Early postnatal care (EPNC) is the care given to the mother and her newborn immediately after birth and up to the first seven days of life that marks the establishment of a new phase of family life for women and their partners and the beginning of the lifelong health record for newborn [
The care of a woman and her baby in the immediate hours, days, and weeks following birth can make an enormous difference to their long-term health and well-being. It leads to a dramatic fall in the maternal mortality rate and helps to establish and maintain contact with a number of health services needed in the short and long terms [
Even though it is the most neglected period for the provision of quality care services, the first week after delivery is a critical phase in the lives of a mother and her newborn. Lack of appropriate care during this period could result in a significant ill-health and even death [
Globally, the majority of maternal and infant mortality occurs in the first month after birth. Almost half of the postnatal maternal deaths occur within the first 24 hours, 66% occur during the first week after delivery, and one million newborns die on the first day of life. The main reasons for these easily preventable problems were poor quality of services, weak community-based heath practice, gender inequality, and poor women-centered maternity care [
Although considerable progress has been made globally to improve maternal health, low utilization of EPNC is one of the major causes of maternal mortality and morbidity in the developing countries. Two regions, sub-Saharan Africa and South-East Asia, account for 86% of maternal mortality worldwide, and most of that occurred within 7 days after delivery. Additionally, the majority of women are not getting a PNC visit within 2 days of childbirth due to cultural practices, lack of education, shortage of income, and lack of awareness on the availability of the services [
The government of Ethiopia endorsed a strategy which is aimed at strengthening the health system to provide quality care. The Health Sector Transformation Plan 2015/16 set a target of up to 95% postnatal coverage by the year 2020 to transform all health districts by creating a high performance of primary health-care units and model kebeles [
Even though the Ethiopian government is providing free maternal and child PNC services regardless of the socioeconomic status of the women to ensure access to the community-based facilities, the maternal mortality ratio remains high at the national level, and low utilization of EPNC continued as the leading cause of maternal morbidity and mortality [
Despite the fact that it has a very significant and positive impact on the reduction of maternal and newborn morbidity and mortality, EPNC service is yet neglected and less attention has been given to it. Therefore, the aim of this study was to assess the prevalence of EPNC service utilization and its associated factors among mothers in Hawassa Zuria district, Sidama Regional State, Ethiopia, in 2020.
The study was conducted in Hawassa Zuria district. Hawassa Zuria District is one of 36 districts in Sidama Regional State, Ethiopia, which is located 21 kilometers away from Hawassa, the capital of the region. The district has an estimated population number of 168,188 according to the current population projection and the estimated deliveries were 5,819. The district has 23 kebeles including three town kebeles. Currently, there are 4 public health centers, 1 primary hospital, 23 health posts, and 5 primary private clinics. The study was conducted from 20 February to 20 March 2020.
A community-based cross-sectional study was conducted among postnatal mothers who had been living in Hawassa Zuria district. All mothers who gave birth six months prior to this survey in the selected kebeles were included in this study. Those who were critically sick and unable to give a response during the data collection period were excluded.
The sample size was determined by using the single population proportion formula with the following assumptions: considering 25.3% of postnatal-care service utilization within seven days taken from the previous study [
Data were collected by using interviewer-administered structured and pretested questionnaires developed by reviewing the related literature. The questionnaire contains sociodemographic and economic factors, reproductive and obstetrics factors, awareness of the mother on postnatal-care service, the attitude of mothers towards postnatal-care services as well as health-care providers, and facility-related factors. Data were collected by six nurses with diploma qualifications. One nurse with Bachelor of Science qualification was assigned as a supervisor. To control the quality of the data, a properly designed data collection tool was developed in English and translated into the local language (Sidaamu Afoo) and back to English by language experts to check its consistency. All data collectors and supervisors were trained for one day by the principal investigator before starting the actual data collection. Training was given on the general objective of the study, contents of the tool, and how to approach the study participants. Before starting the actual data collection, the tool was pretested on 5% of the sample population at one kebele outside the study area and necessary measures were taken accordingly. Collected data were checked for its completeness and consistency before starting actual data entry. The dependent variable was early postnatal-care service utilization that was measured by a ‘yes’ or ‘no’ response. Positive (yes) responses were validated by asking about the types of services utilized. Independent variables were sociodemographic and economic factors, reproductive and obstetrics factors, awareness of the mother on postnatal-care service, the attitude of mothers towards postnatal-care services as well as health-care provider, and facility-related factors.
