Determinants of Postnatal Care Services Utilization Among Women of Reproductive Age in Maridi County South Sudan.

Abstract

Background: Postnatal care programme have remained among the weakest, under-utilized and neglected maternal and child health programs despite its proven evidence in improving the health of mothers and new-borns. Understanding the determinants of postnatal care services utilization in the study area was envisioned to provide baseline data and background for further research, track and document women’s experience of access to postnatal care services, provide recommendations for policy makers at all levels to conduct an evaluation on postnatal care service provision in health facilities as well as influence policy decision making on maternal and child health care in the country in line with the Sustainable Development Goals of ensuring good health and well-being of the population in the country. Objectives: The study was set out to assess the determinants of postnatal care services utilization among women of reproductive age in Maridi County. Specifically to; determine the individual factors affecting the utilization of PNC, establish the socio-economic factors influencing utilization of PNC; and, to determine the health system factors influencing the utilization of postnatal care services in the study area. Methodology: Descriptive cross-sectional study design was used to assess the determinants of PNC. Both quantitative and qualitative data collection techniques were employed. Total of (384) women of reproductive age were the study respondents. Results: This study established that age (p-value 0.042); levels of education (p-value 0.000) were significant determinants of PNC. An important influence of postnatal care services utilization shown by this study is the number of ANC visits (p-value 0.000); (OR 4.803) made by the mothers during their most recent pregnancies. Work done to earn a living such as; peasant farmer p-value 0.018 and, receiving encouragement and social support from a spouse or family members (p-value 0.000) to attend PNC. The amounts of time taken to receive postnatal care services (p= 0.013). Poor response from health care service providers reported by more than a half of the respondents at the last postnatal care visit (p-value 0.016), care and support received from the health service providers (p-value 0.000). Additionally, provision of information on personal hygiene after childbirth (p-value value 0.001), the provision of information on possible mood changes after child birth (p-value 0.004); provision of counseling on possible danger signs following child birth (p-value 0.030); promotion of warmth in the new born (p-value 0.001); promotion of hygiene and good skin, eye and cord care for new born babies (p-value 0.002); (OR 2.217)provision of counseling on danger signs in new born and home care (p-value 0.022); (OR 0.789) were significantly associated with PNC service utilization among mothers in Maridi County. Conclusion: This study established that; age, marital status and levels of education, number of ANC visits made by the mothers during their most recent pregnancies and the last place of delivery determined PNC attendance. The occupation of respondents, receiving encouragement and social support from a spouse and family members also determined PNC attendance by the respondents. Provision of transport, provision of funds for PNC services, time taken to access PNC services, receiving care and support expected from the health facility attitude of health workers at PNC service delivery points, the kind of health care provider, rate of attention given to a mother by the health care providers and quality of PNC services provided. There is low utilization of PNC service by women in Maridi County. Recommendations: This study recommends; MoEST to invest more resources in promoting girl-child education; MoH to adapt and introduce the comprehensive focused PNC strategy to orientate health care service providers on the provision of quality PNC, expand on the coverage of maternity care to PHCUs, integrate TBAs and traditional herbalists into the BHI to regulate their practice, establish formal cost sharing scheme to lessen health inequity and, need for more research to evaluate the quality of PNC services provided.