Research ArticlePrevalence and Determinants of Complete Postnatal CareService Utilization in Northern Shoa Ethiopia

Mohammed Akibu 1 Wintana Tsegaye2 TewodrosMegersa3 and Sodere Nurgi1

1Department of Midwifery Institute of Medicine and Health Sciences Debre Berhan University Debre Berhan Ethiopia2Concordia University Montreal Quebec Canada3Obstetrics Unit Gandhi Maternal Specialized Hospital Addis Ababa Ethiopia

Correspondence should be addressed to Mohammed Akibu mahammedakibugmailcom

Received 4 March 2018 Revised 19 June 2018 Accepted 16 July 2018 Published 14 August 2018

Academic Editor Fabio Facchinetti

Copyright copy 2018 Mohammed Akibu et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Background Postnatal period presents the highest risk of death for mothers and newborns Although progress has been made inexpanding the coverage for most of maternal health services national prevalence of postnatal care service utilization in Ethiopiais still extremely limited Hence this study aims to determine the prevalence and factors associated with complete postnatalcare service utilization in Northern Shoa Ethiopia Methods Community based cross-sectional survey was conducted betweenNovember 2016 and February 2017 A total of 510mothers were included in the study usingmultistage sampling techniqueThe datawere collected through face-to-face interview Bivariate and multivariate logistic regression models were fitted to identify factorsassociated with complete postnatal care utilization at p value of lt 005 SPSS version 20 was used to analyze the data Results Theprevalence of complete postnatal care utilization was found to be 284 in the study areaMode of delivery (AOR=57 95CI = 3919) number of children (AOR= 25 95 CI 14 142) and level of education (AOR=32 95 CI 11 92) were the factors statisticallyassociated with complete postnatal service uptake Being healthy was the major (488) reason mentioned for not complying withthe recommended three postnatal visitsConclusionThe prevalence of complete postnatal care service in the study areawas found tobe low and it is far less than the targeted zonal and regional plan Reinforcing the existing policies and strategies to increase womenlevel of awareness about postnatal care and intensive counseling during antenatal care and delivery are the recommendations basedupon the current finding

1 Background

The postnatal period (PNP) is the time beginning immedi-ately following the delivery of the placenta and extendingthrough the six weeks (42 days) of birth This period repre-sents a critical phase in determining the health and survivalof the mother and her newborn [1]Thewellbeing and chanceof staying free of morbidity or mortality are much dependentupon the care given during pregnancy delivery and mostimportantly after delivery the time whenmany maternal andneonatal deaths take place Therefore lack of care duringpostnatal period may end up in death or morbidity as well asmissed opportunities to various healthy behaviors benefitingthe mother and her newborn [2 3]

For both newborns andmothers the highest risk of deathoccurs at delivery followed by the first hours and days after

childbirth It has been shown that more than two-thirds ofnewborn deaths would occur by the end of the first week afterdelivery with up to one-half of all newborn deaths occurringin the first 24 hours Similarly approximately two-thirds of allmaternal deaths occur in the postnatal period [4 5]

Although some countries have made a dramatic progresshalf of the maternal deaths in the world still take place inSub-Saharan Africa where little or no progress has beenmade Even though there is no single simple straightfor-ward intervention that will significantly decrease maternalmortality several studies have shown that majority of thesematernal and neonatal problems could be reduced if womenreceive appropriate postnatal care [6ndash9] In spite of provenbenefits of postnatal care on maternal and neonatal healthmost newborns and mothers do not receive this service

HindawiJournal of PregnancyVolume 2018 Article ID 8625437 7 pageshttpsdoiorg10115520188625437

2 Journal of Pregnancy

from a skilled healthcare provider during the first few daysafter delivery thus this is the most neglected period forthe provision of quality care Similarly rates of provisionof skilled care are much lower during postnatal periodwhen compared to rates before and during childbirth [3 10]Likewise the coverage of postnatal care (PNC) in Ethiopiaremains alarmingly limited with only 7 increment over thelast one and half decade [11 12] Hence this study aimed atproviding a contemporary evidence about the level of PNCcoverage and various determinant factors in Northern ShoaEthiopia

2 Methods

21 Study Design and Population Community based cross-sectional study was conducted from November 2016 toFebruary 2017 with 520 mothers who gave birth withinthe last ten months preceding the survey The study wasconducted at Debre Berhan town the capital city of North-ern Shoa zone of Amhara regional state located about 130kilometers to the North East of Addis Ababa (the capital ofEthiopia) Debre Berhan town contains nine urban and fiverural kebeles according to administrative classification withestimated population size of 84 944 More than half 43 696(514) of the population in the town are represented byfemales Of total females 26876 of them are found withinreproductive age (15-49) group

22 Inclusion and Exclusion Criteria All women who havegiven birth within the last ten months preceding the surveywere included Women admitted for much of postnatalperiods those who gave birth greater than ten monthsago and women with still births were excluded from thestudy

