Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

Author(s):  
Quraish Sserwanja ◽  
Lilian Nuwabaine ◽  
Kassim Kamara ◽  
Milton W Musaba

Abstract Background Globally, about 289,000 maternal deaths are registered annually. Timely access to quality maternal health services is an effective intervention to reduce maternal deaths. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7,326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7,326 women, 3,329 (45.5%, 95% CI: 44.6–46.8) had their babies have at least a PNC contact, 6,646 (90.7%, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 3,133 (42.8%, 95% CI: 41.9–44.1) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 1.79, 95% CI: 1.20–2.67), having a visit by a health field worker (aOR 1.77, 95% CI: 1.47–2.13), having had eight or more ANC contacts (aOR 1.79, 95% CI: 1.45–2.22), initiating ANC after first trimester (aOR 1.18, 95% CI: 1.04–1.35), being a Muslim (aOR 1.34, 95% CI: 1.11–1.61), belonging to richer wealth quintile (aOR 1.69, 95% CI: 1.22–2.35), being of low parity (2–4) (aOR 1.20, 95% CI: 1.04–1.39), having no big problems seeking permission to access healthcare (aOR 1.52, 95% CI: 1.27–1.83) and having had delivery at home (aOR 1.75, 95% CI: 1.32–2.32) were associated with more PNC utilisation odds. On the other hand, being resident in the Eastern region (aOR 0.31, 95% CI: 0.21–0.46) and urban areas (aOR 0.71, 95% CI: 0.52–0.98) were associated with lower odds of utilising PNC. Conclusion Although maternal PNC utilisation is high, utilisation of PNC by neonates alone and by both the mother and neonatal is low. More focus is needed to mothers and their neonates from the Eastern region, urban areas, Christians, less empowered in terms of healthcare seeking decision making and those who are more parous, utilise less ANC contacts and utilise health facilities for delivery.

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Quraish Sserwanja ◽  
Lilian Nuwabaine ◽  
Kassim Kamara ◽  
Milton W. Musaba

Abstract Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.


2020 ◽  
Vol 5 (12) ◽  
pp. e002169
Author(s):  
Ngatho Samuel Mugo ◽  
Kyaw Swa Mya ◽  
Camille Raynes-Greenow

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.


PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244811
Author(s):  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Eugene Budu ◽  
Ebenezer Agbaglo ◽  
Francis Appiah ◽  
...  

Background In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. Materials and methods Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. Results We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17–0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06–3.86], women who professed other religions [AOR = 3.45; CI = 1.53–7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64–31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17–0.53], compared to those with no formal education. Conclusion The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.


2021 ◽  
Vol 14 ◽  
pp. 117863882110470
Author(s):  
Quraish Sserwanja ◽  
Kassim Kamara ◽  
Linet M Mutisya ◽  
Milton W Musaba ◽  
Shirin Ziaei

Background: Undernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone. Methods: We analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting. Results: Prevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively. Conclusions: Stunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.


2020 ◽  
Author(s):  
Peninah Agaba ◽  
Cyprian Misinde

Abstract Introduction Inadequate use of maternal health services among the youth remains a serious health challenge in Uganda. The low use of maternal health services among youth partly explains the persistence high maternal mortality rate in the country. Yet, improved use of maternal health services by the youth would help reduce maternal deaths in the country. Therefore, this study examines predisposing and enabling factors associated with the timing and the number of antenatal care visits among unmarried compared to married youth aged 15-24 years between 1995 and 2011 in Uganda. Methodology Two-level binary logistic and linear regression models with district as a second level of analysis were conducted on pooled data of the 1995, 2000/01, 2006 and 2011 Uganda Demographic and Health Surveys. This analysis was among 581 unmarried, compared to 5,437 married youth, aged 15-24 years. Results Only 16% of unmarried youth and 18% of married youth had ANC in the first trimester. Education was the only factor that was significantly associated with early use of antenatal care among unmarried youth. Whereas high education was associated with higher odds of using antenatal care in the first trimester among married youth (OR=1.30, 95%CI=1.08-1.57), it was associated with late start among unmarried youth (OR=0.56, 95%CI=0.31-0.98). Higher parity, protestant membership and residence in eastern region were associated with late start of antenatal care, while access to radio and television, and education level of the husband were associated with higher odds of early use of antenatal care among married youth. Overall, married youth were more likely to have more frequent antenatal care visits than unmarried youth. Among both groups, higher educational attainment and greater access to radio were associated with frequent antenatal care use. Residing in western region was associated with fewer antenatal care visits among both married and unmarried youth. Access to newspaper was associated with more antenatal care visits among married youth only. Conclusion This study presents the individual level predisposing and enabling factors that are important predictors of the use of antenatal health care services among youth that will guide policy to reduce maternal deaths among youth in Uganda.


