Assessment of Postnatal Care Service Utilization
and Associated Factors in Asella Town, Arsi Zone, Oromiya Regional State, Ethiopia
Amane Tumbure1, Deme Argaw1, Elile Fantahun1, Megersa Negusu1, Tsegaw Yitbarek1, Legese Tadesse2* and Tewodros Desalegn2
1 Associate professor of reproductive health, Asella Teaching Hospital, Arsi University, Ethiopia
2Department of Public Health, Asella College of Health Science, Arsi University, Ethiopia
Submission: July 17, 2018;Published: September 19, 2018
*Corresponding author: Legesse Tadesse MD, MPH, Associate professor of reproductive health, Asella Teaching Hospital, Arsi University, Ethiopia.
How to cite this article: Amane T, Deme A, Elile F, Megersa N, Tsegaw Y, et al. Assessment of Postnatal Care Service Utilization and Associated
Factors in Asella Town, Arsi Zone, Oromiya Regional State, Ethiopia. Glob J Reprod Med. 2018; 6(1): 555678. DOI: 10.19080/GJORM.2018.06.555678.
Post-natal care refers to the assistance given to the mothers and the babies for a period of six weeks from the time of delivery. It is believed to be low in Ethiopia. This study provided postnatal care service utilization information in the study area.
Objectives: To assess postnatal care service utilization prevalence in Asella Town, Arsi Zone, Ethiopia, 2017.
Methods:Cross sectional community based descriptive study conducted on postnatal care service utilization among women delivered in the last two years Asela. Study carried out from August 01 to December 30/2017. Study cluster selected by using lottery method. A total of 209 households were included in the study. Data collected by using structured questionnaires. The collected data analyzed by using EPI Info version 3.5.4 and SPSS version 21. The result presented using tables, graphs and narrations.
Results: A total of 209 participants included and 99.3 % responded with mean age of 26.7 + 4.4 years. Hundred fifty six (74.2%) heard about PNC while 152(72.7%) reportedly used postnatal care service. Mothers with better education, antenatal follow up and appointment for postnatal care showed better proportion of postnatal care use.
Conclusion and recommendations: The overall prevalence of PNC service utilization in this study was 72.8%. The quarter claimed did not know PNC service. The health care providers and policy makers are recommended to increase the awareness of mothers on postnatal care services. To schedule mothers based on the national postnatal care follow-up protocol in order to increase post-natal care service utilization.
Keywords: Postnatal care utilization; Prevalence; Asella town
Abbrevations: ANC: Ante Natal Care; EDHS: Ethiopian Demographic Health Survey; EMDG: Ethiopian Millennium Development Goal; HC: Health Center; MOH: Ministry Of Health; No: Number; NGO: Nongovernmental Organization; PNC: Postnatal Care; TBAs: Traditional Birth Attendants; UNICEF: United Nations International Children’s Economic Fund; WHO: World Health Organization
Post-natal care refers to the assistance given to the mother and the baby for a period of six weeks from the time of delivery. Maternal and child health are the major concern of public health organization and researchers throughout the world. Health education for mother is strategy many countries have adopted to improve maternal and child health. Yearly over half a million women encounter complication due to child birth and many die .
Post-natal services are the primary comprised of physiotherapy, physical examination, immunization, health education and family planning service . Lack of care in this time period may result in death or disability as well as missed
opportunities to promote healthy behavior, affecting woman, newborn and children. Post-natal care is regarded as one of the most important maternal health care services for the prevention of impairment and disability resulting from child birth .
Different studies in developed countries showed the factor which affects utilization of post-natal care are distance from health service, cost including direct fees and cost of transportation, drug and supplies; multiple demands on women’s time; women lack of power on decision making within the family; and poor quality of services including poor handling by health providers . Half of all post-natal maternal death in Bangladesh occur during the first week after the baby is born, and the majority of these occurrences during the first 24 hours after child birth .