23 Sample Size and Sampling Procedure The sample sizefor the current study was calculated using single populationproportion formula with the assumption of 95 confidencelevel 202 prevalence of postnatal care utilization [13] 5marginal error and design effect of 2 The final sample size(520) was obtained after 5 adjustment for nonresponserate The sample size was distributed proportionally foreach selected kebeles (the smallest administrative unit inEthiopia) Finally systematic random sampling with kth valueof five was used to obtain the study subjects in each selectedkebele

24 Variables and Measurements The outcome variable wascomplete postnatal care service utilization which refers topostnatal care service uptake within 24 hours of delivery thefirst 3-7 days after delivery and 7-14th days subsequentlyWomen who have received the service during all threeperiods were considered to have complete utilization Theindependent variables comprised various sociodemographic(age educational status income and marital status) obstet-rics (parity mode of delivery ANC use course of pregnancyand plan for the current pregnancy) and other health servicerelated characteristics (autonomy distance from health facil-ity)

The outcome variable was measured by asking the prac-tice and timing of postnatal care visit with three possibleresponses (ie (1) only received postnatal care once afterdelivery (2) received twice within the recommended post-natal schedule (successive or interrupted) and (3) receivedthrice subsequent postnatal care within the recommendedtime frame) This self-reported visit was cross-confirmed byreviewing postnatal registration records Finally the outcomevariable was dichotomized as 1 complete PNCutilization and0 sporadic PNC utilization

25 Data Collection and Quality Control The data werecollected using a structured questionnaire via a face-to-faceinterview at the participantrsquos home The questionnaire wasfirst prepared in English and then translated into local lan-guage (Amharic) and back to English to ensure consistencyThe pretest was done on 5 of the total sample size and anecessary adjustmentwasmade Sixmidwives and twonurseswho are fluent in speaking the local language were involvedin the data collection Two-day training was given to the datacollectors and supervisors

26 Operational Definition

Complete Postnatal Visit It is for mothers who have stayedin the hospital for 24 hours after delivery and returned forcheckup between 3-7 days and 7ndash14 days subsequently

Seclusion It is a culturalsocial practice that forbids mothersfrom going out andor joining peoples for 40 days startingfrom the day of delivery

27 Data Analysis The data were described using frequencyandor cross-tabulation for categorical variables and mean(standard deviation (SD)) for continuous variables Binaryand multiple logistic regression tests were carried out toidentify associated factors at p value threshold lt 005 Thedata were coded cleaned and entered using EPI-INFOversion 7 and analyzed with SPSS version 20 The result wasreported strictly following Strengthening the Reporting ofObservational Studies in Epidemiology (STROBE) Statement(Supplementary File (available here))

3 Results

31 Sociodemographic Characteristics A total of 510 mothersparticipated in the study making a response rate of 98Nearly one-third (318) of respondents were found withinthe age group of 25ndash29Majority of the participants were fromAmhara (794) ethic group and orthodox (725) religiousbackground One-quarter (269) of the mothers attended atleast secondary level education and a significant number ofwomen (214) had no any graded education but can readand write (Table 1)

32 Obstetrics Characteristics More than half (567) ofparticipants were low multiparous (with children betweentwo and four) whereas nearly third of (292) motherswere primiparous Some (116) of the mothers reported

Journal of Pregnancy 3

Table 1 Sociodemographic characteristics of women who gavebirth within the last ten months preceding the survey NorthernShoa Ethiopia 2017

Sociodemographic characteristics Frequency (n) Percent ()Age15 ndash 19 44 8620 -24 150 29425-29 162 31830 -34 94 18435 and above 60 118Marital StatusUnmarried 30 59Married 456 894Divorced 24 47EthnicityAmhara 405 794Tigree 37 73Oromo 39 76Gurage 26 51Othersa 3 6ReligionOrthodox 370 725Muslim 86 169Protestant 41 80Catholic 9 18Othersb 4 8Educational StatusIlliterate 26 51Read and write 109 214Primary Education 125 245Secondary Education 137 269Higher Education 113 222Husband EducationIlliterate 54 106Read and write 72 141Primary Education 111 217Secondary Education 98 193Higher Education 175 343Household Incomelt $25 248 486$26 -$99 173 339$100 or more 89 175

Mother occupationHouse Wife 252 494Self-Employee 100 196Government Employee 114 224Maid servant 32 63Student 12 24

aAfar and Wolayita bBhai and apostolic

that the most recent pregnancy was complicated and most(39) of this problem was attributed to premature ruptureof membrane Cesarean section accounted for 18 of these

deliveries and 39 of babies born were twins More thanhalf (537) of participants received the recommended fouror more antenatal care service (ANC) (Table 2)

33 Postnatal Care Service Only 284 of participantsreceived the recommended three postnatal care visits withinsix weeks of delivery Among mothers who have visitedantenatal care clinic the majority (584) of these womendid not receive counseling about postnatal care Similarlyonly 184 of these women initially had information aboutpostnatal care service from different sources About two-thirds (763) of mothers suggested that there was a socialand cultural norm called ldquoSeclusionrdquo which forbids themfrom coming out of home after delivery Most importantlyalmost half (491) of these women respond that this eventwas more important and valuable than any outdoor visit(Table 3)