2020 ◽  
Author(s):  
Quraish Sserwanja ◽  
David Mukunya ◽  
Theogene Habumugisha ◽  
Linet M. Mutisya ◽  
Robert Tuke ◽  
...  

Abstract Background Women are at risk of undernutrition due to biological, socio-economic, and cultural factors. Undernourished women have higher risk of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with undernutrition among women of reproductive age in Uganda.Methods We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4,640 women aged 20 to 49 years excluding pregnant and post-menopausal women. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. We used multivariable logistic regression to determine factors associated with underweight and stunting among 20 to 49 year old women in Uganda.Results The prevalence of underweight and stunting were 6.9% (n = 4640) and 1.3% (n = 4640) respectively. Women who belonged to the poorest wealth quintile (Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to those who belonged to the richest wealth quintile. Women residing in rural areas were less likely to be underweight (AOR 0.63, 95%CI 0.41–0.96) compared to women in urban areas. Women in Western (AOR 0.30, 95% CI 0.20–0.44), Eastern (AOR 0.42, 95% CI 0.28–0.63) and Central regions (AOR 0.42, 95% CI 0.25–0.72) were less likely to be underweight compared to those in the Northern region. Women belonging to Central (AOR 4.37, 95% CI 1.44–13.20) and Western (AOR 4.77, 95% CI 1.28–17.78) regions were more likely to be stunted compared to those in the Northern region.Conclusion The present study showed wealth index, place of residence and region to be associated with undernutrition among 20 to 49 year old women in Uganda. There is need to address socio-economic determinants of maternal undernutrition mainly poverty and regional inequalities.


2020 ◽  
Author(s):  
Quraish Sserwanja ◽  
David Mukunya ◽  
Theogene Habumugisha ◽  
Linet M. Mutisya ◽  
Robert Tuke ◽  
...  

Abstract Background: Women are at risk of undernutrition due to biological, socio-economic, and cultural factors. Undernourished women have higher risk of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with undernutrition among women of reproductive age in Uganda.Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4,640 women aged 20 to 49 years excluding pregnant and post-menopausal women. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. We used multivariable logistic regression to determine factors associated with underweight and stunting among 20 to 49 year old women in Uganda.Results: The prevalence of underweight and stunting were 6.9% (318/4640) and 1.3% (58/4640) respectively. Women who belonged to the poorest wealth quintile (Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to those who belonged to the richest wealth quintile. Women residing in rural areas were less likely to be underweight (AOR 0.63, 95%CI 0.41–0.96) compared to women in urban areas. Women in Western (AOR 0.30, 95% CI 0.20–0.44), Eastern (AOR 0.42, 95% CI 0.28–0.63) and Central regions (AOR 0.42, 95% CI 0.25–0.72) were less likely to be underweight compared to those in the Northern region. Women belonging to Central (AOR 4.37, 95% CI 1.44-13.20) and Western (AOR 4.77, 95% CI 1.28-17.78) regions were more likely to be stunted compared to those in the Northern region.Conclusion: The present study showed wealth index, place of residence and region to be associated with undernutrition among 20 to 49 year old women in Uganda. There is need to address socio-economic determinants of maternal undernutrition mainly poverty and regional inequalities.