In a very poor countries and regions, such as those in sub-
Saharan Africa only 5% of women receive post-natal care. In
Ethiopia, factors associated to utilization of PNC service have
been the major cause of maternal and infant death for majority
of people, especially for those having low income. Therefore, it is
important to assess the factor that cause underutilization of postnatal
care service .
Approximately 80% of maternal death globally occur due
to hemorrhage, sepsis, unsafe induced abortion, hypertensive
disorder of pregnancy and obstructed labor . These deaths
are unjust and can be avoided with key health interventions, like
provision of ANC and medically assisted delivery . The emphasis
on two out of eight critical united nation millennium development
goals, that is reducing under five mortality by 2/3, between 1990
and 2015 and reducing maternal mortality ratio by ¾ between
1990 and 2015 epitomize of the relevance of indicator sign global
efforts towards human development . A fully functioning
mother-baby package intervention has been estimated to have
post-natal cumulative effect of averting 75%-85% of maternal
death in developing countries .
A woman living in sub-Saharan Africa high chance of dying
in pregnancy, child birth and after child birth . Post-natal
service are also among the strategies aimed at preventing the
onset of physical and mental impairments among women who
have delivered . Nearly 4.7 million mothers, newborns, and
children die each year in sub-Saharan Africa: 265,000 mothers die
due to complications of pregnancy and childbirth and 3,192,000
children, who survived their first month of life, die before their fifth
birthday . 1,208,000 babies die before they reach one month
of age ; this toll of more than 13,000 deaths per day accounts
for half of the world’s maternal and child deaths. In addition, an
estimated 880,000 babies are stillborn in sub-Saharan Africa and
remain invisible on the policy agenda .
Despite remarkable progress to reduce mortality of children
under 5 years of age in Ethiopia, little change has occurred
in neonatal mortality, which accounts for 42% of all under-5
deaths. The 2000 , 2005 , 2011  and 2016 ,
Ethiopian Demographic and Health Surveys (EDHS) reported
neonatal mortality rates of 49, 39, 37 and 35 per 1000 live births,
respectively. The decline in neonatal mortality rates by 24% over
11 years is substantially less than the decline in infant (39%) and
child (60%) mortality over the same period.
Use of maternal and newborn health care services is low in
Ethiopia. According to the 2016 EDHS, only 62.4% of women
who gave birth in the 5 years preceding the survey received any
antenatal care from a skilled provider (eg, physician, midwife,
nurse), and 9% received antenatal care from a health extension
worker. Only 10% of women gave birth in a health facility or with
a skilled birth attendant, and less than 1% gave birth with a health
extension worker. Of note, only 7% of women received postnatal
care within 48 hours of birth (6% from a skilled provider, <1%
from a health extension worker). Substantially fewer mothers and
newborns living in rural areas received postnatal care, compared
to those living in urban areas (3% versus 32%) .
Low use of postnatal care services by rural Ethiopian women
may be due to the tradition of a 40-day period of confinement
to protect the mother and newborn from malevolent spirits
. However, other community-based projects in Ethiopia and
elsewhere have achieved mixed results in terms of improving
postnatal care coverage; none have achieved postnatal care
coverage greater than 32% , even though the utilization of
maternal health care service varies with the socio-economic
characteristics of the population .
Significance of this study is taking in to consideration,
that, post-natal health service utilization operates at various
individual, house hold and community levels; authors aimed not
only evaluating how postnatal care was conducted, but also tried
describing why women did not receive postnatal care. Little is
known in the study area on current magnitude of utilization of
maternity services in health facilities especially postnatal care
and associated factors for their utilization to the knowledge of the
authors. This study, therefore, tried to assess extent of postnatal
care utilization and attempted to describe factors that are assumed
to be barriers to postnatal care utilization among mothers who
gave birth. It provided relevant information to PNC programmers,
Implementers and beneficent.
The study was conducted in Asella town. Asella is administrative
town found in central Ethiopia, west of mount Chilalao. It is located
in the Arsi zone which is one of the zones in Oromia Region divided
into 26 districts, including two especial Administrative towns,
namely Asella and Bokoji. Asella is the capital town of Arsi zone.
