RT Journal Article
SR Electronic
T1 Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200502
DO 10.9745/GHSP-D-22-00502
VO 11
IS 4
A1 Serbanescu, Florina
A1 Abeysekara, Purni
A1 Ruiz, Alicia
A1 Schmitz, Michelle
A1 Dominico, Sunday
A1 Hsia, Jason
A1 Stupp, Paul
YR 2023
UL http://www.ghspjournal.org/content/11/4/e2200502.abstract
AB Key FindingsCoverage for postnatal care (PNC) in a remote, mostly rural region of Tanzania was low, with 5 of 6 women not using facility-based postnatal checkups.Controlling for all other factors, we found that several individual and community characteristics were associated with PNC, including decision-making autonomy, presence of a birth companion for support during labor and delivery, cesarean delivery, district of residence, and presence of an adequate health facility within 5 km travel distance.Increasing the use of PNC services would require improving the adequacy of care in proximal health facilities, empowering women to use preventive services, and increasing women’s and communities’ birth preparedness.Key ImplicationsEfforts to increase quality of care in lower-level facilities to ensure high-quality services will close the “quality gap” and improve PNC coverage.More research is needed to understand and address barriers to using facility PNC.Introduction:Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use.Methods:We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment.Results:PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88).Conclusion:Women’s decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.