utilization of postnatal care services

Besides these variables, few additional covariates were also included considering their biological plausibility. Marginalization of women emerged as a strong determinant for utilization of maternal health services. Breastfeeding mothers who had postpartum food taboos perceived that meat consumption could make the newborn ill and that some vegetables, such as roselles, cause abdominal pain and flatulence for both mother and baby. Statistical methods are suitable and interpretations are appropriate. Out of the 500 women, almost half of them (49.6%) had misconception regarding postnatal practices; these included food taboos such as avoiding the consumption of meat and some vegetables or behavioral restrictions such as avoiding going outside the delivery room within 7 days of the birth and massaging lower abdomen for the removal of impure blood. This suggests that women might have gone to other centres for taking TT injections or went to receive only TT injection and did not receive antenatal check-up. The utilization of the recommended three postnatal checkups within seven days after delivery, which plays a vital role in preventing maternal and neonatal deaths, is low in Nepal. The variation in presenting this utilization rate might be due to different operational definitions for outcome variable in different studies. The possible explanation might that low income resulted in financial hardship, leading to barriers for taking full PNC. Lancet. Int J Equity Health. The socio-demographic and background characteristics of respondents were presented as frequencies and percentages for categorical variables and as summary statistics, such as mean ± standard deviation for continuous variables. 2011;10(1):59. The presence of misconceptions regarding postnatal practice had a strong negative impact on the utilization of full PNC, with an AOR of 0.12 (95% CI, 0.04-0.36). This study is aimed at identifying the factors associated with the utilization of complete postnatal care (PNC) among mothers. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Data for the present paper was derived from a baseline survey of an intervention study in which RGMVP was working in ten blocks of eight districts of UP. This proportion is lower than the national figure in rural areas (25.9%) [24]. An awareness-raising program highlighting the importance and availability of postnatal care is essential to improve full PNC utilization; it is urgently needed to facilitate the health care providers for provision of essential and updated health information concerning safe motherhood and newborn care, in order to correct harmful misconceptions and upgrade knowledge regarding perinatal danger signs … This was a cross-sectional survey conducted in 2013 in the rural areas of five selected districts of UP: Raebareli, Hardoi, Mirzapur, Maharajganj and Sultanpur. From each township, a random selection of 5 villages (having not less than 18 women who had delivered 2 years prior to the survey) was done. Maternal Health Division, Ministry of Health & Family Welfare G of I. Long waiting time, rudeness of health providers and cultural beliefs were among the factors found to affect utilization of postnatal care services. Accessed 20 June 2016. The highest risk of maternal mortality is during delivery and in the immediate postnatal period, especially the first 24 hours6. J Fam Med Prim Care. In another study in India, proportion of institutional deliveries among women from low socio-economic status was just 13% as compared to 84% among highest wealth quintile [7]. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh (UP) and examines its determinants. Among the 337 respondents who took postnatal care, 83.68% received their first postnatal contact with skilled provider within 24 hours of delivery (the WHO-recommended timing of the first visit). Routine Postnatal care is also given for all mothers in accordance with their newborns to assess and check for bleeding, checking the breasts to prevent mastitis, manage Postnatal care seeks to improve maternal, newborn and infant receiving essential postpartum, newborn care and family planning services (WHO, 2006).According to WHO (2006) the elements of postnatal care are inter alia; prevention of complication of the mother and baby including vertical transmission of diseases from mother to baby, early detection and treatment of problems and complication read… Conclusion: The majority of postnatal mothers in Nepal did not seek postnatal care. Almost all of them (98.8%) were given postnatal supplements, such as vitamin B1 and iron. 2013. 2013;8(6):e67452. postnatal care, full PNC utilization, rural women, Myanmar. Keywords: postnatal care, utilization, Nigeria, determinants, maternal neonatal and child health Word count: 13,117 Descriptive statistics were used to present socio-economic, demographic and household characteristics for all households, and also for SHG and non-SHG households separately. In order to obtain determinants of at least three ANC visits, place of delivery and PNC, the covariates considered were age of the women, type of family, working status of the women, mass-media exposure, number of contacts with the health worker during ANC period, SHG membership and marginalization. In India, there are existing women groups in the community, called self-help groups (SHG), which can be used to create health-related awareness within and outside the group in the community. Background: Postnatal care is essential to save the life of the mother and newborn. Table 2 provides the information on utilization of various maternal health services. DM conceived and designed this study. Epidemiology including research methodology and data analysis, Biostatistics, Public Health, NCDs, Infectious Diseases, Maternal and Child Health. You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. 