early postnatal care use, ANC visit, delivery complication, distance, postnatal home visit, awareness on early postnatal care, age, and income.
– These findings highlight the need for targeted interventions to improve early postnatal care service utilization and address the identified factors.

Recommendations:

Based on the study findings, the following recommendations are suggested:

1. Strengthen education and awareness programs on the importance of early postnatal care for both mothers and healthcare providers.
2. Improve access to early postnatal care services by addressing distance barriers and ensuring availability of transportation options.
3. Enhance the quality and coverage of antenatal care services, as it was found to be associated with early postnatal care service use.
4. Provide postnatal home visits to support and encourage mothers to seek early postnatal care services.
5. Develop and implement policies and strategies to address delivery complications and ensure timely and appropriate care.

Key Role Players:

1. Ministry of Health: Responsible for developing and implementing policies and strategies to improve maternal and newborn health outcomes, including early postnatal care service utilization.
2. Healthcare Providers: Involved in delivering early postnatal care services and providing education and support to mothers.
3. Community Health Workers: Play a crucial role in raising awareness, providing education, and facilitating access to early postnatal care services at the community level.
4. Non-Governmental Organizations (NGOs): Collaborate with the government and healthcare providers to implement interventions and programs aimed at improving early postnatal care service utilization.

Cost Items for Planning Recommendations:

1. Training and Capacity Building: Budget for training healthcare providers and community health workers on early postnatal care guidelines and best practices.
2. Awareness and Education Campaigns: Allocate funds for developing and implementing awareness and education programs targeting both healthcare providers and the community.
3. Transportation: Consider the cost of providing transportation options for mothers who face distance barriers in accessing early postnatal care services.
4. Infrastructure and Equipment: Assess the need for improving healthcare facilities and ensuring they are equipped to provide quality early postnatal care services.
5. Monitoring and Evaluation: Allocate resources for monitoring and evaluating the implementation and impact of interventions aimed at improving early postnatal care service utilization.
Please note that the provided cost items are general suggestions and may vary based on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which provides valuable information about the prevalence and associated factors of early postnatal care service use. The sample size of 481 mothers is adequate for this type of study. The data collection procedure was closely supervised, and the collected data were checked for completeness, consistency, and reliability. The statistical analysis was conducted using SPSS version 20.0. However, the study is limited by its cross-sectional design, which cannot establish causality. Additionally, the study relies on self-reported data, which may introduce recall bias. To improve the strength of the evidence, future research could consider using a longitudinal design to establish causality and validate the findings. It would also be beneficial to use objective measures of early postnatal care service utilization, such as medical records, to reduce recall bias.

