TY - JOUR
T1 - Determinants of postnatal care use at health facilities in rural Tanzania
T2 - Multilevel analysis of a household survey
AU - Mohan, Diwakar
AU - Gupta, Shivam
AU - LeFevre, Amnesty
AU - Bazant, Eva
AU - Killewo, Japhet
AU - Baqui, Abdullah H.
N1 - Funding Information:
The authors would like to acknowledge the women who gave their time to be interviewed; the team of research assistants who conducted the interviews; the MUHAS-based team consisting of Dr.David Urassa, Dr. Charles Kilewo, Ms. Idda Mosha, Dr. Rose Mpembeni, Ms. Aisha Omary, and Mr. Deogratias Maufi; the Jhpiego-based team consisting of Ms. Maryjane Lacoste, Dr. Chrisostom Lipingu, Dr. Miriam Kombe, Ms. Elaine Charurat, Ms. Rebecca Mdee; and the JHSPH-based team consisting of Ms. Carla Blauvelt, Dr. Jennifer Callaghan, Dr. Asha George, Dr. Peter Winch, Dr. Shannon McMahon, Ms. Jesse Greenspan, Ms. Joy Chebet and Ms. Nicola Martin. Research reported in this publication was funded by USAID through the Health Research Challenge for Impact (HRCI) cooperative agreement (#GHS-A-00-09-00004-00). The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID, the National Institutes of Health or the United States Government.
Publisher Copyright:
© 2015 Mohan et al.
PY - 2015/10/30
Y1 - 2015/10/30
N2 - Background: Postnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health facilities in Tanzania. Methods: This study examined the role of individual and community-level variables on the use of postnatal health services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression analysis. We analyzed data of 1931 women, who had delivered in the preceding 2-14 months, from a two-stage household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received. Community level variables included community levels of family planning, health service utilization, trust, poverty and education, and distance to health facility. Results: Less than one in four women in Morogoro reported having visited a health facility for postnatal care. Individual-level attributes positively associated with postnatal care use were women's education of primary level or higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04-1.81], having had a caesarean section or forceps delivery (2.95, 1.8-4.81), and being counseled by a community health worker to go for postnatal care at a health facility (2.3, 1.36-3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19-3.15), and whose partners tested for HIV (1.41, 1.07-1.86). High community levels of postpartum family planning usage (2.48, 1.15-5.37) and high level of trust in health system (1.77, 1.12-2.79) were two significant community-level predictors. Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33-0.76), health center (0.57, 0.38-0.85), or dispensary (0.48, 0.33-0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43-0.97). Conclusions: In the context of low postnatal care use in a rural setting, programs should direct efforts towards reaching women who do not avail themselves of postnatal care as identified in our study.
AB - Background: Postnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health facilities in Tanzania. Methods: This study examined the role of individual and community-level variables on the use of postnatal health services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression analysis. We analyzed data of 1931 women, who had delivered in the preceding 2-14 months, from a two-stage household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received. Community level variables included community levels of family planning, health service utilization, trust, poverty and education, and distance to health facility. Results: Less than one in four women in Morogoro reported having visited a health facility for postnatal care. Individual-level attributes positively associated with postnatal care use were women's education of primary level or higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04-1.81], having had a caesarean section or forceps delivery (2.95, 1.8-4.81), and being counseled by a community health worker to go for postnatal care at a health facility (2.3, 1.36-3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19-3.15), and whose partners tested for HIV (1.41, 1.07-1.86). High community levels of postpartum family planning usage (2.48, 1.15-5.37) and high level of trust in health system (1.77, 1.12-2.79) were two significant community-level predictors. Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33-0.76), health center (0.57, 0.38-0.85), or dispensary (0.48, 0.33-0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43-0.97). Conclusions: In the context of low postnatal care use in a rural setting, programs should direct efforts towards reaching women who do not avail themselves of postnatal care as identified in our study.
KW - Multilevel model
KW - Postnatal care
KW - Tanzania
UR - http://www.scopus.com/inward/record.url?scp=84945921849&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84945921849&partnerID=8YFLogxK
U2 - 10.1186/s12884-015-0717-7
DO - 10.1186/s12884-015-0717-7
M3 - Article
C2 - 26518337
AN - SCOPUS:84945921849
SN - 1471-2393
VL - 15
JO - BMC pregnancy and childbirth
JF - BMC pregnancy and childbirth
IS - 1
M1 - 282
ER -