Assessing suspected postpartum illnesses, associated factors and self reported management actions adopted among mothers in Wakiso district,Uganda.

Abstract

Background: Every day 15 women die in Uganda due to pregnancy and child birth related causes which mostly occur during the post-partum period. Health care workers sometimes lack capacity to conduct essential care actions for management of these causes and have limited knowledge on risk factors, danger signs of complications and post-partum illnesses. This study was done to contribute to information on suspected post-partum illnesses and the associated factors among mothers that report at lower level health facilities during post-partum period. Objective: To assess suspected postpartum illnesses, associated factors and self-reported management actions adopted among mothers with suspected post-partum illnesses. Methods: A cross-sectional study was carried out in June 2019 and a total of 430 mothers reporting to 6 out of 47 health facilities were enrolled voluntarily for clinical examinations and interviews by midwives in Wakiso district. Midwives based on mothers’ history, and validated clinical definitions from Uganda Clinical Guidelines to detect and categorise mothers with suspected postpartum illnesses. In addition, midwives interviewed mothers using a structured questionnaire to gather data on associated factors. Focus Group discussions among mothers were carried out to identify self-reported management actions among mothers with suspected post-partum illnesses. Data was entered in Epidata and analyzed using Stata.14. The Primary outcome was proportion of mothers with suspected postpartum illnesses. Modified Poisson regression was used to determine factors independently associated to mothers with suspected postpartum illnesses. Transcriptions from focus group discussions were thematically analysed to understand the self-reported management actions among mothers with suspected post-partum illnesses. Results: Overall, 16.7% of the mothers were suspected with postpartum illnesses most of which was mild. Among these mothers, 9.8% had postpartum haemorrhage, 2.3% had sepsis, 2.3% had post-partum infections, 1.2% had fistula and 0.7% had preeclampsia &eclampsia. Birth interval (p=0.01, AOR 0.53, 95% CI 0.31-0.89), employment status (p-value=0.01, AOR 0.58, 95% CI 0.37-0.91) and awareness about danger signs (p<0.001, AOR 9.73, 95% CI 3.01-31) were independently associated to mothers with suspected post-partum illnesses. Among the self-reported management actions adopted among mothers with suspected post-partum illnesses include; seeking medical care, use of home remedies, self-medication with pain killers and use of herbal medicine Conclusion: The proportion of mothers with suspected post-partum illnesses at lower level facilities in this district was high though the common illnesses detected by midwives using validated clinical definitions were mild. Birth interval, awareness of danger signs and employment status were associated to mothers with suspected post-partum illnesses. Recommendation: There is need for continuous sensitisation of mothers about the danger signs during post-partum period and the risk factors to post-partum illnesses so as to encourage timely reporting and detection of suspected cases of post-partum illnesses at the lower level health facilities.