Abstract

A community-based cross-sectional study was conducted from March to April 2018 in Adigrat Town Eastern zone of Tigray among 481 mothers who had given birth in the last 12 months. Adigrat town is found 903 km far from the capital of the country Addis Ababa. Adigrat town has 6 Kebeles, 14,443 households. According to the 2007 census population projection, the total population of Adigrat town is 63,548. Out of which 50.8% are females, and 23.5% of them are reproductive-age females. There are one district hospital, two governmental health centers, two private higher clinics, and 351 women development armies. There are about 992 total lists of birth in the town 12 months before the survey. All Mothers who were randomly selected and who has given birth in the last 12 months before our study was considered source populations. All mothers who gave birth in the previous 12 months preceding the survey and resided in the town for at least six months were included in the study. Mothers who had a mental problem and critically ill during data collection were excluded from this study. A single population proportion formula was used to get the required sample size based on the following assumption. Prevalence of early postnatal care (P=0.24).17 Level of confidence=95%. The margin of error=4. Then By adding a 10% non-response rate, the total sample size was becoming 481 mothers. To get the study participants, first four kebeles were selected by lottery method from the six kebeles in Adigrat town. The number of mothers who gave birth in the past 12 months in each kebele was; kebele 01 (200), kebele 02 (170), kebele 04 (220), kebele06 (150). The total sample size of 481 was distributed proportionate allocation to size to each kebele. Finally, the participants were selected by simple random sampling (Figure 1). Schematic presentation of sampling procedure about early post natal care service utilization among mothers given birth in Adigrat town, Tigray, Ethiopia, 2018. To get the study participants, first 4 kebeles were selected by lottery method from the 6 kebeles in Adigrat town. The number of woman who gave birth in the past 12 months in each kebele were; kebele 01 (200), kebele 02 (170), kebele 04 (220), kebele06 (150). The total sample size of 481 was distributed proportionate allocation to size to each kebele. Finally, the participants were selected by simple random sampling. The dependent variable for our study was early postnatal care use. The Independent variables for our study were: Socio-demographic factors include Age, Religion, Ethnicity, Monthly income, marital status, Family size, Occupation, Educational status, partner education, and partner’s occupation; Maternal factors include: Knowledge of mother on the danger sign of post-partumpost-partum, experience on the utilization of early postnatal care, place of delivery, Pregnancy plan, parity, ANC follow up and the number of visits, mode of delivery, and delivery attendant; Health institution related factors include: Access to transportation, distance from the health facility, length of stay at a health facility after delivery, advice by a health professional on early postnatal care after discharge, awareness of postnatal care service. Is defined as healthcare services given after delivery to the end of the first week of delivery for the mothers and newborn babies by health workers. In this study, mothers who had at least one postnatal care check-up for the current delivery within 2–7 days after delivery in a health facility. The coverage of early postnatal care use was defined as the percentage of mothers and newborns that were visited the health facilities at any time within seven days after delivery and after discharged. The visits were measured by mothers/caretakers words.i.e.by yes or no options for a visit (yes = 1, no = 0). Knowledge was measured concerning; Knowledge of the mothers about postnatal maternal danger signs, knowledge of the mothers about newborn danger signs, and knowledge of mothers about early postnatal services provided. Knowledge of mothers about obstetric danger signs was measured by the total number of correct answers to 7 items. And knowledge of mothers on the early postnatal service provided was measured by the total number of correct answers to 8 items. Accordingly, two categories were developed for each item. A mother who answers at least two danger signs of post-partum and early postnatal service was labeled as having Good knowledge. A mother who did not answer at least two danger signs of post-partum and early postnatal service provided was labeled as having no knowledge.17,24 An interviewer-based structured questionnaire was used to collect the data. The questionnaire was developed in English, then translated into the Tigrigna language (the local language of the area), and back to English to ensure its consistency. Additionally, training was given to data collectors and supervisors. A pre-test was conducted on (5%) of the total sample size, then after, a necessary adjustment was made before the questionnaires were used for actual data collection. The data collection procedure was closely supervised, and the collected data were checked for completeness, consistency, and reliability. Data were entered and analyzed using SPSS version 20.0 statistical software package. Descriptive statistics such as frequencies, percentages, means, standard deviations, and crosstabs were computed. In the bivariate logistic regression analysis model, variables with a p-value of less than 0.2526 at binary were taken into multivariable logistic regression. Those variables with a P-value of <0.05 at the final model were considered independent predictors of early postnatal care use. To determine the association between dependent and independent variables, OR with 95% confidence intervals were used. Finally, results were presented using text, tables, and figures.

Materials

N/A

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and reminders about early postnatal care, including danger signs, services provided, and the importance of seeking care. These apps can also send notifications for postnatal check-ups and provide access to teleconsultations with healthcare providers.

2. Community Health Workers (CHWs): Train and deploy CHWs to provide education and support to mothers in their homes. CHWs can conduct postnatal home visits, assess the health of mothers and newborns, provide counseling on breastfeeding and newborn care, and refer women to health facilities when necessary.

3. Telemedicine: Establish telemedicine services to enable remote consultations between healthcare providers and mothers who may have difficulty accessing health facilities due to distance or transportation challenges. This can help address the issue of distance mentioned in the study.

4. Maternal Health Vouchers: Implement voucher programs that provide financial assistance to mothers for accessing early postnatal care services. These vouchers can cover the cost of transportation, consultations, and medications, making it more affordable for women to seek care.

5. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of early postnatal care and address misconceptions or cultural barriers that may prevent women from seeking care. These campaigns can use various media channels, including radio, television, and community gatherings.

6. Integration of Services: Integrate early postnatal care services with other maternal and child health services, such as antenatal care and immunization programs. This can ensure continuity of care and increase the likelihood of mothers accessing postnatal services.

