Factors affecting utilization of skilled birth attendance and post natal care services among teenage mothers in Kamuli district, eastern Uganda

Abstract

Background: According to the Uganda Demographic and Health Survey (UDHS) of 2016, 78.6% of births among teenage mothers were by skilled birth attendants and only 53.1% of teenage mothers attend a postnatal check during the first two days. This low utilization of Maternal and Child Health (MCH) services disproportionately affects rural districts such as those in the Busoga region where the Kamuli district is located. Although there is available national and regional information on the utilization of MCH services, this information is either limited or not representative at the district level. This study used the Kamuli district as a case for a deep-dive of MCH services utilization by teenage mothers among rural districts in Uganda. Objective: To assess the factors associated with utilization of Maternal Health care services by teenage mothers in Kamuli district Methods: A cross-sectional study of 338 teenagers that gave birth within the previous 12 months was conducted. A total of 13 VHTs from each of the selected villages and 6 key resource persons (the Health Assistant, the MCH focal person, the Community Development Officer, the Subcounty Chief, the Local Council III Chairperson, and a prominent religious leader) from each of the 13 sub-counties were interviewed as Key Informants. MCH services utilization-based univariate and multivariate analyses were conducted using stata 15. Variables related to the ability to need, seek, reach, pay, and engage in MCH services were considered as independent variables. Qualitative data were analyzed using a thematic approach. Key informants were selected due to their perceived detailed information on health and health systems within the village and are expected to be the best source of information for the study. xii For this study, MCH services utilization was considered as birth attendance and postnatal care by a skilled attendant and for the birth that occurred within 12 months of the study. Results: The study found that perception of waiting time was too long [AOR=0.25 CI (0.08-078) P=0.02] was associated with decreased maternal health service utilization. Convenient opening time [AOR=3.22 CI (1.10-9.42) P=0.03] was found to be associated with an increase in maternal health service utilization, while teenager's mother attended SBA [AOR:3.89 CI(1.28-11.83) P=0.02] was associated with an increase in maternal health service utilization. All these associations were statistically significant. Study findings revealed that knowledge of ANC [AOR=2.2.1 CI(1.17-4.16) P=0.01] and teenage mothers living in urban residence [AOR=1.71 CI(1.04-2.81) P=0.03] was associated with increased maternal health service utilization. Married or cohabiting [AOR =0.53 CI (0.32-086) P= 0.01] was associated with a decrease in maternal health service utilization. All these associations were statistically significant. Conclusion: This study aimed at investigating determinants of maternal healthcare service utilization among teenage mothers in Kamuli district by exploring the association between demand and supply factors and with outcome variables (SBA and PNC). First and foremost, the utilization of MHC services was found to be suboptimal (poor). The extent of maternal health care utilization was found to be largely determined by the demand and supply factors. Findings indicated that long distances, poor roads, poor attitudes of health workers, lack of safe public means of transport like ambulance frustrated many teenage mothers from utilizing SBA and postnatal services. Other factors that lead to decreased utilization included Married/cohabiting teenage mother, thinking that waiting hours at health facilities is too long.