34 Factors Associated with Complete Postnatal Care Uti-lization In multivariate logistic regression model motherswho have given birth through cesarean section were 57[AOR=57 95 CI = 39 - 19] times more likely to receivecomplete postnatal care service than those who deliveredthrough spontaneous vaginal delivery Similarly mothershaving one child (primiparous) were 45 more likely tohave full postnatal care [AOR= 25 95 CI 14 ndash 142] thanmultiparous women Level of education [AOR=32 95 CI11 92] was another factor which is statistically significantwith complete postnatal care utilization (Table 4)

4 Discussion

The current study revealed that only 145 (284) of mothershave received complete postnatal care as per the standardrecommendation This finding was slightly higher comparedto the reports from other studies [13 14] This discrepancymay be attributed to the time gap difference as there wouldbe an improvement on access to healthcare and awarenessabout the service through time However a study conductedin Addis Ababa city administrative by Senait Berhanu andBerhanuwordofa indicated that the postnatal care prevalencewas twice of this report (656) [15] This disparity mightbe explained by the sociodemographic variation betweenthe study participants such as educational level and livingstandard as well as nature of the study area including betteraccess to healthcare

The current study has shown that mothers who attendedhigher education were three timesmore likely to receive com-plete postnatal care service than illiterate women [AOR=3295 CI 11 92] This finding was in agreement with resultsfromDembecha district Northwest EthiopiaNepal Nigeriaand one more study in Ethiopia [16ndash19] This could beexplained by the notion that education is a key factorin empowering maternal decision making towards health-care service increasing awareness of basic health servicesand being informed about health risks with all of theseeventually leading to the improved health seeking behav-ior

4 Journal of Pregnancy

Table 2 Distribution of obstetrics history of women who gave birth within the last ten months preceding the survey in Northern ShoaEthiopia 2017

Obstetrics characteristics Frequency (n) Percent ()Number of children aliveOne 149 292Two ndash four 290 567Five and above 71 139ANC in recent pregnancy 454 89Yes 56 11NoNumber of visitsOne 38 84Two 54 119Three 88 194Four and above 274 604Course of PregnancyComplicated 59 116Uncomplicated 451 884Type of conditions facedHypertensive disorders 10 169PROM 23 390Post Term 14 237Anemia 7 119Bleeding during pregnancy 5 85Mode of deliverySVD 356 698SVD assisted with Instrument 62 122Cesarean section 92 180Number of babies bornSingle 490 961Twins 20 39Autonomy on Heath care seekingItrsquos up to me to decide 424 831Itrsquos not only me 86 169lowastANC antenatal care lowastSVD spontaneous vaginal delivery lowast PROM premature rupture of membranes

Cesarean section delivery resulted in increased odds ofhaving complete postnatal service This finding has also beensupported by different studies from Ethiopia and Tanzania[20ndash22] This could be because mothers who had operativedelivery are tending to have greater perceived susceptibilityto a wide range of postoperative complications thereforefrequent return to the health institution would be the strategyto minimize these perceived risks Primiparity was anotherobstetrics determinant for full postnatal care service atten-dance Studies in Ethiopia and Nepal have shown consistentfinding [19 20 23] This might be justified by the factthat first time mothers are usually dependent upon thesupport of health professionals and their family on infantcare and feeding practice Similarly they would be verycurious about the health of their newborn baby thus theseneeds might be satisfied through frequent contact with healthprofessionals

5 Limitation of the Study

The result of this study must be interpreted cautiouslyconsidering the following inevitable limitations Though thestudy has included mothers who gave birth in the last tenmonths there might be a possibility of some recall biasCausality cannot be inferred due to the cross-sectional natureof the study Moreover the external validity of the findingmight be limited However it is the first study which triedto assess the level of complete postnatal care visit in the studyarea

6 Conclusion

The coverage of full postnatal care service in the study wasfound to be lower than the targeted zonal and regional planMaternal educational status parity and mode of delivery

Journal of Pregnancy 5

Table 3 Coverage of postnatal care services and related informationrsquos among women who gave birth in the last ten months preceding thissurvey Northern Shoa Ethiopia 2017

Variables Frequency (n) Percent ()Postnatal care utilizationComplete PNC (3 or more visits) 145 284Sporadic PNC (2 or less PNC) 365 716Reason for not complying with PNC recommendationI didnrsquot know about its importance 124 339Itrsquos a waste of time once we get birth 39 107I waited long time to get the service 57 156Baby and I were completely healthy 178 488Social reasons 84 23Counseling about PNCYes 189 416No 265 584Previous Information about PNCHad information 94 184Never had information 416 816Source of InformationMedia 19 202Magazines or other reading materials 30 319Health extension workers 57 606Friends 13 138Postdelivery seclusionYes 389 763No 121 237Postnatal care vs seclusionItrsquos more important than any clinic visit 191 491No difference to me 103 265No the visit would be more important 95 244lowastPNC postnatal care

were factors significantly associated with postnatal acre ser-vice utilization Reinforcing the existing policies and strate-gies to increase motherrsquos level of awareness about postnatalcare intensive counseling during antenatal and deliveryand scheduling mothers based on the national postnatalcare follow-up protocol to increase postnatal care serviceutilization were recommended