After data cleaning and checking its completeness, data were coded and entered into Epi data version 3.1 software and finally exported to statistical software for social science (SPSS) version 21 for analysis. Descriptive analysis was performed for each predictor variable, and cross tabulation was performed to see the distribution of predictor variables in relation to outcome variable. The goodness-of-fit of the model was also checked by Hosmer–Lemeshow goodness-of-model fit. Bivariable analysis was performed for each independent variable with the outcome variable, and variables with a
Used early postnatal-care services: if the mother used at least one PNC service in the first seven postpartum days that was provided by the health professionals regardless of the place of delivery Awareness on the postnatal danger signs: those mothers mentioned at least one obstetrics danger sign occurred after delivery Awareness of early postnatal care: mothers who had information about at least one postnatal-care service provided within one week after delivery Positive attitude on postnatal care: those correctly scored above mean from attitude-related items
From 320 participants planned for this survey, all of them were interviewed. The mean age of the respondents was 29.1 ± 5.8 years. Of the interviewed respondents, 257 (80.3%) were protestant. About 263 (82.2%) of them were from the Sidama ethnic group. 311 (97.2%) of them were married, and 151 (47.2%) attended primary schools. 254 (79.4%) of the respondents had either TV and/or radio in their house (Table
Sociodemographic characteristics of the study participants in Hawassa Zuria district, Sidama Regional State, Ethiopia, 2020.
Variables | Categories | Frequency | Percentage |
---|---|---|---|
Age in years | <25 | 125 | 39.1 |
25–35 | 119 | 37.2 | |
>35 | 76 | 23.8 | |
Religion | Protestant | 257 | 80.3 |
Muslim | 44 | 13.8 | |
Orthodox | 19 | 5.9 | |
Residence | Urban | 25 | 7.8 |
Rural | 295 | 92.2 | |
Marital status | Married | 290 | 90.6 |
Unmarried | 19 | 5.9 | |
Widowed | 11 | 3.5 | |
Mother’s educational status | Secondary and above | 69 | 21.6 |
Primary school | 151 | 47.2 | |
No formal education | 100 | 31.3 | |
Husband educational status | Secondary and above | 139 | 43.5 |
Primary school | 162 | 50.6 | |
No formal education | 19 | 5.9 | |
Mother’s occupation | Employer | 27 | 8.4 |
Student | 64 | 20 | |
Merchant | 103 | 32.2 | |
Housewife | 126 | 39.4 | |
Husband’s occupation | Farmer | 131 | 40.9 |
Employer | 59 | 18.4 | |
Merchant | 110 | 34.4 | |
Daily labor | 20 | 6.3 | |
Monthly income | >1500 ETB | 120 | 55.9 |
1000–1500 ETB | 39 | 12.2 | |
<1000 ETB | 102 | 31.9 | |
Have mass media | Yes | 254 | 79.4 |
No | 66 | 20.6 |
ETB = Ethiopian Birr.
One hundred and ninety-four (60.6%) of the respondents had less than four children. Two hundred and sixty-one (86.1%) had one or more ANC follow-ups during their last pregnancy; out of these, only 96 (36.8%) had four or more ANC visits. The common complications faced after delivery were vaginal bleeding (9.1%) followed by severe abdominal pain (6.6%) (Table
Obstetrics complications and reproductive characteristics of the study participants in Hawassa Zuria district, Sidama Regional State Ethiopia, 2020.
Variables | Categories | Frequency | Percentage |
---|---|---|---|
Parity | <4 | 194 | 60.6 |
≥4 | 126 | 39.4 | |
Condition of pregnancy | Planned and supported | 147 | 45.9 |
Unplanned but supported | 83 | 26.0 | |
Unplanned and unsupported | 90 | 28.1 | |
Had ANC visit | Yes | 261 | 81.6 |
No | 59 | 18.4 | |
Had complication during pregnancy | Yes | 68 | 21.3 |
No | 252 | 78.8 | |
Had complication during delivery | Yes | 65 | 20.3 |
No | 255 | 79.7 | |
Had complication after delivery | Yes | 76 | 23.8 |
No | 244 | 76.2 | |
Mode of delivery for the last birth | Normal | 240 | 75.0 |
Instrumental | 54 | 16.9 | |
Surgery | 26 | 8.1 |
More than half (55%) had awareness on the EPNC services. Regarding obstetric danger signs, 135 (42.2%) have mentioned at least one danger sign. The most commonly mentioned signs were vaginal bleeding (26.7%) followed by severe abdominal pain (26.7%). Concerning respondents’ attitudes toward EPNC utilization, the mean attitude score was 25 (Table
Awareness and attitude of the study participants on EPNC services and danger signs after birth in Hawassa Zuria district, Sidama Regional State, Ethiopia, 2020.