2020 ◽  
Author(s):  
ELIZABETH KASAGAMA ◽  
Jim Todd ◽  
Jenny Renju

Abstract Background: Antenatal care (ANC) is crucial for the health of the mother and the unborn child as it delivers highly–effective health interventions that can prevent maternal and newborn deaths and morbidity. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits and the trend has been fluctuating over time. An understanding on the factors that have been contributing to the fluctuating trend over years is crucial in increasing the proportions of pregnant women attaining adequate ANC visits in Tanzania.Methods: The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15-49 years. Data were analyzed using stata version 13. Categorical and continuous variables were summarized using descriptive statistics and using the weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate antenatal. A multivariable Poisson decomposition analysis was done to determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016.Results: The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62%, 43% and 51% respectively. The identified determinants of adequate ANC visits were: early ANC initiation, zones, having more than one child, being aged 20 years and above, wanting pregnancy later, belonging to a richer and richest wealth quintile, having secondary and higher education, reporting distance to health facility not a big problem and watching TV at least once per week. Comparing 2004/05 and 2010 surveys, changes in the population structure contributed 4.2% of changes in adequate antenatal care visits while changes in coefficients contributed 95.8% of the changes. Also, comparing 2015/16 to 2010 surveys, changes in population structure and coefficients contributed 66.2% and 33.8% respectively. Conclusion: Early ANC initiation has greatly contributed to increased proportion of pregnant women who attain four or more ANC visits overtime. More effort should focus on pregnant women to initiate ANC in the first trimester in order to increase proportion of women with adequate ANC visit.


2020 ◽  
Author(s):  
ELIZABETH KASAGAMA ◽  
Jim Todd ◽  
Jenny Renju

Abstract Background: Antenatal care (ANC) is crucial for the health of the mother and the unborn child as it delivers highly–effective health interventions that can prevent maternal and newborn deaths and morbidity. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits and the trend has been fluctuating over time. An understanding of the factors associated with changes in adequate ANC visits over years is crucial in improving the proportions of pregnant women attaining adequate ANC visits in Tanzania. Methods The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15–49 years. Data were analyzed using stata version 13. Categorical and continuous variables were summarized using descriptive statistics and using the weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate antenatal. A multivariable Poisson decomposition analysis was done to determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016. Results The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62%, 43% and 51% respectively. The identified determinants of adequate ANC visits were: early ANC initiation, zones, having more than one child, being aged 20 years and above, wanting pregnancy later, belonging to a richer and richest wealth quintile, having secondary and higher education, reporting distance to health facility not a big problem and watching TV at least once per week. Comparing 2004/05 and 2010 surveys, changes in the population structure contributed 4.2% of changes in adequate antenatal care visits while changes in coefficients contributed 95.8% of the changes. Also, comparing 2015/16 to 2010 surveys, changes in population structure and coefficients contributed 66.2% and 33.8% respectively. Conclusion Early ANC initiation has greatly contributed to increased proportion of pregnant women who attain four or more ANC visits overtime. More effort should focus on pregnant women to initiate ANC in the first trimester in order to increase proportion of women with adequate ANC visit.


2020 ◽  
Author(s):  
Quraish Sserwanja ◽  
David Mukunya ◽  
Theogene Habumugisha ◽  
Linet M. Mutisya ◽  
Robert Tuke ◽  
...  

Abstract Background: Women are at risk of undernutrition due to biological, socio-economic, and cultural factors. Undernourished women have higher risk of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with undernutrition among women of reproductive age in Uganda.Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4,640 women aged 20 to 49 years excluding pregnant and post-menopausal women. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. We used multivariable logistic regression to determine factors associated with underweight and stunting among 20 to 49 year old women in Uganda. Results: The prevalence of underweight and stunting were 6.9% (318/4640) and 1.3% (58/4640) respectively. Women who belonged to the poorest wealth quintile (Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to those who belonged to the richest wealth quintile. Women residing in rural areas were less likely to be underweight (AOR 0.63, 95%CI 0.41–0.96) compared to women in urban areas. Women in Western (AOR 0.30, 95% CI 0.20–0.44), Eastern (AOR 0.42, 95% CI 0.28–0.63) and Central regions (AOR 0.42, 95% CI 0.25–0.72) were less likely to be underweight compared to those in the Northern region. Women belonging to Central (AOR 4.37, 95% CI 1.44-13.20) and Western (AOR 4.77, 95% CI 1.28-17.78) regions were more likely to be stunted compared to those in the Northern region.Conclusion: The present study showed wealth index, place of residence and region to be associated with undernutrition among 20 to 49 year old women in Uganda. There is need to address socio-economic determinants of maternal undernutrition mainly poverty and regional inequalities.


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