It is located 175 KM from Addis Ababa, capital city of Ethiopia
has a latitude and longitude of 7° 57′N39°7′Ewith an elevation of
2,430 meters. According to Ethiopian national census (CSA 2007),
Assela town has a total population of 74,268 of whom 37,337 were
male and 36,931 were females [21,22]. The study period was from
March 14- September 30, 2017.
Asella town has fourteen kebeles, among these kebele 09
was select by using Convenience method. There was 1824 total
population. Number of females aged 15-49 years is 800.There are
seven ketenas in Assela kebele 09. The first ketene was select by
using lottery method. Simple random sampling technique was
conduct to select couples in each ketenas proportional to their
number of currently married couples. The first household was
select by lottery method and then K value will be used. K= total
households / sample size =800/209=3.8=4 every 4th house hold
was interview starting from the end of each village house until the
allocated sample achieved. Couples who fulfilled the criteria of the
study subject was interview and in the absence of illegible couples
in that household the nearby household was interview (Figure 1).
Data collection instrument: Data was collected using
interview administered structured questionnaire. The principal
investigator was involved in the data collection. A structured
interviewer administered questionnaire was adapted by
investigators after review of different literatures to collect the
information based on study objective.
First the questionnaire was prepared in English language
and then it was translated to local language (Amharic) and which
was again back translated to English. Comparisons were made on
the consistency of two versions. The variable to being collected
includes socio demographic, economic and question on prevalence
of PNC and awareness of people on risk associated with not use
Data processing and analysis: The Data were entered
using EPI-INFO version 3.5.4 and exported to SPSS version 21
for analysis. After it was edited, sorted, organized, and checked
for completeness. Descriptive statistics were carried out to
characterize the study population using different variables. The
result was presented by using table, graph and texts as based on
type of data.
Data quality assurance: To assure the quality of collected
data the following measure was under taken. The appropriately
designed data collection instrument was used. Every day
the collected data was cross checked by group members and
comments and measures was being undertaken throughout the
data collection period for completeness and consistency of the
i. Post-natal care: refers to the assistance given to the
mother and the baby for a period of six weeks from the time of
ii. Utilization of service: It refers to use of post-natal
service such as family planning, immunization and other services
by women till six months after the delivery of the babies.
iii. Post-natal service: Is the service that consists of
immunization, family planning and heath care education on
child care, breast feeding, physiotherapy, physical examination,
treatment and counseling service.
iv. Immunization: Is the process of administering
vaccination to neonates, infant and child.
v. Conceptual frame work; A schematic presentation
showing the association between factors and outcomes
vi. Puerperal sepsis: Is infection that occurs after delivery
up to six weeks.
vii. Family planning: Is service important for spacing
number of pregnancy and prevents unwanted pregnancy.
viii. Traditional birth attendants: Are unprofessional birth
attendant who get skill from professionals.
Ethical clearance was taken from community and research
committee. We were taken permission letter from Arsi University.
Permission was being obtained from both the administrator to
obtain the desired cooperation and participation.
Verbal informed consent was obtained from each study subject
prior to the interview after the purpose of the study is explained
to respondent. Confidentiality of the information was being
assured and privacy of the respondent was being maintained.
The respondents told to have the right to dropout the interview
at any time she wishes. At the end of the interview, Information
about advantage of postnatal care by skilled health professional
explained to the respondents.
