Postnatal care (PNC) is the care given to the mother and her newborn baby immediately after the birth and extends up to six weeks (42 days) after birth (1, 2). PNC is important to reduce death, disability as well as missed opportunities to promote healthy behaviours in women, newborns, and children (3). Globally 2.4 million children died in the first month of life in 2019 (4). Every year in Africa, at least 870,000 newborns die in the first week after birth (3). In 2019, Sub-Saharan Africa had the highest neonatal mortality rate at 27 deaths per 1,000 live births (5, 6). Ethiopia is ranked fourth among the top ten countries with the highest number of newborn deaths in 2019 (6). According to the most recent Ethiopia Mini Demographic and Health Survey (EMDHS), the early newborn death rate was very high, with 30 babies dying in the first 28 days of life for every 1,000 live births (7).
The most vulnerable time for both mother and newborn are during the first six weeks after birth (Postnatal period). Health checks during this time especially the first two days after delivery are essential (3, 8). Approximately 7000 newborns die every day; with about a third of all neonatal deaths occurring within the first day after birth, and close to three-quarters occurring within the first week of life (9, 10).
Elsewhere, literature reveals that most of the factors that lead to neonatal deaths could be prevented through postnatal check-ups (8, 11–13). Postnatal care for the baby is an important opportunity to check for danger signs, such as insufficient feeding, fast breathing, severe chest in-drawing, lethargy, fever, low body temperature or jaundice. Simultaneously, mothers can receive advice on how to identify and respond to these symptoms, as well as the benefits of exclusive breastfeeding and immunization (8).
The WHO recommends postnatal care within 24 hours of birth, regardless of where the baby is born. Newborns should receive at least three additional postnatal care visits by a skilled provider, on day 3 (48–72 hours after birth), between day 7 and day 14, and again 6 weeks after birth (14). Globally, only 48 percent of newborns received a post-natal health check within the recommended time period (8). Postnatal care (PNC) programmes are among the weakest of all reproductive and child health programmes in Africa region (3). In Ethiopia, as in all countries, the postnatal period is often marked by specific cultural practices and socioeconomic factors and mothers and newborns spend most of this period at home (1, 3, 15).
The 2019 EMDHS shows some improvement in the survival rates of infants and of children under age 5 in recent years. Under-five mortality rate dropped from 123 to 43 deaths per 1,000 live births between 2005 and 2019, and Neonatal mortality decreased from 39 to 29 deaths per 1,000 live births between the 2005 and 2016 EDHS, but has remained stable since the 2016 EDHS. This situation may be explained in part by the low level of PNC (34%) (7).
As mortality among children under five declines globally, deaths among these children are more and more concentrated in the first days of life. This makes focus on newborn care more critically than ever before (8). The Ethiopian government proposed the National Newborn and Child Survival Strategy (2015-2020) aims to reduce neonatal mortality rate from 28/1,000 live births to 11/1,000 live births (16). If all newborns received high impact and cost-effective interventions during the postnatal period, it is estimated that neonatal mortality could be reduced to 12 per 1,000 live births. In other words, high postnatal care coverage could save up to 210,234 newborn lives a year in Ethiopia (16), and help the country to meet the Sustainable Development Goal of ending preventable deaths of newborns and children under 5 years of age by the year 2030 (17).
To increase coverage of PNC of newborn in Ethiopia, a better understanding of its determinant factors is important. The objectives of this study were to assess factors associated with any PNC for newborns and the timing of the first PNC. Understanding of such factors may help develop necessary strategies and interventions to help improve not only PNC coverage but also its timing in the most critical period (within 48 hours) and in turn increase neonatal survival chance in Ethiopia.