Variables | Categories | Frequencies | Percent |
---|---|---|---|
Had awareness on EPNC | Yes | 176 | 55.0 |
No | 144 | 45.0 | |
Had awareness on postnatal danger sign | Yes | 135 | 42.2 |
No | 185 | 57.8 | |
Common postnatal danger signs mentioned | Vaginal bleeding | 85 | 26.7 |
Severe abdominal pain | 85 | 26.7 | |
Headache | 55 | 17.0 | |
High-grade fever | 50 | 15.6 | |
Blurring of vision | 45 | 14.0 | |
Attitude towards EPNC | Positive | 175 | 54.7 |
Negative | 145 | 45.3 |
Concerning the time taken to get to the services, more than half (55.9%) of them traveled at least 30 minutes to reach the health facility. The majority of the respondents (89.1%) used health facility delivery services for their last birth. Only 95 (29.7%) of them used EPNC for recent delivery (Figure
Magnitude of early postnatal-care services utilized by the respondents in Hawassa Zuria District, Sidama Regional State, Ethiopia, 2020.
Health-care provider and facility-related factors affecting utilization of EPNC in Hawassa Zuria district, Sidama Regional State, Ethiopia 2020.
Variables | Categories | Frequencies | Percent |
---|---|---|---|
Time taken to reach health facility | <30 minutes | 179 | 55.9 |
30 min–1 hour | 118 | 36.9 | |
>1 hour | 23 | 7.2 | |
Place of delivery | Health facility | 285 | 89.1 |
Home | 35 | 10.9 | |
Appointed by health professionals for EPNC ( | Yes | 136 | 47.7 |
No | 149 | 52.3 | |
Time of stay at health facility after delivery ( | ≥24 hours | 138 | 48.4 |
<24 hours | 147 | 51.6 | |
Reasons for not using EPNC services | Lack of information | 90 | 40.0 |
Lack of time | 70 | 31.0 | |
Unwanted pregnancy | 35 | 15.6 | |
Far health facility | 30 | 13.4 |
To identify the association of independent variables with the outcome variable (utilization of EPNC), both bivariate and multivariable logistic regression analysis were performed. In bivariable logistic regression analysis age of the mother, educational status of the mother, the number of children alive, history of ANC follow-up for the last pregnancy, condition of the last pregnancy, complications faced during the last pregnancy and after delivery, awareness on obstetrics danger signs, and attitude towards EPNC services were variables associated with EPNC service utilization.
In multivariable logistic regression analysis after controlling for potential confounder, age of the mother, having planned and supported pregnancy, having awareness on obstetric danger signs, and having a positive attitude towards EPNC services were the factors statistically associated with the outcome variable (EPNC service utilization).
Mothers whose age was below 25 years were 3.2 times more likely to utilize early postnatal-care services when compared with those whose age was above 35 years [AOR = 3.2, 95% CI (1.37, 7.53)]. Those mothers who had planned and supported pregnancy for their last birth were 2.28 times more likely to utilize early postnatal-care services than those who had unplanned and unsupported pregnancy for their last pregnancy [AOR = 2.28, 95% CI (1.15, 4.52)].
Mothers who had awareness on obstetric danger sign and symptoms were 2.2 times more likely to utilize early postnatal-care services when compared with those who had no awareness [AOR = 2.2, 95% CI (1.27, 3.87)]. Mothers who had a positive attitude towards EPNC-care services were 3.5 times more likely to utilize early postnatal care when compared with those who had negative attitude [AOR = 3.5, 95% CI (1.95, 6.33)] (Table
Factors associated with EPNC service utilization in Hawassa Zuria district, Sidama Regional State, Ethiopia, 2020.