The final report will be presented to Arsi University, School
of Health science, Department of public health. The result of the
study will be disseminated to Assela health desk, Arsi zone health
desk through seminar or written formal report. It will also be
communicated to Arsi University College of Health Science staff
members and students through the university library
A total of 209 women participated in the study with a response
rate of 99.3%. Almost much of (46.9%) of the participants were
found between the age of 25 to 29 years. The mean age of the
Participants was 26.7 years (+SD=4.4). 111 (53.1%) of them were
Muslim and 193 (92.3%) of them were married. With respect to
level of education only 67(32.1%) of the respondents had college
and above education. The average monthly house hold income
was 3948 ETB. More than half 129(61.7%) of the participants
were using foot for manse of transportation to the health facilities
About 176 (84.2%) of the participants didn’t have history
of abortion,33(15.8%) have history of abortion. More than Half
164(78.5%) of the participants were multi gravid 135 (64.6%)
of the previous pregnancy were Planned and support, 74(35.4%)
was unplanned and support. More than half 180(86.1%)
respondents had ANC follow up at least one, on top participants
were 209(100%). Three fourth 151(72.2%) of the participants
were given appointment for postnatal care by the health care
professionals before discharge. The remaining 58(27.8%)
participants were not informed to have postnatal care by the
health professionals before discharge from the health institution.
Among women who gave birth 124(59.3%) in governmental
hospital, health center 73(34.9%,7(3.3% in privet clinic and home
delivery 5(2.4%) (Table 2).
About 152(72.7%) had PNC and 57(27.3%) didn’t have any
PNC visit. The most frequent place of postnatal care were at
government hospitals 75(49.3%) followed by the health centers
70(46.0%). The proportion of postnatal care visit across 2 weeks
of discharge, after four week of discharge and at six weeks
of postpartum were 23(15.1%), 65(42.7%) and 58(38.2%)
respectively. Contraceptive use after delivery 118(56.4%)
Contraceptive initiation period At 6 month 86(71.1%) (Table 3).
Concerning what was done for the women during postnatal
care visit we found that nearly half 56.1% of the respondents
provided contraceptives, 3.9% had physical examination,16.8%
advice on danger signs, 18.1% provided TT vaccination, and
3.2%had laboratory investigations (Figure 2). Concerning what
was done for the baby as it displayed on Figure 3, 87.5% of the
babies had received immunization, 9.2% of women were counseled about danger signs of their baby, and only 0.7% of the babies had
physical examination and 0.7% laboratory investigation (Figure
About 156(74.2%) heard about PNC,53(25.4%) didn’t
heard about PNC. From this who heard about PNC from Health
works 118(75.6%), 26(16.7%) from mass media,12(7.7%) from
neighbor.135(84.1%) know what is given in PNC,21(15.9%) didn’t
As shown in the Figure 4 women participated in study know
PNC service as immunization 79.7%, Family planning 12.8% and
Out of twenty independent variables categorized under
Socio demographic, reproductive characteristic, knowledge, Six
variables namely educational status, ANC follow up, whether
or not PNC appointment given, were determinant of post-natal
care utilization in our study (Figure 5). Over all 57(27.3%) of
respondents were not using PNC, the major reasons explained
by these Women were being not appointed by the health care
provider 68.4 % and lack of knowledge on the importance of PNC
service and 31.4% (Figure 5).
Post-natal care is one of the components of maternal and
child health which plays an important role in the prevention of
complications that occurs following delivery of the new baby. This
study tried to assess the prevalence and knowledge of postnatal
care utilization among selected village Assela Town of Arsi Zone,
Ethiopia. The selected socio-demographic status of the participants
showed most of them 193(92.3%) married, 164(78.5 %) were
multiparous and 22(10.4%) were illiterate. This study indicated
that (72.7%) of the participants had received a health checkup
after delivery despite the fact that almost all women were given
birth at health institution 204(97.6%). But this figure is very high
when compared with the 2016 EDHS postnatal care utilization
rate of 9.0% and 18.8% of institutional delivery rate respectively
. This difference might be due to the time difference and the
presence of diverse intervention to improvement in accessing and
utilizing maternal health care service in the urban area as the case
in current study. This study finding on PNC prevalence was also
higher than three similar studies conducted in Enderta District, Tigray, 49.7%) , Jabitena District, Amhara Region (20.2%)
, and South Nation and Nationality Region (37.2%) in Ethiopia
. The discrepancies might be associated with the variation in
the study areas and as well study population.