2010;10(1):30. Recognition of danger signs by the women during pregnancy, delivery and postnatal period is crucial for timely action and management. Effect of implementation of integrated management of neonatal and childhood illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial. The required sample size of 500 participants was estimated based on the multiple logistic regression analysis, as described previously17. Indian J Community Med. Uttar Pradesh (UP) is India’s fourth largest state and the country’s most populated state contributing 16% to the national population. Hence, this study was designed to assess the level of utilization of PNC services and its predictors among postpartum women in Ekiti State, Nigeria. Some independent variables are explained in detail as follows. Directorate of census operations, Uttar Pradesh, Ministry of Home Affairs, Government of India. Conclusion: The postnatal care utilization rate in Debre Birhan townwas83.3%.Maritalstatus,maternalknowledge,and place of delivery were predictors of postnatal care service uti lization. The major strengths of this study lie in its design, as this was a community-based cross-sectional study with a fairly large sample size. Jat TR, Ng N, San Sebastian M. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Utilization of postpartum services is a major concern worldwide due to the great impact it has on infant and maternal mortality. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Likewise, postnatal care has been poorly implemented in Ethiopia [ 4 ]. Socio-economic status, caste and education of women were reported as the important determinants of availing ANC services [9, 32, 39, 40] which is consistent to the relationship we observed here with marginalization (which includes education, caste and household wealth). Skilled attendance during the birth of all babies is considered to be crucial for reducing maternal and infant mortality and morbidity, especially in poor-resource countries [10]. 19(1), 93. To identify the eligible women from SHG households, house listing of the SHG members was done in all the villages of listed GPs of the 15 selected blocks. PLoS One. If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. CAS  In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. 2016;9:21. You can change the regional settings on your computer so that the spreadsheet can be interpreted correctly. The statistical analysis was conducted using the STATA version 13.1. Complete de-identified demographic information for each women taking part in the study, in addition to the answer provided to each question of the questionnaire. A cluster randomized trial conducted in an indigenous community of Odisha and Jharkhand states of India found a positive association between presence of SHG and likelihood of newborn survival within first 6 weeks [16]. The authors declare that no grants were involved in supporting this work. Google ScholarÂ. Accessed 22 June 2016. Utilization of antenatal services was an important determinant both for institutional delivery and postnatal care. The average number of children that the respondents had during the study period was 2 (SD=1.4) and 34 respondents (6.8%) had 5 children and more. 2014;14:1–13. Int J Equity Health. The covariates adjusted in the model included age of women, type of family, women working to earn, mass-media exposure, number of contacts with the health worker during pregnancy, SHG membership and marginalization. SN, AH, LI, JR, DA, SK and NM reviewed the manuscript and provided inputs in statistical analysis and interpretations. 2014;8(4):175–81. Studies have revealed that general health care utilization for every kind of service is affected by distance from those services. Firstly, out of 26 townships, 4 were selected by simple random sampling using a lottery. The leading cause of maternal death was post-partum haemorrhage (PPH), and the second and third-leading causes were pregnancy-induced hypertension and abortion, respectively. The direction of association was also similar to what has been observed in various studies except the study from Nigeria, where it was observed that the likelihood of utilization of PNC services was more if women delivered at home [35]. majority of the women (67.4 %) had more than 2 children. 13 % of the mothers attend postnatal care .Adequate utilization of postnatal care can help reduce mortality and morbidity among mothers and their babies. Hence, apart from the PNC at the hospital, emphasis should be given to the health care worker for doing PNC during home visits. 2015;15(1):1–10. Most marginalized women were less likely to avail ANC visits (OR = 0.69, 95% CI = 0.47, 1.02, p value = 0.032) as compared to non-marginalized women. Springer Nature. BMJ Open. For analysis, the outcome responses were dichotomized into the women who reported less than four postnatal visits or postnatal care after 24 hours =0 and those who received four or more postnatal visits and the first visit within 24 hours =1. F1000Research 7. Interventions targeted at increasing women’s awareness of the importance of postnatal services and improving accessibility, particularly in rural areas, is needed. Acharya A, Kaur R, Prasuna J, Rasheed N. Making pregnancy safer-birth preparedness and complication readiness study among antenatal women attendees of a primary health center, Delhi. Of the 500 women in this study with children under 2 years age, 126 utilized full PNC, i.e. No association was observed between the utilization of ANC, institutional delivery and PNC with SHG membership after controlling for the covariates. Table (1): Table construction should be like, Table (2): Table construction should be like. It was reported that about 38% of maternal deaths were caused by haemorrhage, 11% due to sepsis and 5% due to obstructed labor [3], majority of which can be prevented if women regularly go for antenatal care (ANC), deliver in an institution and utilize postnatal care services. 2010;28(4):383–91. Available from: https://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf?sequence=1. Reviewer Expertise: ‘Public Health’ focusing on vector-borne diseases especially malaria and dengue, neglected tropical diseases particularly schistosomiasis, nutrition and food safety, and cancer. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21069697. PubMed Google Scholar. However, it was reported in AHS (2012–2013) that around 77% of mothers received PNC within 48 h of delivery which is quite high when compared to the findings of this study [25]. In: Chaurasia AR SR (Southampton: U of S, editor. The population covered in the survey was mainly the marginalized section from rural areas with low education and from other backward caste (OBC)/SC/ST; hence, the generalization of the findings to the larger population would be questionable. In connection with male involvement, 46.8% of the participants were provided with assistance from their husband regarding maternal care usage, such as transportation assistance, and mutual discussion for seeking and receiving maternal healthcare services. Of them, 61% reported three or more ANC visits. This is reflected from the proportion of women who reported consumption of IFA tablets and examined for blood pressure, weight gain and blood and urine test. Various studies in India have concluded socio-economic factors and service delivery environment as important determinants influencing maternal health services [5, 6]. There was a decay effect of the distance on the health care service utilization, i.e., as the distance increases from the healthcare facilities; utilization of services was reduced [30-32]. You have a close personal relationship (e.g. Objective. Karkee R, Lee AH, Khanal V. Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey, 2011. India fact sheet. Khanal V, Adhikari M, Karkee R, Gavidia T. Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011. A Cochrane review showed that community-based interventions are effective in significantly reducing maternal and neonatal morbidity and mortality [14]. Downloaded data do not display as expected? The Khon Kaen University Ethics Committee for human research with reference number [HE592256] and the Ethical Committee of University of Public Health, Yangon, Myanmar [Ethical (6/2016)] approved this study. Reviewer Report For: Utilization of full postnatal care services among rural Myanmar women and its determinants: a cross-sectional study [version 1; peer review: 3 approved], Mon MM. To take into account the clustering of women, where women were nested within GPs and GPs were nested within blocks, multilevel random intercept logistic regression was used for each of the three outcomes. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Utilization of maternal health services is influenced by multiple factors and this required focused attention. Currently married women in the age group of 15 to 49 years and those who delivered a baby during 15 months prior to the survey were eligible to be included in the study. Soe HZ. Similar findings of high coverage but low quality of ANC services are being reported from different countries [26, 27]. Nearly two-thirds of the women in the study (64.4%) selected their home as their place of delivery. The health care workers had informed only 15 % of the women, to attend the PNC services. Please confirm that you accept the User Comment Terms and Conditions. Postnatal care services utilization was 73.7% and 61.4% in the urban and rural settlements respectively. Sample Registration System; Available from: http://www.cghr.org/wordpress/wp-content/uploads/RGI-CGHR-Maternal-Mortality-in-India-1997-2003.pdf. A period of 15 months was selected in order to minimize the recall bias. Regarding accessibility, about half of respondents (44.8%) encountered difficulty in accessing their nearest health center (that is, they experienced more than 2 hours travel there or it was not easily accessed in the rainy season). 2014;4(3):e004372. All commenters must hold a formal affiliation as per our Policies. With increase in institutional delivery, the maternal mortality and newborn mortality is expected to decline due to the presence of skilled birth attendants, supported by the essential infrastructure and referral services when required. BMC Womens Health. Terms and Conditions, 2015;8(1):345. 2013;55(1):55–9. Accessed 21 June 2017. International Institute for Population Sciences. Soc Sci Med. Almost 70% of the maternal deaths happen within the age group of 20 to 29 years which is the age group where fertility rates are also very high [2]. Moreover, just under half of mothers could get knowledge about contraception methods (49.3%) although over three-quarters of them (75.4%) were provided with contraceptives. The proportion of postnatal care service utilization in the reviewed articles ranged from 11.4% to 66.8%. Khan ME, Hazra A, Bhatnagar I. The health authorities and staff from Magway Regional Health Division are acknowledged for their kind support in field data collection. Quality of antenatal care in primary health care centers of Bangladesh. South East Asia J Public Heal. About one fourth of them had decided about the place of delivery a priori, and only 30% had arranged for transport in advance to go to the health facility. Validity was arranged by the three experts to obtain the finalized version of questionnaire. 2010;375(9730):2009–23. Even in institutional deliveries, only about one third of the women stayed for 48 h or more (Table 2). Khan ME, Agrawal PK, Hazra A, Dixit A, Bhatnagar I, Ahmad J, et al. TBA, traditional birth attendant; ANC, antenatal care. Further study focusing on quality of PNC services and satisfaction on services the rural women received should be recommended. Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey. Competing Interests: No competing interests were disclosed. Slightly under a quarter (23.6%) did not take antenatal care at all. Even though rural women are likely to have higher birth rates, most of them have greater reluctance in seeking, reaching and receiving care from skilled providers3. The attainment of a higher level of education was significantly associated with the receipt of full PNC in the current study, which was consistent with other studies conducted in Bangladesh and Nepal9,21 and, in addition, also homogeneous with the findings of a national survey20.

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