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Ethical Approval

Ethical approval was obtained from the Institutional ReviewBoard (IRB) of Debre Berhan University Institute ofMedicine and Health Science

Consent

Both written and verbal consent were taken from the studysubjects after explaining the purpose and procedures of thestudy Information obtained was kept confidential

Conflicts of Interest

The authors declare that they have no conflicts of interest

Authorsrsquo Contributions

Mohammed Akibu conceived and designed the studyMohammed Akibu Tewodros Megersa and Sodere Nurgisupervised the data collection and prepared the manuscriptMohammed Akibu andWintana Tsegaye performed analysisand interpretation of the data All authors read and approvedthe final manuscript

Acknowledgments

The authors would like to pass their gratitude to theUniversity of Debre Berhan for its ethical approval Theirappreciation also extends to all mothers who took part in thestudy

Supplementary Materials

Supplementary File Strengthen the report of observa-tional studies in Epidemiology (STROBE) checklist (Supple-mentary Materials)

Journal of Pregnancy 3

Table 1 Sociodemographic characteristics of women who gavebirth within the last ten months preceding the survey NorthernShoa Ethiopia 2017

Sociodemographic characteristics Frequency (n) Percent ()Age15 ndash 19 44 8620 -24 150 29425-29 162 31830 -34 94 18435 and above 60 118Marital StatusUnmarried 30 59Married 456 894Divorced 24 47EthnicityAmhara 405 794Tigree 37 73Oromo 39 76Gurage 26 51Othersa 3 6ReligionOrthodox 370 725Muslim 86 169Protestant 41 80Catholic 9 18Othersb 4 8Educational StatusIlliterate 26 51Read and write 109 214Primary Education 125 245Secondary Education 137 269Higher Education 113 222Husband EducationIlliterate 54 106Read and write 72 141Primary Education 111 217Secondary Education 98 193Higher Education 175 343Household Incomelt $25 248 486$26 -$99 173 339$100 or more 89 175

Mother occupationHouse Wife 252 494Self-Employee 100 196Government Employee 114 224Maid servant 32 63Student 12 24

aAfar and Wolayita bBhai and apostolic

that the most recent pregnancy was complicated and most(39) of this problem was attributed to premature ruptureof membrane Cesarean section accounted for 18 of these

deliveries and 39 of babies born were twins More thanhalf (537) of participants received the recommended fouror more antenatal care service (ANC) (Table 2)

33 Postnatal Care Service Only 284 of participantsreceived the recommended three postnatal care visits withinsix weeks of delivery Among mothers who have visitedantenatal care clinic the majority (584) of these womendid not receive counseling about postnatal care Similarlyonly 184 of these women initially had information aboutpostnatal care service from different sources About two-thirds (763) of mothers suggested that there was a socialand cultural norm called ldquoSeclusionrdquo which forbids themfrom coming out of home after delivery Most importantlyalmost half (491) of these women respond that this eventwas more important and valuable than any outdoor visit(Table 3)

34 Factors Associated with Complete Postnatal Care Uti-lization In multivariate logistic regression model motherswho have given birth through cesarean section were 57[AOR=57 95 CI = 39 - 19] times more likely to receivecomplete postnatal care service than those who deliveredthrough spontaneous vaginal delivery Similarly mothershaving one child (primiparous) were 45 more likely tohave full postnatal care [AOR= 25 95 CI 14 ndash 142] thanmultiparous women Level of education [AOR=32 95 CI11 92] was another factor which is statistically significantwith complete postnatal care utilization (Table 4)

4 Discussion

The current study revealed that only 145 (284) of mothershave received complete postnatal care as per the standardrecommendation This finding was slightly higher comparedto the reports from other studies [13 14] This discrepancymay be attributed to the time gap difference as there wouldbe an improvement on access to healthcare and awarenessabout the service through time However a study conductedin Addis Ababa city administrative by Senait Berhanu andBerhanuwordofa indicated that the postnatal care prevalencewas twice of this report (656) [15] This disparity mightbe explained by the sociodemographic variation betweenthe study participants such as educational level and livingstandard as well as nature of the study area including betteraccess to healthcare

The current study has shown that mothers who attendedhigher education were three timesmore likely to receive com-plete postnatal care service than illiterate women [AOR=3295 CI 11 92] This finding was in agreement with resultsfromDembecha district Northwest EthiopiaNepal Nigeriaand one more study in Ethiopia [16ndash19] This could beexplained by the notion that education is a key factorin empowering maternal decision making towards health-care service increasing awareness of basic health servicesand being informed about health risks with all of theseeventually leading to the improved health seeking behav-ior

4 Journal of Pregnancy

Table 2 Distribution of obstetrics history of women who gave birth within the last ten months preceding the survey in Northern ShoaEthiopia 2017

