Socio- Demographic Characteristics of respondents
Of a total of 568 sampled women who gave birth within the last 12 months, 556 were participated in the study which yielded a response rate of 97.8%. The maternal age was ranged from 18–42 with average of 28.84 ± 5.306 years. Majorities (79.1%) of respondents were between 20–34 years. Almost half (49.5%) of the respondents were orthodox by religion and Guraghe was the predominant ethnic group, 518 (93.2%) (Table 1).
Table 1
Distribution of Socio-demographic characteristics among women who gave birth in the last 12 months in Ezha District, Southern Ethiopia, from March1-30, 2019
Variables | Categories | Frequency(n) | Percent (%) |
Age (in years) (n = 556) | < 20 | 19 | 3.4 |
20–34 | 437 | 79.1 |
35+ | 96 | 17.5 |
Maternal Educational status | No formal education | 246 | 44.3 |
Primary education | 167 | 30.0 |
Secondary education | 125 | 22.5 |
College and above | 18 | 3.2 |
Marital status | Married | 530 | 95.3 |
Single | 12 | 2.1 |
Divorced | 9 | 1.6 |
Widowed | 5 | 1.0 |
Ethnicity | Guraghe | 518 | 93.2 |
Others | 38 | 6.8 |
Religion | Orthodox | 275 | 49.5 |
Muslim | 243 | 43.7 |
Protestant | 38 | 6.8 |
Maternal occupation | House wife | 392 | 70.5 |
Merchant | 113 | 20.3 |
Daily laborer | 40 | 7.2 |
Civil servant | 11 | 2.0 |
Husband Educational status | No formal education | 222 | 41.9 |
Primary education | 194 | 36.6 |
Secondary education | 93 | 17.5 |
College and above | 21 | 4.0 |
Husband occupation | Farmer | 380 | 71.7 |
Merchant | 119 | 22.4 |
Civil servant | 20 | 3.8 |
Daily laborer | 11 | 2.1 |
Number of family | < 5 | 283 | 50.9 |
≥ 5 | 273 | 49.1 |
Wealth index in quintiles | Lowest | 109 | 19.6 |
Low | 114 | 20.5 |
Middle | 111 | 20.0 |
High | 114 | 20.5 |
Highest | 108 | 19.4 |
Maternal and Neonatal Characteristics
Two hundred eighty (50.4%) of participants were multiparous. Majority (89.2%) of respondents were received at least one antenatal care (ANC) visit during their last pregnancy and among them 124(22.3%) of participants received four or more visits. With respect to place of delivery 405(72.8%) of mothers gave their last birth at health center. Forty one (7.4%) of mothers delivered their last child by Caesarean section. Persistent vomiting 58(38.9%) and gush of fluid before the onset of labor 31(20.8%) accounted for the major complaints reported (Table 2).
Table 2
Obstetric characteristics of respondents who gave birth within the last 12 months in Ezha district, Southern Ethiopia, March 2019
Variables | Categories | Frequency(n) | Percent (%) |
Parity | Primiparous | 87 | 15.6 |
Multiparous | 280 | 50.4 |
Grand multiparous | 189 | 34.0 |
Previous history of NND | Yes | 45 | 8.1 |
No | 511 | 91.9 |
Planning status of last pregnancy (n = 553) | Intended | 438 | 79.2 |
Unwanted | 42 | 7.6 |
Mistimed | 73 | 13.2 |
ANC visits | No | 60 | 10.8 |
One visit | 165 | 29.7 |
Two visits | 94 | 16.9 |
Three visits | 113 | 20.3 |
Four and more visits | 124 | 22.3 |
Last Birth outcome | Live birth | 540 | 97.1 |
Still birth | 16 | 2.9 |
Place of delivery | HC | 405 | 72.8 |
Hospital | 94 | 16.7 |
HP | 20 | 3.8 |
Others * | 37 | 6.7 |
Mode of delivery | Caesarean delivery | 41 | 7.4 |
Instrumental delivery | 53 | 9.5 |
Spontaneous vaginal delivery (SVD) | 462 | 83.1 |
Key: Others * (delivery took place at home or on the way to health facility) |
Out of total respondents 132(23.7%) mentioned that they faced at least one maternal health problem during post-partum period. Breast problems (31.8%), abnormal vaginal bleeding (34.4%), high grade fever (sepsis) (26.2%), severe abdominal pain (7.7%) and swelling of the body parts (2.5%) were the major health problems reported by the mothers.
On the other hand one quarter (25%) of respondents reported that they faced newborn illness during postpartum period with at least one reported health problem. Unable to breast fed (53.1%) and breathing difficulty (30.4%) accounted for majorly reported newborn health problems followed by umbilical area infections(11.7%), vomiting(9.4%) and high grade fever(8.6%).
Level of Maternal Knowledge on Post Natal Care and Postnatal Danger Signs
A composite indicator of knowledge was constructed, whereby just over one fifth (21.6%) of the women had good knowledge about recommended postnatal care services and postpartum danger signs. Majority 45.0% and 33.4% of respondents had poor and moderate knowledge regarding to post-natal care and danger signs following delivery.
