Postnatal care service utilization and its determinants in Ramechhap district, Nepal: A community-based cross-sectional study

Abstract

Nepal is one of the 10 countries worldwide that have reduced maternal mortality rate during 1990-2013 by 75% due to programs aiming to improve utilization of maternal care services. Nevertheless, the national utilization rate of  postnatal  care  is  very  low  as  only  half  of  women  uptaking  postnatal  care  services  at  least  one  time  within  42 days  after  delivery.  Therefore,  this  study  was  to  identify  factors  affecting  postnatal  care  utilization  in Ramechhap district,  Nepal, where is  one  of the  districts  with  lower postnatal  care rate.

A  community-based  cross-sectional  study  was  conducted  from  March  to  April  2017.  A  two-stage  cluster sampling  technique  was  used  to  draw  a  sample  of  380  mothers  who  gave  birth  in  the  last  1  year  from  four village  development  committees.  Descriptive  statistics,  Chi-square  test  and  multiple  logistic  regression  were  used to  determine  the  predictors  of postnatal  care uptake.

This  study  showed  utilization  of  postnatal  care  services  at  least  one  time  within  42  days  after  delivery  was only 28.4%. Among predisposing factors, mother’s age < 30 (Adj OR=3.35, 95% CI=1.48-7.60), higher husband’s education (Adj OR=3.42, 95% CI=1.53-7.68), husband’s occupation like officers (Adj OR=2.60, 95% CI=1.21–5.98), nuclear  family  (Adj  OR=3.03,  95%  CI=1.40-6.56),  and  higher  level  of  awareness  on  postnatal  complication  (Adj OR=7.23, 95% CI=3.33-15.67). Among enabling factors, experience of antenatal care (Adj OR= 4.47, 95% CI=2.12-9.41), satisfactions to quality of health services (Adj OR=3.01, 95% CI=1.38-6.54), longer spending time for travel and waiting for postnatal care (Adj OR=8.48, 95% CI=3.66-19.68) and among need factors, postpartum depression of mothers  (Adj OR=4.13, 95% CI=1.37-12.43)  were significantly  associated  with  postnatal  care services uptake.

Postnatal  care  service  use  was  relatively  low  in  the  district.  Raising  awareness  on  postpartum  complications and  importance  of  postnatal  care  service,  and  strengthening  the  capacity  of  health  facilities  and  outreach  clinics should  be  promoted  for improving postnatal  healthcare  service uptake.