Similarly, the postnatal care utilization of this study finding
also a bit higher when compared to the studies conducted in
African and Asian countries; the prevalence of not using postnatal
care in Bangladesh (73%), Nepal (72%), Rwanda (71%), Burkina
Faso (44%), Cambodia (46%), Haiti (55%), and Kenya (46%)
Concerning the quality of postnatal care provided by the health
professional, it was found that about more than half (56.1%) of
the women were reportedly provided only contraceptives and less
than one in three women received the remaining postnatal care
services such as counseling on danger signs, physical examination,
and health promotion. Similarly, the postnatal care provided to
their babies mainly focused on providing immunization (87.5%).
The remaining services accounted for less than 11.3 %. This was
also true in a study done in southern Ethiopia .
The key determinant factor for PNC utilization in our study were
educational status, ANC follow up, provision of PNC appointment
given by health provider. Women who were counseled and given
appointment for postnatal care service were utilized the PNC
service higher than those women who didn’t informed about the
PNC service on discharge. This was also supported by the reason
given by those women who didn’t utilized PNC during this study.
Similarly, a study done in northern Ethiopia found that those
women who had got information about postnatal care services
from Health Extension Workers and Midwife/Nurse had larger
oddis (24.87) to attend postnatal care service compared to those
women who had got information from other sources . This
finding may lead to a conclusion that the PNC service utilization
is strongly influenced by the knowledge of women on postnatal
Those mothers with secondary levels of education had more
postnatal care utilization than mothers who didn’t have formal
education. A study done on the assessment of factors affecting
utilization of postnatal care services was conducted in Jabitena
district, Amhara regional state in Ethiopia found that among the
socio-demographic factors, the key predictor for PNC utilization
was educational status of the respondents. A participant whose
level of education was secondary school and above showed better
utilization of PNC service as compared to illiterate women [25,26],
similarly a study done in Nepal found that mothers who were
educated had better score of using .
History of ANC follow up was one of the strongest predictors
of postnatal care service utilization mothers who have history
of ANC follow up utilize PNC more than women who didn’t have
ANC follow up. Another community based study done in northern
Ethiopia found that women who had ANC follow up were 4 times
more likely to attend postnatal care services as compared to
women who didn’t had . A study done in Nepal a woman who
had attended a four or more antenatal were more likely to report
attending at least one postnatal care visit . This is because it
improves the knowledge of better outcome of having post-natal
The source of the data for this study was based on the selfreport
of respondents and provided no validation of obtained
information with any objective source such as health facility cards.
A high response rate of 99.3% gained from the participants of the
Using non probability sampling method was one limitation.
Recall bias was more likely since women were asked for events
which have already happened within the past two years prior to
this study despite the consideration of recent births. Study design
was descriptive cross sectional and not association done to show
determinants. Use of health professionals as data collectors may
create bias as they might direct the respondents during the data
The overall prevalence of PNC service utilization in this study
was relatively good as compared to Oromiya region 77% of women
use post-natal care. In Arsi zone 78% of women use post-natal
care utilization in 2009, also the same in Tiyo woreda, but it is very
high compare to EDHS 2016 Oromyia 9.0% of women had postnatal
care in the first 2 days after delivery. To enhance PNC service
utilization all women should be counseled about postnatal period
and provided appointment. The health care providers and policy
makers are recommended to increase the awareness mothers
on postnatal care services, to prevent maternal and neonatal
complication and to schedule mothers based on the national
postnatal care follow-up protocol in order to increase post-natal
care service utilization.
a. To health professionals: Should be counsel about the
danger signs of postnatal period and give appointment for PNC.
b. To health facilities: Should assure comprehensive and
quality of postnatal care services. Should give continuous training
for health care providers on PNC appointment and counseling
about danger sign during postnatal period
c. To Health bureau: Should emphasize the improvement
of quality of service PNC utilization. Should prepare guide lines on
danger sign during Post-natal care visit.