Regarding exposure to information, 355(63.8%) got any information about recommended PNC service. Majority 266(74.9%) got from Health Extension workers followed by from health institutions 156(43.9%). In addition, 121(34.1%) and 31(8.7%) of respondents got information from their friends and radio respectively. Nearly half (49.2%) of mothers knew at least one advantage of receiving recommended PNC. Around a quarter (23.3%) of respondents knew the time for PNC service delivery (i.e. following delivery and lasts till six weeks) whereas only 102(18.4%) knew the recommended number of postnatal visits(i.e. at least three visits). Furthermore, 54.9% and 57.4% of mothers knew at least one maternal and newborn danger signs during postpartum periods respectively.
Prevalence of Complete Post Natal Care Utilization
Interviewed women were categorized into two groups; women who got three and more PNC visits (complete PNC) and those who did not (sporadic PNC). From a total of 556 respondents (19.6%); [95%CI: (16.5, 23.2)] received complete PNC service.
Four hundred fifty eight (82.4%) mothers got at least one postpartum visit. Regarding timing of PNC visits, majority 305(66.6%) received their postnatal contact within the first 24 hours after delivery. In addition, 264(57.6%) and 224(48.9%) of respondents received postnatal visit on day 3(48–72 hrs.) and 7–14 days respectively. Relatively, few mothers (12.8%) got the service at sixth week. Regarding to service delivery platform for majority of visits, 398 (86.9%) respondents got the service by health extension workers through home to home visit and/or at health post level while the remaining 60(13.1%) got the service in at health center and hospital by skilled health providers.
Reasons for not receiving CPNC services
From a total of 447 respondents with sporadic PNC, 161(36.2%) and 146(32.6%) of respondents mentioned lack of information on the importance of complying with recommended visits and health care providers related problems as the main reason for not receiving CPNC service respectively.
Table 3
Reasons for not completing recommended PNC among mothers who gave birth in the last 12 months in Ezha district, Southern Ethiopia, March 2019
Reason for not completing | count | Percent |
Having no information about PNC | 161 | 36.0 |
Health care provider related problems | 146 | 32.6 |
Cultural issues(seclusion) | 109 | 24.4 |
Being healthy | 82 | 18.3 |
Long distance | 42 | 9.4 |
Lack of transportation | 24 | 5.4 |
Contents of Care Given During Service Delivery |
Regarding contents of care received during service delivery, 321(70.1%) of respondents got health education on exclusive breast feeding (EBF). Three hundred eighteen (69.4%) and 294(64.3%) got examination for abnormal bleeding and cord care respectively. Around half of the mothers were provided with information regarding to postnatal danger signs (51.8%). When compared to other services few respondents got blood pressure measurement, breast examination and iron folate supplementation (Table 4).
Table 4
Distribution of contents of care among respondents who gave birth in the last 12 months, in Ezha district, SNNPR, southern Ethiopia, March2019
Contents of care(458) | Frequency (%) |
Health education on exclusive breast feeding (EBF) | 321(70.1) |
Examination of abnormal vaginal bleeding (AVB) | 318(69.4) |
Counseling on danger signs | 288(62.8) |
Counseling on personal hygiene | 188(41.0) |
Health education on contraception | 257(56.1) |
Health education on HIV/AIDS transmission | 170(37.1) |
Iron folate supplementation(IFAS) | 93(20.1) |
Cord care given to the new born by using clorhexidine, ”Yemisrach” | 294(64.2) |
Eye care given | 118(25.8) |
Breast examination | 69(15.0) |
Measuring body temperature of the newborn | 208(45.6) |
Getting referral service | 92(20.1) |
Measuring body weight of the new born | 242(43.5) |
Great Variations were noticed among mothers in receiving recommended contents of cares between mothers with complete PNC and their counterparts. Among a total of 109 respondents who got complete PNC, majority (90.8%) got counseling on exclusive breast feeding and 102(93.5%) were examined for abnormal vaginal bleeding. In contrast, most of those service uptakes were low among respondents with sporadic PNC category (Table 5).