Obstetrics characteristics Frequency (n) Percent ()Number of children aliveOne 149 292Two ndash four 290 567Five and above 71 139ANC in recent pregnancy 454 89Yes 56 11NoNumber of visitsOne 38 84Two 54 119Three 88 194Four and above 274 604Course of PregnancyComplicated 59 116Uncomplicated 451 884Type of conditions facedHypertensive disorders 10 169PROM 23 390Post Term 14 237Anemia 7 119Bleeding during pregnancy 5 85Mode of deliverySVD 356 698SVD assisted with Instrument 62 122Cesarean section 92 180Number of babies bornSingle 490 961Twins 20 39Autonomy on Heath care seekingItrsquos up to me to decide 424 831Itrsquos not only me 86 169lowastANC antenatal care lowastSVD spontaneous vaginal delivery lowast PROM premature rupture of membranes

Cesarean section delivery resulted in increased odds ofhaving complete postnatal service This finding has also beensupported by different studies from Ethiopia and Tanzania[20ndash22] This could be because mothers who had operativedelivery are tending to have greater perceived susceptibilityto a wide range of postoperative complications thereforefrequent return to the health institution would be the strategyto minimize these perceived risks Primiparity was anotherobstetrics determinant for full postnatal care service atten-dance Studies in Ethiopia and Nepal have shown consistentfinding [19 20 23] This might be justified by the factthat first time mothers are usually dependent upon thesupport of health professionals and their family on infantcare and feeding practice Similarly they would be verycurious about the health of their newborn baby thus theseneeds might be satisfied through frequent contact with healthprofessionals

5 Limitation of the Study

The result of this study must be interpreted cautiouslyconsidering the following inevitable limitations Though thestudy has included mothers who gave birth in the last tenmonths there might be a possibility of some recall biasCausality cannot be inferred due to the cross-sectional natureof the study Moreover the external validity of the findingmight be limited However it is the first study which triedto assess the level of complete postnatal care visit in the studyarea

6 Conclusion

The coverage of full postnatal care service in the study wasfound to be lower than the targeted zonal and regional planMaternal educational status parity and mode of delivery

Journal of Pregnancy 5

Table 3 Coverage of postnatal care services and related informationrsquos among women who gave birth in the last ten months preceding thissurvey Northern Shoa Ethiopia 2017

Variables Frequency (n) Percent ()Postnatal care utilizationComplete PNC (3 or more visits) 145 284Sporadic PNC (2 or less PNC) 365 716Reason for not complying with PNC recommendationI didnrsquot know about its importance 124 339Itrsquos a waste of time once we get birth 39 107I waited long time to get the service 57 156Baby and I were completely healthy 178 488Social reasons 84 23Counseling about PNCYes 189 416No 265 584Previous Information about PNCHad information 94 184Never had information 416 816Source of InformationMedia 19 202Magazines or other reading materials 30 319Health extension workers 57 606Friends 13 138Postdelivery seclusionYes 389 763No 121 237Postnatal care vs seclusionItrsquos more important than any clinic visit 191 491No difference to me 103 265No the visit would be more important 95 244lowastPNC postnatal care

were factors significantly associated with postnatal acre ser-vice utilization Reinforcing the existing policies and strate-gies to increase motherrsquos level of awareness about postnatalcare intensive counseling during antenatal and deliveryand scheduling mothers based on the national postnatalcare follow-up protocol to increase postnatal care serviceutilization were recommended

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Ethical Approval

Ethical approval was obtained from the Institutional ReviewBoard (IRB) of Debre Berhan University Institute ofMedicine and Health Science

Consent

Both written and verbal consent were taken from the studysubjects after explaining the purpose and procedures of thestudy Information obtained was kept confidential

Conflicts of Interest

The authors declare that they have no conflicts of interest

Authorsrsquo Contributions

Mohammed Akibu conceived and designed the studyMohammed Akibu Tewodros Megersa and Sodere Nurgisupervised the data collection and prepared the manuscriptMohammed Akibu andWintana Tsegaye performed analysisand interpretation of the data All authors read and approvedthe final manuscript

Acknowledgments

The authors would like to pass their gratitude to theUniversity of Debre Berhan for its ethical approval Theirappreciation also extends to all mothers who took part in thestudy

Supplementary Materials

Supplementary File Strengthen the report of observa-tional studies in Epidemiology (STROBE) checklist (Supple-mentary Materials)

4 Journal of Pregnancy

Table 2 Distribution of obstetrics history of women who gave birth within the last ten months preceding the survey in Northern ShoaEthiopia 2017

Obstetrics characteristics Frequency (n) Percent ()Number of children aliveOne 149 292Two ndash four 290 567Five and above 71 139ANC in recent pregnancy 454 89Yes 56 11NoNumber of visitsOne 38 84Two 54 119Three 88 194Four and above 274 604Course of PregnancyComplicated 59 116Uncomplicated 451 884Type of conditions facedHypertensive disorders 10 169PROM 23 390Post Term 14 237Anemia 7 119Bleeding during pregnancy 5 85Mode of deliverySVD 356 698SVD assisted with Instrument 62 122Cesarean section 92 180Number of babies bornSingle 490 961Twins 20 39Autonomy on Heath care seekingItrsquos up to me to decide 424 831Itrsquos not only me 86 169lowastANC antenatal care lowastSVD spontaneous vaginal delivery lowast PROM premature rupture of membranes