7. Task-Shifting: Train and empower lower-level healthcare providers, such as nurses and midwives, to provide early postnatal care services. This can help alleviate the burden on doctors and increase the availability of care in resource-limited settings.

It is important to note that the specific context and needs of the community should be considered when implementing these innovations. Additionally, further research and evaluation may be needed to assess the effectiveness and feasibility of these interventions in improving access to maternal health.

AI Innovations Description

Based on the description provided, the study aimed to determine the prevalence and associated factors of early postnatal care service use among mothers who had given birth in the last 12 months in Adigrat Town, Tigray, Ethiopia. The study found that the prevalence of early postnatal care service use was low, with only 34.3% of mothers utilizing these services.

The study identified several factors associated with early postnatal care service use, including previous early postnatal care use, ANC visit, delivery complication, distance, postnatal home visit, awareness on early postnatal care, age, and income.

Based on these findings, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Strengthening ANC services: Since ANC visits were found to be associated with early postnatal care service use, it is important to focus on improving the quality and accessibility of ANC services. This can be done by ensuring that pregnant women receive comprehensive information and education about the importance of postnatal care during their ANC visits.

2. Community-based postnatal care: Given that distance was identified as a barrier to early postnatal care service use, implementing community-based postnatal care programs can help overcome this challenge. This can involve training and deploying community health workers or midwives to provide postnatal care services in the homes of new mothers, especially those living in remote areas.

3. Increasing awareness: The study found that awareness of early postnatal care was a significant factor in its utilization. Therefore, innovative strategies should be developed to raise awareness among pregnant women and their families about the importance of early postnatal care. This can include community health education campaigns, use of mass media, and targeted messaging through mobile phone applications or text messages.

4. Integration of services: To improve access to postnatal care, it is crucial to integrate postnatal care services with other maternal and child health services. This can be done by ensuring that postnatal care is included as part of routine care during childbirth and that healthcare providers are trained to provide comprehensive postnatal care services.

By implementing these recommendations, it is possible to improve access to early postnatal care services and ultimately enhance maternal health outcomes in Adigrat Town, Tigray, Ethiopia.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Strengthening Health Education: Increase awareness and knowledge among pregnant women and their families about the importance of early postnatal care services. This can be done through community-based health education programs, antenatal care visits, and media campaigns.

2. Improving Availability and Accessibility: Ensure that health facilities providing early postnatal care services are easily accessible to all women, especially those in remote areas. This can be achieved by establishing more health centers and clinics, improving transportation infrastructure, and providing mobile health services.

3. Enhancing Healthcare Provider Training: Train healthcare providers on the importance of early postnatal care and equip them with the necessary skills and knowledge to provide quality care. This includes training on identifying and managing postpartum complications, breastfeeding support, and counseling on postnatal care practices.

4. Strengthening Referral Systems: Develop and strengthen referral systems between health facilities to ensure that women with complications during the postnatal period receive timely and appropriate care. This includes establishing clear protocols for referral, improving communication channels, and providing training to healthcare providers on referral procedures.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify the key indicators that will be used to measure the impact of the recommendations. This could include the proportion of women receiving early postnatal care, the distance to the nearest health facility, the knowledge level of women about postnatal care, etc.

2. Collect baseline data: Gather data on the current status of access to maternal health services in the target area. This can be done through surveys, interviews, and existing health records.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should take into account factors such as population size, geographical distribution, healthcare infrastructure, and resource availability.

4. Run the simulation: Use the simulation model to project the potential impact of the recommendations over a specified time period. This can be done by adjusting the input parameters based on the expected changes resulting from the recommendations.

5. Analyze the results: Evaluate the simulation results to assess the potential impact of the recommendations on improving access to maternal health. This can include analyzing changes in the selected indicators, identifying potential challenges or limitations, and assessing the cost-effectiveness of the recommendations.

6. Refine and validate the model: Continuously refine and validate the simulation model based on new data and feedback from stakeholders. This will help improve the accuracy and reliability of the simulation results.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on implementing the most effective strategies.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.2147/IJWH.S266248

Research Areas:

Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female