Table 5
Distribution of contents of care among respondents who gave birth in the last 12 months, in Ezha district, southern Ethiopia, february10-March10, 2019
Contents of care(N = 556) | Level of completion | From total respondents( N = 556) |
Complete(n = 109) | Incomplete (n = 447) |
Health education on exclusive breast feeding (EBF) | 99(90.8%) | 222(49.6%) | 321(57.7%) |
Examination of abnormal vaginal bleeding (AVB) | 102(93.5%) | 216(48.3) | 318(57.1%) |
Counseling on danger signs | 69(63.3%) | 219(48.9%) | 288(51.7%) |
Counseling on personal hygiene | 81(74.3%) | 107(23.9%) | 188(33.8%) |
Health education on contraception | 69(63.3%) | 188(42.0) | 257(46.2%) |
Health education on HIV/AIDS transmission | 72(66.0%) | 98(21.9%) | 170(30.6%) |
Iron folate supplementation(IFAS) | 41(37.6%) | 52(11.6%) | 93(16.7%) |
Cord care given to the new born by using clorhexidine | 93(85.3%) | 201(44.9%) | 294(52.8%) |
Eye care given with tetracycline ointment (TTC) | 39(35.7%) | 79(17.7%) | 118(21.2%) |
Measuring body temperature of the newborn | 64(58.7%) | 144(32.2%) | 208(37.4%) |
Getting referral service | 14(12.8%) | 32(7.1%) | 46(8.3%) |
Measuring body weight of the new born | 74(67.9%) | 168(37.6%) | 242(43.5) |
Source: field work, 2019 |
Factors Associated with Complete postnatal care Utilization.
Multi variable logistic regression analysis was performed and maternal education was found to be significantly associated with complete postnatal care (CPNC) utilization. Mothers who attend secondary education and above were more than 4 times [AOR: 4.3; 95%CI: (2.15, 8.05)] more likely to get complete postnatal care than mothers with no formal education. Similarly, Mothers who got four and more ANC visits were more than 3.75 times [AOR: 3.75 95%CI: (1.78, 7.92)] more likely to utilize CPNC service when compared to those who got at most one visits. Furthermore, mothers who gave birth by cesarean section were nearly four times (AOR: 3.96; 95%CI: (1.50, 7.94) more likely to get CPNC services than mothers who gave birth by spontaneous vaginal delivery (Table 6).
Table 6
Bivariate and multivariable logistic regression analysis of factors associated with complete postnatal care service utilization among study participants in Ezha district, Southern Ethiopia, March 2019.
Variables | Categories | PNC status | COR(95%CI) | AOR(95%CI) |
Complete(= 1) | Sporadic (= 0) |
Maternal Educational status | No formal education | 16 | 230 | 1 | 1 |
Primary education | 43 | 124 | 4.98(2.69,9.21) | 2.46(1.22,4.92)* * |
Secondary and above | 50 | 93 | 7.73(4.19,14.26) | 4.30(2.15,8.05)* * |
Maternal age | 35+ | 5 | 91 | 1 | 1 |
20–34 | 98 | 342 | 5.21(2.06,13.19) | 2.25(0.78,6.50) |
< 20 | 6 | 14 | 7.80(2.09,21.01) | 2.09(0.35,12.29) |
Family size | ≥ 5 | 40 | 233 | 1 | 1 |
< 5 | 69 | 214 | 1.88(1.22, 2.89) | 0.67(0.38,1.18) |
Planning status of last pregnancy (n = 553) | Planned | 102 | 336 | 4.68(2.11, 9.38) | 2.34(0.92,5.18) |
Unplanned*** | 7 | 108 | 1 | 1 |
Number of ANC visits | ≤ one visit | 15 | 210 | 1 | 1 |
Two visits | 17 | 77 | 3.09(1.47,6.49) | 2.18(0.92,5.14) |
Three visits | 31 | 82 | 5.29(2.71,10.31) | 2.49(1.15,5.39)* * |
Four or more | 46 | 78 | 8.25(4.36,15.63) | 3.75(1.78,7.92)* * |
Parity | Grand multiparous | 20 | 169 | 1 | 1 |
Multiparous | 61 | 219 | 2.35(1.37,4.05) | 1.26(0.51,3.07) |
Primiparous | 28 | 59 | 4.01(2.1,7.65) | 1.24(0.58,2.64) |
Mode of delivery | SVD | 71 | 391 | 1 | 1 |
Instrumental | 20 | 33 | 3.34(1.81,6.14) | 1.57(0.76,3.26) |
C/S | 18 | 23 | 4.31(2.213,8.39) | 3.96(1.5,7.94)* * |
Maternal waiting room utilization | No | 61 | 330 | 1 | 1 |
Yes | 48 | 117 | 2.22(1.44,3.42) | 1.55(0.91,2.64) |
Knowledge on PNC and postnatal danger sign | Poor | 15 | 171 | 1 | 1 |
Moderate | 51 | 199 | 2.92 (1.58,5.38) | 2.17(1.00,4.70) |
Good | 43 | 77 | 6.37(3.34,12.15) | 5.31(2.34,10.04)* * |
Time To reach nearby HF | Far (> 1hr) | 27 | 168 | 1 | 1 |
Close ( < = 1hr) | 82 | 279 | 1.83(1.14,2.94) | 1.17(0.63,2.19) |
Being MHH | Yes | 91 | 178 | 7.64(4.45,13.1) | 3.61(1.97,6.64)* * |
No | 18 | 269 | 1 | 1 |
**= statistically significant at p < 0.01, |
1: reference category; COR: crude odds ratio; AOR: adjusted odds ratio. |
*** Unplanned pregnancy (mistimed and unwanted pregnancy) |