Utilisation of postnatal care services among adolescent mothers in Hoima District, Uganda

Abstract

Introduction and background: The postnatal period is critical in the lives of newly delivered mothers and their babies, especially for adolescents since the majority of the maternal and neonatal deaths occur during this period. Provision and utilisation of post-natal care (PNC) provides a window to avert preventable deaths within the post-natal period, yet, what increases or deters adolescent mothers from utilizing post-natal care in areas where adolescents’ pregnancies are more prevalent remains largely unknown. This study therefore aimed at determining the factors influencing utilization of PNC services among adolescent mothers in Hoima District, Uganda. Methods: This cross-sectional study was conducted among randomly selected adolescent mothers recruited from five sub counties within Hoima district. Quantitative data were collected using an interviewer administered structured questionnaire among 510 randomly selected adolescents mothers. Qualitative data were collected among eight adolescent mothers using an in-depth interview guide and using key informant guides among five health workers who offered PNC services at health facilities within the sampled sub counties. Qualitative respondents were purposively selected. PNC utilization was defined as an adolescent mother (15-19 years) reporting to have had a PNC check at 6 weeks (42 days) post-delivery. Quantitative data were analysed using STATA Version 14. Data were subjected to multi-variable analysis using the modified Poisson regression model. Factors were considered to have a statistical association if the P value was ≤ 0.05. Audio interviews were transcribed verbatim. Qualitative, analysis was conducted manually using thematic content analysis. Results: only 23% utilized postnatal care within 6 weeks post-delivery as compared to the 53% at national level. After adjusting for confounding, adolescent mothers who had a caesarean birth [APR=1.53,95%CI:1.336-1.744], assisted by skilled birth attendant during delivery [APR=1.26,95%CI:1.205-2.111], had been visited by a VHT three or more times after delivery [APR=1.57,95%CI:1.18-1.915] and were peasant farmers [APR=1.82,95%CI:1.633-2.249] were more likely to utilize PNC while those who had a non-skilled birth assistance and were visited by VHTs during pregnancy [APR=0.48,95%CI:0.344-0.941] were less likely to use PNC. Qualitative results showed that, better experience while at the health center facilitated utilization of PNC whereas a bad experience hindered PNC utilization by adolescent mothers.

Conclusion and recommendations: PNC utilization at 6 weeks was low and factors associated with low PNC utilization included having non-skilled birth assistance, having a normal birth, being visited by a VHT during pregnancy and having less than three VHT visits postpartum. Non skilled birth assistance should be discouraged at community level through engagement and motivation of VHTs to continuously conduct home visits and sensitization of mothers.