Variables and categories | Utilized EPNC | COR (95%CI) | AOR (95% CI) | |
---|---|---|---|---|
Yes | No | |||
Age of the respondents | ||||
<25 | 52 | 73 | 3.45 (1.72, 6.91) | |
25–35 | 30 | 89 | 1.63 (0.79, 3.37) | 1.64 (0.73, 3.63) |
>35 | 13 | 63 | 1 | 1 |
Educational status of the mother | ||||
Secondary school and above | 41 | 59 | 2.73 (1.34, 5.54) | 1.23 (0.56, 2.68) |
Primary school | 40 | 111 | 1.41 (0.71, 2.82) | 1.76 (0.78, 3.93) |
No normal education | 14 | 59 | 1 | 1 |
Parity | ||||
<4 | 66 | 128 | 1.72 (1.03, 2.87) | 1.45 (0.73, 2.88) |
≥4 | 29 | 97 | 1 | 1 |
Condition of the last pregnancy | ||||
Planned and supported | 58 | 89 | 2.60 (1.41, 4.81) | |
Unplanned but supported | 19 | 64 | 1.18 (0.57, 2.45) | 1.11 (0.48, 2.57) |
Unplanned and unsupported | 18 | 72 | 1 | 1 |
Had ANC visit | ||||
Yes | 80 | 181 | 1.29 (0.68, 2.46) | 0.75 (0.35, 1.60) |
No | 15 | 44 | 1 | 1 |
Faced complication during last pregnancy | ||||
Yes | 26 | 42 | 1.64 (0.93, 2.88) | 1.42 (0.72, 2.79) |
No | 69 | 183 | 1 | 1 |
Faced complication after delivery | ||||
Yes | 30 | 46 | 1.79 (1.04, 3.08) | 1.88 (0.99, 3.58) |
No | 65 | 179 | 1 | 1 |
Had awareness on obstetric danger sign and symptoms | ||||
Yes | 55 | 80 | 2.49 (1.52, 4.069) | |
No | 40 | 145 | 1 | 1 |
Attitude towards EPNC | ||||
Positive | 71 | 104 | 3.44 (2.022, 5.858) | |
Negative | 24 | 121 | 1 | 1 |
This study evaluated the EPNC practices in Hawassa Zuria district, Sidama Regional State, Ethiopia. According to this study, the level of EPNC service utilization was found to be 29.7% (95% CI: 24.7, 35.5). This result was similar to the findings from the study conducted in rural Myanmar (25.20%), Northern Shoa, Ethiopia (28.4%), and Debre Markos town (33.5%) [
This result was higher than the previous findings from eastern Uganda (15.4%), Aseko District (23.7%), and Mertule Mariam District (19%) [
However, this result was lower when compared with previous findings in Benin (68.42%), Addis Ababa (65.6%), and Shebe Sombo district, Jimma Zone (58.5%) [
In view of addressing the different factors in influencing the practices of EPNC services in the study area, an attempt was made to examine the associations between various explanatory variables and the outcome variables. The study identified four variables which have positive significant associations with early postnatal-care service utilization.
This study revealed that younger mothers whose age was below 25 years were 3.2 times more likely to practice EPNC services [AOR = 3.2, 95% CI (1.37, 7.53)] when compared with older ones. This was also seen in previous studies conducted in Shebe Sombo and Fiche town, Oromia Region, Ethiopia [
The odds of having EPNC services were 2.28 times more likely [(AOR = 2.2, 95% CI (1.15, 4.52)] among those mothers who had planned and supported pregnancy when compared with those whose pregnancy was unplanned and unsupported. This finding was in line with the previous study conducted in Debre Tabour town and Tigray Region, Ethiopia [
Awareness on potential postnatal danger signs has a positive association with EPNC utilization. Mothers who have mentioned at least one obstetric danger sign and symptom were 2.2 times more likely [AOR = 2.2, 95% CI
Finally, attitude towards EPNC service also had a positive association with EPNC service utilization. Mothers who had a positive attitude towards EPNC were 3.5 times more likely to utilize EPNC services [AOR = 3.50, 95% CI (1.95, 6.33)] when compared with those who had negative attitude. This finding was consistent with that of previous studies which reported that a respondent’s attitude was a critical factor in encouraging a mother to receive EPNC services [
This study revealed that the coverage of early postnatal-care service utilization was low in the study area. Age of the respondents, having planned and supported pregnancy, having awareness on obstetrics danger signs, and having a positive attitude towards EPNC service were factors significantly associated with the utilization of EPNC service. Strengthening family planning services, giving information on obstetrics danger signs and symptoms, and creating awareness on benefits of EPNC will increase uptake of the service in a timely manner.
Antenatal care
Adjusted odds ratio
Crude odds ratio
Early postnatal care
Postnatal care
Statistical package for social science
World Health Organization.
The finding of this study is generated from the data collected and analyzed based on stated methods and materials. The original data supporting these findings are available from the corresponding author on reasonable request.
Ethical clearance was obtained from the Institutional Review Board of the Hawassa University College of Medicine and Health science. Official permission letters were obtained from Hawassa Zuria District Health Office.
After informing aims, risks, and benefits of the study and assuring confidentiality of the information, verbal informed consent was obtained from each participant.
The authors declare that they have no conflicts of interest.
SY contributed to conception design and analysis and interpretation of data. AD and AD codesigned, analyzed, prepared, and revised the manuscript. Finally, all authors gave final approval of the version to be published.
The authors would like to thank Hawassa University College of Medicine and Health Sciences, School of Public Health, for its support to conduct this study. The authors would like to thank the study participants, data collectors, supervisors, and all Hawassa Zuria District Health Office workers.