Globally, about 4 million neonates die every year. Of these, about 71% of deaths occur within the first week of life and 1.2 million dies on the first day following birth. Furthermore, estimated 287,000 maternal deaths occur each year, mostly in low- income countries, due to obstetric complications occurring within 24 hours of birth and thereafter (1). In Ethiopia, maternal and neonatal mortality remains the highest among the world, at 412/100,000 and 29/1,000, respectively. In other words, in Ethiopia 1 in every 33 children dies within the first month, 1 in every 23 children dies before celebrating the first birthday, and 1 of every 18 children dies before reaching the fifth birthday based on recent Ethiopia Mini Demographic and Health Survey (EMDHS)(2).
Despite the fact improvements observed on antenatal care (ANC) and facility delivery, PNC utilization coverage remains low due to many reasons such as unavailability, inaccessibility, poor quality of health services, socio-cultural beliefs, awareness on danger signs of postnatal period, long waiting time and distance (3–10). Even with different multiple interventions, postnatal maternal and new-born care utilization at the facility remains low (2, 11). Studies also showed that a significant proportion of mothers prefer to return home or discharged within a few hours after delivery which makes them not receive the required care(12, 13).
Studies in low and middle -income countries with high new-born mortality demonstrated that early postnatal home visits, by community health workers help to reduce neonatal deaths and improve maternal and neonatal health. For example, studies conducted in India, Bangladesh, and Pakistan have shown that home visits can reduce deaths of newborns by 30–61% in developing countries where there is high mortality. In particular, home visits improved coverage of the key high-impact and cost-effective neonatal interventions such as early initiation of breastfeeding, skin-to-skin contact between newborns and their mothers, delayed bathing of the newborn, hygienic care of the baby’s umbilical cord stump (14).
Based on the experiences and evidence from South Asian trials, in 2009, WHO and UNICEF issued a joint statement recommending PNHVs for delivery of postnatal care. Following the 2009 Joint Statement, many countries adopted policies to deliver postnatal home visits. Among the 75 countries included in the Countdown to 2015 report, 59 have policies to deliver such home visits within one week of birth(15, 16).
The health extension program, which was launched in 2003 contributed to mobilizing community members towards the utilization of antenatal care and institutional delivery. HEWs were trained to give basic maternal and child health care and improve the health of the mothers and newborns during the antenatal, delivery and postnatal period and HEWs are expected to spend 75% of their time in the community and provide essential health services through the house to house visit(17).
Postnatal home visiting by the HEWs includes assessing both mother’s and neonate’s general physical examination and vital signs; checking cord; checking for danger signs such as any bleeding, convulsion, breathing problems, any health problems; counseling about breastfeeding, skin to skin contacts; and providing health education based on mother’s health status(18).
Studies on the coverage of postnatal visit within 48 hours showed low(19) and the coverage within three days after delivery from three Countries (Bangladesh, Nepal, and Malawi) by Community Health Workers(CHWs) showed that 57%, 50%, and 11% respectively and the pooled results of the study in these countries found that early visits were more likely if a mother had been visited by CHWs during pregnancy, birth notification by CHWs, and home deliveries(20).
In Ethiopia, since the implementation of the health extension program (HEP), few studies have published findings on the coverage of PNHVs by HEWs. In Southern Ethiopia, 12.4% of mothers and their neonates were visited by the HEWs during the first month of birth and the major factors associated with early PNHVs were HEWs visit home during pregnancy, skilled delivery, and having HEW’s cell phone and no association were observed with maternal socio-demographic characteristics and early PNHVs (21, 22)
In the northern Ethiopia, to improve the lives of mothers and newborns, different activities have conducted by HEWs in line with the government’s policies and strategies and EDHS report showed the percentage of facility-based postnatal care utilization within the first two days after delivery was 45.4% (23). However, paucity exists on the evidence about the coverage of early PNHVs by HEWs. Moreover, little is known about the contents of care given during PNHVs. Therefore, the study aimed to determine the coverage and contents of PNHVs and associated factors by HEWs in rural Tigray, northern Ethiopia.