Spatial patterns and determinants of postnatal care use in Ethiopia: findings from the 2016 demographic and health survey

Malede Mequanent Sisay; Tesfahun Taddege Geremew; Yeshambel Worku Demlie; Asaye Tariku Alem; Desalew Kassahun Beyene; Melkitu Fentie Melak; Kassahun Alemu Gelaye; Tadesse Awoke Ayele; Asrat Atsedeweyn Andargie

doi:10.1136/bmjopen-2018-025066

Spatial patterns and determinants of postnatal care use in Ethiopia: findings from the 2016 demographic and health survey

BMJ Open. 2019 Jun 11;9(6):e025066. doi: 10.1136/bmjopen-2018-025066.

Authors

Malede Mequanent Sisay¹, Tesfahun Taddege Geremew², Yeshambel Worku Demlie², Asaye Tariku Alem³, Desalew Kassahun Beyene⁴, Melkitu Fentie Melak⁵, Kassahun Alemu Gelaye¹, Tadesse Awoke Ayele¹, Asrat Atsedeweyn Andargie¹

Affiliations

¹ Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia.
² West Gojjam Zone Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia.
³ North Gondar Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia.
⁴ Awi Zone Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia.
⁵ Human Nutrition, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia.

Abstract

Objective: Postnatal care (PNC) is essential for preventing maternal and newborn deaths; however, it still remains less well recognised in low-income and middle-income countries. This study was aimed to explore geographical patterns and identify the determinants of PNC usage among women aged 15-49 years in Ethiopia.

Methods: A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. A total of 7193 women were included in this analysis. We employed spatial scan statistics to detect spatial inequalities of PNC usage among women. A multilevel binary logistic regression model was fitted to identify factors associated with women's PNC.

Results: The prevalence of PNC usage among women was 6.9% (95% CI 6.3% to 7.5%). The SaTScan spatial analysis identified three most likely clusters with low rates of PNC use namely southwestern Ethiopia (log likelihood ratio (LLR)=18.07, p<0.0001), southeast Ethiopia (LLR=14.29, p<0.001) and eastern Ethiopia (LLR=10.18, p=0.024). Women with no education (Adjusted Odd Ratio (AOR)=0.55, 95% CI 0.37 to 0.84) and in the poorest wealth quantile (AOR=0.55, 95% CI 0.39 to 0.78) were less likely to use PNC, while women aged 35-49 years (AOR: 1.75, 95% CI 1.01 to 3.04) and with at least four antenatal care (ANC) visits (AOR=2.37, 95% CI 1.71 to 3.29) were more likely to use PNC.

Conclusion: PNC usage remains a public health problem and has spatial variations at regional levels in the country. Low prevalence of PNC was detected in the Somali, Oromia, Gambella and Southern Nations, Nationalities, and People's Region (SNNPR) regions. Women with low educational status, old age, being in poorest wealth quantile and history of ANC visits were significantly associated with PNC usage. Hence, it is better to strengthen maternal health programmes that give special emphasis on health promotion with a continuum of care during pregnancy.

Keywords: demography and health survey; maternal medicine; postnatal care; primary care; public health.

MeSH terms

Adolescent
Adult
Demography
Ethiopia
Female
Health Surveys
Humans
Infant, Newborn
Middle Aged
Postnatal Care / statistics & numerical data*
Pregnancy
Prevalence
Spatial Analysis