Socio-demographic characteristics
A total of 274 mothers with the first six weeks of delivery were participated in the study with a 100% response rate. Accordingly, 137 (50 %) of respondents belong to the age group 18-25 years with a mean age of 26.74 (SD of ±5.43) years. Of the interviewed respondents about 154 (56.2%) were protestant, 265 (96.7%), and 113 (41.2%) were completed primary education. Regarding occupation, 241 (88%) of the respondents were unemployed housewives, followed by merchant 14 (5.1%), 9 (3.3%) government employees and the rest 14(5.1%) were employees of private organizations. Regarding the household income, 164 (59.9%) earns less 500 ETB (17.34 USD 2019 value) (Table 1).
Maternal health characteristics
Mothers are asked for history abortion as well as history delivery, antenatal care, and postnatal care use. From total respondents, 21 (7.7%) had a history of abortion and two third (75.5%) had ANC during their last pregnancy. From the mother interviewed in this study, 39 (14.2%) of mothers have experience at least one type of pregnancy-related complication. Similarly, out of the total respondents, 65 (23.7%) of mothers visited the health facility for postnatal care service within the first week of delivery. From mothers who had given birth in a health facility, about 124 (89.2%) were given postnatal care appointments. Of those, 1 (0.8%), 36 (29%), 23 (18.5%) and 64 (51.6%) were given postnatal care appointments at less than 24 hours, within 2-3 days, within 6-7 days and on six weeks, respectively (Table 2).
Awareness of postnatal care
Out of all participants, about 181 (66.1%) had awareness about PNC within one week services. From those who had awareness about the PNC services, a large percentage of respondents had heard about immunization services for their children 91 (50.3%) followed by advice on dangers signs after delivery (29.8%). About 29 (16%) of respondents indicated postnatal care visit is to take family planning service information. Less proportion of responded mothers showed that they have information on hygiene (1.7%). Similarly, the respondents indicated that they have less information on physical examination for mothers (1.1%), as well as newborn (1.1%) (Table 3).
Factors associated with the use of PNC within the first week of delivery
Table 4 indicates the factors found to be associated with postnatal care utilization with the first week of delivery in the Dano district. Accordingly, mothers who had appointed by health professionals for PNC Visit before discharge were more likely to return for postnatal care [AOR=4.84, 95% CI= (1.46 - 16.1)] than to those who had no appointed by health professionals during discharge from delivery care. Mothers who have postnatal care in their previous delivery are also more likely to use postnatal care within the first week of delivery [AOR= 7.4, 95% CI= (2.9, 18.5)].
The finding showed, mothers who had awareness of PNC within one week services were 4.2 times more likely utilized PNC within one week of delivery as compared to those who had no awareness [AOR=4.27, 95% CI= (1.46, 12.49)]. Socio-demographic and other health service factors did not indicate a statistically significant association with the utilization of postnatal care with the first week of delivery.
Barriers for attending postnatal care within the first week of delivery
Focus group discussion which composed of 48 of the participants was conducted based on six major thematic areas which then merged into three major themes. Three themes were problems mothers face during childbirth, reasons that hinder mother from PNC use with the first week of delivery and cultural belief and practices on postnatal care within one week.
Both health extension workers and mothers identified problems that some mothers face during the first week of delivery. The discussant indicated that there are problems like severe headache, shivering, severe vaginal bleeding, abdominal pain, delaying of the placenta, and obstructed labor and death of neonate. This idea is summarized with what 34 years old mother said that she faced severe headache and abdominal cramp during her delivery. But they have also indicated that, lack of information on when to visit the health facility. The following quote was taken from one of the ideas raised by mothers.
“… I had usually faced severe headache and abdominal cramp during my past deliveries, and I lost nine days aged newborn, in my second delivery, as no one informed me to visit a health facility.”
Furthermore, mothers groups are asked why mothers in their village do not attend postnatal care early. Accordingly, mothers indicated they are not informed to visit the health facility until 45 days. The reasons why they visit after 45 days of delivery are for the purposes of receiving their child immunization and family planning services. To support this, a mother of 38 ages old forwarded her lack of information about the utilization of PNC within one week service saying:
“… I don’t have any information to utilize PNC service within the first week of delivery but to visit health facilities after 45 days of delivery for the purposes of receiving my child immunization and family planning services.”
Participants also identified different traditional and cultural beliefs during the postpartum period which may hinder postnatal care use. Based on the discussion points raised participants reasoned out mainly believe that mothers’ body doesn’t get strength until for 40 days of delivery to go somewhere. Culturally they fear exposure to sunlight may cause of illness called “michii” to mother and newborn. There is also fear an evil spirit may affect the mother and newborn because their life not yet established. So discussants argued mother should carry sharp (metals) such as spears whenever she wants to go out to protect from evil spirits as evil is believed to fear such metals. Little baby (newborn) also should be accompanied with dry cow dung. In support of this, a 38 years old mother says that:
“...Our culture and tradition as descended down from our elders discourage us (postnatal mothers) not to go to the health facility for PNC within first months of delivery because they (postnatal mothers) will suffer from illnesses resulted from sunlight (michii) and evil spirit if they move out of the home. In addition, it is believed that postnatal mothers wouldn’t have enough energy to go out of the home before 40 days of delivery.”
Health extension also strengthened the issues which have been raised by mothers. According to them, low utilization of postnatal care within the first week of delivery was the distance of their from the health facility, lack transportation, and cultural believes and lack of trust in health services.
It also recognized by health extension workers cultural beliefs and practice during postpartum period prominently affect postnatal use. The discussants underlined that because of the fear of the health problems which caused by sunlight (michii) and fear of evil spirits on newborn and mother, they are not allowed to go out of the home. To avert this problem mothers have culturally advised to carry sharp metals like spear and awl (mutaa) in case she goes out. Going out with a child are believed to culturally protect the mother and newborn from evil. While they are in the home they have to put metal under the pillow and leg. Health extension also pointed out that mothers should be kept in closed curtains until for 40 days of delivery to protect from sun rays (lights) that could raise problems on newborns. It is also a means of protection from exposure to gusts eyes that could be associated with evil eyes. To support this idea one of 26 years health extension workers said:
“... until for 40 days of delivery mother should be kept in closed curtain and she is advised culturally to stay at home because of the fear of sun rays that could cause problem to newborn, and should not be openly seen by guests eyes that could be associated with evil eyes.” says a 26 years old community health extension worker.