Cesarean section delivery resulted in increased odds ofhaving complete postnatal service This finding has also beensupported by different studies from Ethiopia and Tanzania[20ndash22] This could be because mothers who had operativedelivery are tending to have greater perceived susceptibilityto a wide range of postoperative complications thereforefrequent return to the health institution would be the strategyto minimize these perceived risks Primiparity was anotherobstetrics determinant for full postnatal care service atten-dance Studies in Ethiopia and Nepal have shown consistentfinding [19 20 23] This might be justified by the factthat first time mothers are usually dependent upon thesupport of health professionals and their family on infantcare and feeding practice Similarly they would be verycurious about the health of their newborn baby thus theseneeds might be satisfied through frequent contact with healthprofessionals

5 Limitation of the Study

The result of this study must be interpreted cautiouslyconsidering the following inevitable limitations Though thestudy has included mothers who gave birth in the last tenmonths there might be a possibility of some recall biasCausality cannot be inferred due to the cross-sectional natureof the study Moreover the external validity of the findingmight be limited However it is the first study which triedto assess the level of complete postnatal care visit in the studyarea

6 Conclusion

The coverage of full postnatal care service in the study wasfound to be lower than the targeted zonal and regional planMaternal educational status parity and mode of delivery

Journal of Pregnancy 5

Table 3 Coverage of postnatal care services and related informationrsquos among women who gave birth in the last ten months preceding thissurvey Northern Shoa Ethiopia 2017

Variables Frequency (n) Percent ()Postnatal care utilizationComplete PNC (3 or more visits) 145 284Sporadic PNC (2 or less PNC) 365 716Reason for not complying with PNC recommendationI didnrsquot know about its importance 124 339Itrsquos a waste of time once we get birth 39 107I waited long time to get the service 57 156Baby and I were completely healthy 178 488Social reasons 84 23Counseling about PNCYes 189 416No 265 584Previous Information about PNCHad information 94 184Never had information 416 816Source of InformationMedia 19 202Magazines or other reading materials 30 319Health extension workers 57 606Friends 13 138Postdelivery seclusionYes 389 763No 121 237Postnatal care vs seclusionItrsquos more important than any clinic visit 191 491No difference to me 103 265No the visit would be more important 95 244lowastPNC postnatal care

were factors significantly associated with postnatal acre ser-vice utilization Reinforcing the existing policies and strate-gies to increase motherrsquos level of awareness about postnatalcare intensive counseling during antenatal and deliveryand scheduling mothers based on the national postnatalcare follow-up protocol to increase postnatal care serviceutilization were recommended

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Ethical Approval

Ethical approval was obtained from the Institutional ReviewBoard (IRB) of Debre Berhan University Institute ofMedicine and Health Science

Consent

Both written and verbal consent were taken from the studysubjects after explaining the purpose and procedures of thestudy Information obtained was kept confidential

Conflicts of Interest

The authors declare that they have no conflicts of interest

Authorsrsquo Contributions

Mohammed Akibu conceived and designed the studyMohammed Akibu Tewodros Megersa and Sodere Nurgisupervised the data collection and prepared the manuscriptMohammed Akibu andWintana Tsegaye performed analysisand interpretation of the data All authors read and approvedthe final manuscript

Acknowledgments

The authors would like to pass their gratitude to theUniversity of Debre Berhan for its ethical approval Theirappreciation also extends to all mothers who took part in thestudy

Supplementary Materials

Supplementary File Strengthen the report of observa-tional studies in Epidemiology (STROBE) checklist (Supple-mentary Materials)

Journal of Pregnancy 5

Table 3 Coverage of postnatal care services and related informationrsquos among women who gave birth in the last ten months preceding thissurvey Northern Shoa Ethiopia 2017

Variables Frequency (n) Percent ()Postnatal care utilizationComplete PNC (3 or more visits) 145 284Sporadic PNC (2 or less PNC) 365 716Reason for not complying with PNC recommendationI didnrsquot know about its importance 124 339Itrsquos a waste of time once we get birth 39 107I waited long time to get the service 57 156Baby and I were completely healthy 178 488Social reasons 84 23Counseling about PNCYes 189 416No 265 584Previous Information about PNCHad information 94 184Never had information 416 816Source of InformationMedia 19 202Magazines or other reading materials 30 319Health extension workers 57 606Friends 13 138Postdelivery seclusionYes 389 763No 121 237Postnatal care vs seclusionItrsquos more important than any clinic visit 191 491No difference to me 103 265No the visit would be more important 95 244lowastPNC postnatal care

were factors significantly associated with postnatal acre ser-vice utilization Reinforcing the existing policies and strate-gies to increase motherrsquos level of awareness about postnatalcare intensive counseling during antenatal and deliveryand scheduling mothers based on the national postnatalcare follow-up protocol to increase postnatal care serviceutilization were recommended

Data Availability

The data used to support the findings of this study areavailable from the corresponding author upon request

