Postnatal care service utilization and associated factors among women who gave birth in Debretabour town, North West Ethiopia: a community- based cross-sectional study

This study was conducted from March 1st to 21th, 2017, at Debretabour town. Debretabour, the city of South Gondar zone is found in the northern part of Amhara regional state 98 Kilometers from Bahirdar, the main city of Amhara regional state and 666 Kilometers away from Addis Ababa, the capital city of Ethiopia. According to the 2015 population projection estimate, there were 55,596 residents and around half of them were females. There are 3 health centers, 4 health posts, and 1 general hospital providing postnatal care services in the town.

A quantitative research involving community based cross-sectional study was conducted among randomly selected reproductive age group of mothers who gave birth in the past one year preceding the data collection period.

Mothers who lived less than six months in the study area at the time of interview and who had communication problem were excluded from the study.

The single population proportion formula was used to calculate the sample size considering the following assumptions: proportion of women using postnatal care services 33.5% [8], 95% confidence level, 4% margin of error (absolute level of precision).

Adding 10% non-response rate, a total sample size of 588 women were included.

Debretabour town intentionally was selected as a study site by considering the health status of women in the town and lack of previous researches related to maternal health care services. Systematic sampling technique was used to select the study units. From the four kebeles all kebeles were selected. The calculated sample size was distributed across the four kebeles proportionally to the size of the households in each kebele. Then the proportion of eligible mothers those who gave birth in the last one year prior to this study were identified. Based on this assumption the available data from registry of the local health extension workers they recently conducted the survey for immunization program was used. The sampling interval of households in each kebele was determined by dividing the total number of households to the allocated sample size. The initial household to be interviewed was selected randomly from the kebele house number registry using a number between 1 and the sample interval. The subsequent household to be included in the study was identified systematically through house-to-house visit. For households with more than one eligible woman, interview was done for one of the mothers using simple random sampling technique. Revisits of two to three times were made in case where eligible respondents were not available at the time of the survey by asking the neighbors whether an eligible women in that house was present or not, after all they were considered as non-respondents.

Data was collected by face to face interview using a structured and pre-tested questionnaire. The questionnaire first prepared in English and translated to Amharic, and then back to English. Four 3rd year diploma midwife students were used to collect data. Two BSC midwives were assigned to supervise the data collection process. Both the data collectors and supervisors were given one day training before the actual work about the aim of study, procedures and collection techniques going through the questionnaires question by question, art of interviewing and ways of collecting the data.

The quality of data was assured by proper designing and pre-testing of the questionnaires in one of the Kebeles other than Debretabour, in Woreta town on 30 participants. Every day after data collection, questionnaires were reviewed and checked for completeness by the supervisor and principal investigator and the necessary feedback was offered to data collectors in the next morning and before ending all session incomplete questions were completed using precoded for controlling errors during data analysis.

The entire questionnaire were checked, coded and entered into EPI Info version 7 and exported to SPSS version 21 software. For analysis descriptive statistical procedures were utilized. Descriptive statistics like percentage, mean and standard deviation were used for the presentation of demographic data and magnitude of post natal care service utilization. Tables and graphs were also used for data presentation.

Binary logistic regression was used to identify factors associated with PNC service utilization on mothers. Variables with P-value less than or equal to 0.2 were selected in to multiple logistic regression models for controlling the possible effect of confounders and finally variables which had independent association with PNC service utilization were identified on the basis of AOR, with 95%CI and p-value less than 0.05.

Ethical clearance was obtained from institutional Ethical Committee of Bahirdar University. Formal letter of cooperation was written for Regional Health Bureau, Debretabour health office and respective kebeles and permission was obtained. Written informed consent was obtained from each study subjects, each respondent was informed about the objective of the study that it contribute to improve maternal health. Any mother who was not willing to participate in the study has not been forced to participate. They were also informed that all data obtained from them would be kept confidential by using codes instead of any personal identifiers and is meant only for the purpose of the study. Health education on postnatal care service and related complication and other information was given for the participants during interview.

The total of 588 women participated in the study making the overall response rate 100%. More than half 330(56.1%) of the respondents were in the age group 20–29 with the mean ± SD 27.35 ± 5.48 years. Five hundred twenty one (88.6%) of them were married and 564(95.9%) of them were Orthodox Christian followers. Nearly one-six, 102(17.3%) of the respondents were unable to read and write and 260(44.2%) of them attend secondary school and above. Concerning their husbands’ educational status, 337(57.3%) of them were attended secondary school and above, and 269(45.7%) of respondents’ husband were government employed by occupation. The total monthly household’s income was ranging from 100 to 16,000 ETB while 74% of the participants had earned above 1500 ETB per month. Majority, 530 (90%) of the respondents had either TV and/or Radio in their houses (Table 1).

Among the total respondents, 347 (59.0%) mothers were categorized as Para two to Para four. Of these, 18(3.1%) of mothers faced stillbirth while they gave the last birth.

Three hundred ninety- six (67.3%) of the current pregnancy were planned and supported. Almost all, 567(96.4%) of the mothers had antenatal care follow-up during the last pregnancy while 559(95.1%) of mothers gave their last birth at health institution.

Regarding to the mode of delivery, most respondents 432(77.28%) delivered by spontaneous vaginal delivery (Table 2).

From total respondents, 338(57.5%) mothers were utilized postnatal care services with confidence interval of (53.4–61.6). Regarding to the frequency of postnatal care visit, 228(67.5%) of participants had visited once, 63(18.6%) women had two times, and the remaining 47(13.9%) were having three or more. The proportion of postnatal care visit within 24 h, at 3–7 days and at six weeks of postpartum were 103(30.5%),104(30.8%) and 162(47.9%) respectively.

Concerning types of service utilization during the postnatal visit, one-hundred sixty seven (28.4%) of the respondents utilized family planning, nearly half (44.9%) of them received immunization, 22.6% of them were tested and counseled for HIV and 106(18%) of them was counseled on breast feeding.

Different reasons were given by the participants for not attending postnatal care services. The most common reason mentioned by the participants for none utilization of postnatal care service was being apparently healthy (Fig. 1).

During bivariable logistic regression analysis, those variables that had significant association were marital status, respondents educational level, monthly income, decision making style of the women on her health, decision making style of the women on her child health, parity, birth outcome of the last baby, nature of the last pregnancy and place of delivery.

Accordingly, those women whose educational status secondary school and above were 3 times (AOR = 3.29, 95% CI: 1.94–5.57) more likely to utilize PNC service than those women who couldn’t read and write. Those mothers who had monthly household income greater than 1500 ETB were 2.8 times more likely to utilize PNC services than those women who earned less than 500 ETB (AOR = 2.85, 95%CI:1.21–6.68).Mothers who gave birth alive neonate were 5.7 times more likely to get postnatal care services than mothers who gave still birth(AOR = 5.70,95%CI:1.53–21.21).

The odds of having postnatal care visit for those women whose pregnancy were planned and supported were 3.9 times more likely to have PNC visit than those women whose pregnancy were unplanned and unsupported(AOR = 3.96,95%CI:1.72–9.01).

Those mothers who gave birth to their latest child at the health institution were 3 times (AOR = 3.08, 95%CI: 1.24–7.68) more likely to get postnatal care service utilization when compared with those mothers who gave birth to their latest child at home (Table 3).

There could be recall bias since the women were asked for events within the last one year prior to the study. On the other hand the study did not include the rural population which is restricting the scope and relevance. Lastly, since the the design is quantitative it doesn’t address cultural issues of the respondents.