Ethical Approval

Ethical approval was obtained from the Institutional ReviewBoard (IRB) of Debre Berhan University Institute ofMedicine and Health Science

Consent

Both written and verbal consent were taken from the studysubjects after explaining the purpose and procedures of thestudy Information obtained was kept confidential

Conflicts of Interest

The authors declare that they have no conflicts of interest

Authorsrsquo Contributions

Mohammed Akibu conceived and designed the studyMohammed Akibu Tewodros Megersa and Sodere Nurgisupervised the data collection and prepared the manuscriptMohammed Akibu andWintana Tsegaye performed analysisand interpretation of the data All authors read and approvedthe final manuscript

Acknowledgments

The authors would like to pass their gratitude to theUniversity of Debre Berhan for its ethical approval Theirappreciation also extends to all mothers who took part in thestudy

Supplementary Materials

Supplementary File Strengthen the report of observa-tional studies in Epidemiology (STROBE) checklist (Supple-mentary Materials)

6 Journal of Pregnancy

Table 4 Bivariate and multivariate analysis of factors associated with complete postnatal care service utilization Northern Shoa Ethiopia2017

Variables PNC Crude OR (95 CI) Adjusted OR (95 CI)Complete Sporadic

Husband education

Illiterate 15 39 1 1Read andWrite 15 57 684 (3001559) 431 (151 1226)

Primary education 16 95 438 (196972 254 (091 706)Secondary education 26 72 939 (446 198) 807 (316 2061)Higher education 73 102 1861 (125 362)lowast 1253 (531 2956)

Maternal Education

Illiterate 2 24 1 1Read and write 27 82 39 (876 1783) 31 (597 169)

Primary Education 30 95 37 (846 169) 25 (476131)Secondary Education 35 102 41 (925 1832) 202 (387105)Higher education 51 62 68 (2226 1434) 32 (119 92 )lowast

ParityPrimiparous 58 91 208 (12 78) 25 (142142)lowastMultiparous 88 202 17 (692 437) 176 (575 539)

Grande multiparous 24 47 1 1

Information about PNC Had information 32 62 134 (108223)lowast 198(553374)Had no information 113 303 1 1

Autonomy on health care Self-decision 117 307 179 (1479 630)lowast 127 (362 2261)Collaborative decision 28 58 1 1

Mode of deliverySVD 88 268 1 1

SVD with instrumentation 19 43 327 (927 43) 427 (8262)Cesarean section 38 54 235 (145 381)lowast 57 (396 183)lowast

Number of babies born Singleton 140 350 1 1Twins 5 15 833 (297 2336) 1025 (295 3558)

Counseling on PNC Received 48 141 709 (467 1075) 737 (446 1217)Not received 86 179 1 1

lowastStatistically significant variable 1 reference category COR crude odds ratio AOR adjusted odds ratio

References

[1] X F Li J A Fortney M Kotelchuck and L H Glover ldquoThepostpartum period The key to maternal mortalityrdquo Interna-tional Journal of Gynecology and Obstetrics vol 54 no 1 pp1ndash10 1996

[2] J E Lawn S Cousens and J Zupan ldquo4Million neonatal deathswhen Where Whyrdquo The Lancet vol 365 no 9462 pp 891ndash900 2005

[3] The Partnership for Maternal Newborn and Child HealthOpportunities for Africarsquos newborns Practical data policyand programmatic support for newborn care in Africa worldhealth organization 2006 (cited 2017 February) Available fromhttpwwwwhointpmnchknowledgepublicationsafricanew-bornsen

[4] Joy E Lawn analysis based on 38 DHS datasets (2000 to 2004)with 9022 neonatal deaths using MEASURE DHS STAT com-piler (httpsdhsprogramcom) Used in Save the Children-US State of the World1015840s Mothers 2006 (Washington DCSave the Children-US 2006)

[5] R Carine and J G Wendy ldquoMaternal mortality who whenwhere and whyrdquo The Lancet vol 368 no 9542 pp 1189ndash12002006

[6] World Health Organization WHO technical consultationon postpartum and postnatal care 2010 (cited 2017 March)

Available from httpwwwwhointmaternal child adolescentdocumentsWHO MPS 10 03en

[7] P K Singh C Kumar R K Rai and L Singh ldquoFactorsassociated with maternal healthcare services utilization in ninehigh focus states in India A multilevel analysis based on 14 385communities in 292 districtsrdquo Health Policy and Planning vol29 no 5 pp 542ndash559 2014

[8] R Pattinson K Kerber E Buchmann et al ldquoStillbirths Howcan health systems deliver for mothers and babiesrdquoThe Lancetvol 377 no 9777 pp 1610ndash1623 2011

[9] A Blank H Prytherch J Kaltschmidt et al ldquolsquoQuality of prena-tal and maternal care bridging the know-do gaprsquo (QUALMATstudy) an electronic clinical decision support system for ruralSub-Saharan Africardquo BMC Medical Informatics and DecisionMaking vol 13 article 44 2013

[10] World Health Organization WHO recommendations on post-natal care of the mother and newborn 2013 (cited 2017 May)Available from httpwwwwhointmaternal child adolescentdocumentspostnatal-care-recommendationsen

[11] Central Statistical Authority [Ethiopia] and ORC Macro 2001Ethiopia Demographic and Health Survey 2000 Addis AbabaEthiopia and Calverton Maryland USA Central StatisticalAuthority and ORC Macro

[12] Central Statistical Agency (CSA) [Ethiopia] and ICF 2016Ethiopia Demographic and Health Survey 2016 Key Indicators

Journal of Pregnancy 7

Report Addis Ababa Ethiopia and Rockville Maryland USACSA and ICF

[13] Y Gebeyehu Workineh ldquoFactors Affecting Utilization ofPostnatal Care Service in Amhara Region Jabitena DistrictEthiopiardquo Science Journal of Public Health vol 2 no 3 pp 169ndash176 2014

[14] H AlemayehHAssefa andY Adama ldquoPrevalence andFactorsAssociated with Post Natal Care Utilization in Abi-Adi TownTigray Ethiopia A Cross Sectional Studyrdquo International Journalof Pharmaceutical and Biological Sciences Fundamentals vol 8no 1 2014

[15] S Berhanu Y Asefa and B W Giru ldquoPrevalence of PostnatalCare Utilization and Associated Factors among Women WhoGave Birth and Attending Immunization Clinic in SelectedGovernment Health Centers in Addis Ababa Ethiopiardquo Journalof Health Medicine and Nursing vol 26 2016

[16] M Ayana Hordofa S S Almaw M G Berhanu and H BLemiso ldquoPostnatal Care Service Utilization and AssociatedFactors Among Women in Dembecha District NorthwestEthiopiardquo Science Journal of Public Health vol 3 no 5 pp 686ndash692 2015

[17] K Vishnu M Adhikari R Karkee and T Gavidia ldquoFactorsassociated with the utilisation of postnatal care services amongthe mothers of Nepal Analysis of Nepal Demographic andHealth Survey 2011rdquo BMCWomenrsquos Health vol 14 no 19 2014

[18] O D Somefun and L Ibisomi ldquoDeterminants of postnatal carenon-utilization amongwomen inNigeriardquoBMCResearchNotesvol 9 no 1 article no 21 2016

[19] S M Tarekegn L S Lieberman and V Giedraitis ldquoDetermi-nants of maternal health service utilization in Ethiopia analysisof the 2011 Ethiopian Demographic and Health Surveyrdquo BMCPregnancy and Childbirth vol 14 no 1 article 161 2014

[20] K Mehari and E Wencheko ldquoFactors affecting maternal healthcare services utilization in rural Ethiopia a study based on the2011 EDHS datardquo Ethiopian Journal of Health Development vol27 no 1 pp 16ndash24 2013

[21] MA Limenih ZM Endale andBADachew ldquoPostnatal CareService Utilization and AssociatedFactors amongWomenWhoGave Birth in the Last 12 Months prior to the Study in DebreMarkos Town Northwestern Ethiopia A Community-BasedCross-Sectional Studyrdquo International Journal of ReproductiveMedicine vol 2016 Article ID 7095352 7 pages 2016

[22] D Mohan S Gupta A LeFevre E Bazant J Killewo and A HBaqui ldquoDeterminants of postnatal care use at health facilities inrural Tanzania Multilevel analysis of a household surveyrdquoBMCPregnancy and Childbirth vol 15 no 282 2015

[23] S Dhakal G N Chapman P P Simkhada E R van TeijlingenJ Stephens and A E Raja ldquoUtilisation of postnatal care amongrural women in Nepalrdquo BMC Pregnancy and Childbirth vol 7no 1 p 19 2007

Stem Cells International

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Disease Markers

Hindawiwwwhindawicom Volume 2018

BioMed Research International

OncologyJournal of

Hindawiwwwhindawicom Volume 2013

Hindawiwwwhindawicom Volume 2018

Oxidative Medicine and Cellular Longevity

Hindawiwwwhindawicom Volume 2018

PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Computational and Mathematical Methods in Medicine

Hindawiwwwhindawicom Volume 2018

Behavioural Neurology

OphthalmologyJournal of

Hindawiwwwhindawicom Volume 2018

Diabetes ResearchJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Research and TreatmentAIDS

Hindawiwwwhindawicom Volume 2018

Gastroenterology Research and Practice

Hindawiwwwhindawicom Volume 2018

Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom

Stem Cells International

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Disease Markers

Hindawiwwwhindawicom Volume 2018

BioMed Research International

OncologyJournal of

Hindawiwwwhindawicom Volume 2013

Hindawiwwwhindawicom Volume 2018

Oxidative Medicine and Cellular Longevity

Hindawiwwwhindawicom Volume 2018

PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Computational and Mathematical Methods in Medicine

Hindawiwwwhindawicom Volume 2018

Behavioural Neurology

OphthalmologyJournal of

Hindawiwwwhindawicom Volume 2018

Diabetes ResearchJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Research and TreatmentAIDS

Hindawiwwwhindawicom Volume 2018

Gastroenterology Research and Practice

Hindawiwwwhindawicom Volume 2018

Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom