Factors Associated with Post-Natal Care (PNC) Services Utilization among Adolescent Mothers in Rural Northern Malawi

Glad Tako Ngwira^1, and Zhuo Lulin²

¹School of Management, Jiangsu University, Zhenjiang 212013, China

²School of Management, Jiangsu University, Zhenjiang 212013, Jiangsu Province, China

Cite this paper:
Glad Tako Ngwira and Zhuo Lulin. Factors Associated with Post-Natal Care (PNC) Services Utilization among Adolescent Mothers in Rural Northern Malawi. American Journal of Public Health Research. 2021; 9(1):38-47. doi: 10.12691/ajphr-9-1-5

Abstract

World Health Organization (WHO) statistics indicate that Sub-Saharan Africa accounts for the vast majority of global maternal deaths. Specifically, maternal deaths among adolescent mothers in rural settings contribute significantly to high maternal mortality. Among others, adolescent mothers’ susceptibility to maternal deaths has been attributed to utilization of post-natal care (PNC) services. Using the Andersen Behavioral Model of Health Services Use, our study sought to examine factors associated with PNC utilization among adolescent mothers in a northern rural district of Malawi. A structured questionnaire was used to conduct interviews among adolescent mothers. A hierarchical logistic regression analysis was carried out using statistical package for social sciences (SPSS). Results show that need factors (severe abdominal pains, vaginal bleeding and obstetric complications) was the most significant factor associated with PNC utilization. Further, the study shows that predisposing factors such as age, educational level, marital status had considerable influence on PNC utilization. Lastly, enabling factors such as family income, adolescent mothers’ occupation, distance to health facility positively influenced mothers’ utilization of postnatal health care. The study recommends to health sector practitioners to use the need factors as the baseline in initiating postnatal health care policies and programs for adolescent mothers, while also paying attention to other factors such as predisposing and enabling because they all have the specific role they play in influencing adolescent mothers’ behavior in accessing postnatal health care.

Keywords:
postnatal care utilization adolescent mothers maternal mortality predisposing enabling need factors

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References:

[1]	Fantaye, A. (2020). Understanding Maternal Care Preferences and Perceptions to Curb Maternal Mortality in Rural Africa. Université d'Ottawa/University of Ottawa,
[2]	Cosden, M. (2011). Adolescent Mothers. In S. Goldstein & J. A. Naglieri (Eds.), Encyclopedia of Child Behavior and Development (pp. 50-52). Boston, MA: Springer US.
[3]	WHO. (2017). World Health Statistics 2016: Monitoring health for the sustainable development goals (SDGs). Accessed on November, 2020. Available at http://www.who.int/iris/handle/10665/206498.
[4]	Singh, A., Yadav, A., & Singh, A. (2012). Utilization of postnatal care for newborns and its association with neonatal mortality in India: an analytical appraisal. BMC pregnancy childbirth, pp. 12(1), 33.
[5]	WHO. (2015). Postnatal care for mothers and newborns: Highlights from World Health Organisation 2013 guidelines. Accessed on November, 2020. Available at https://www.who.int/maternal_child_adolescent/publications/WH O-MCA-PNC-2014-Briefer_A4.pdf.
[6]	WHO. (2019). Maternal mortality. Accessed on November, 2020. Available at https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
[7]	Survey, M. D. H. (2015-16). National Statistical Office (NSO). Accessed on November, 2020. Available at dhsprogram.com/pubs/pdf/FR319/FR319.pdf.
[8]	Khaki, J., & Sithole, L. (2019). Factors associated with the utilization of postnatal care services among Malawian women. Malawi Medical Journal, pp. 31(1), 2-11.
[9]	Sibiya, M. N., Ngxongo, T. S. P., & Bhengu, T. J. J. I. j. o. A. n. s. (2018). Access and utilisation of antenatal care services in a rural community of eThekwini district in KwaZulu-Natal., pp. 8, 1-7.
[10]	Tolera, H., Gebre-Egziabher, T., & Kloos, H. (2020a). Risk factors for women’s non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia. Therapeutic advances in reproductive health, pp. 14.
[11]	Wudineh, K. G., Nigusie, A. A., Gesese, S. S., Tesu, A. A., & Beyene, F. Y. (2018). Postnatal care service utilization and associated factors among women who gave birth in Debretabour town, North West Ethiopia: a community-based cross-sectional study. BMC pregnancy childbirth pp. 18(1), 508.
[12]	Seddiky, M. A., Rahman, S. T., & Studies, P. (2015). Role of Union Health and Family Welfare Center (UH&FWC) to promote maternal education and reduce child mortality rate in Bangladesh. Journal of Emerging Trends in Educational Research, pp. 6(2), 169-181.
[13]	Mon, A. S., Phyu, M. K., Thinkhamrop, W., & Thinkhamrop, B. (2018). Utilization of full postnatal care services among rural Myanmar women and its determinants: a cross-sectional study. F1000Research 7.
[14]	Adedokun, S. T., & Uthman, O. A. (2019). Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live? BMC pregnancy childbirth, pp. 19(1), 93.
[15]	Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W., & Akhter, H. H. (2003). Determinants of the use of maternal health services in rural Bangladesh. Health promotion international pp. 18(4), 327-337.
[16]	Bouvier-Colle, M. H., Mohangoo, A., Gissler, M., Novak-Antolic, Z., Vutuc, C., Szamotulska, K., . . . Committee, E. P. S. (2012). What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. An International Journal of Obstetrics Gynaecology pp. 119(7), 880-890.
[17]	Ny, P. (2007). Swedish maternal health care in a multiethnic society-Including the fathers: Malmö University, Faculty of Health and Society.
[18]	Kurji, J., Gebretsadik, L. A., Wordofa, M. A., Sudhakar, M., Asefa, Y., Kiros, G., . . . Bedru, K. H. (2019). Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis. BMJ open, pp. 9(8), e028210.
[19]	Ndugga, P., Namiyonga, N. K., & Sebuwufu, D. (2019). DHS WORKING PAPERS.
[20]	Mosiur Rahman, M., Haque, S. E., & Sarwar Zahan, M. (2011). Factors affecting the utilisation of postpartum care among young mothers in Bangladesh. Health social care in the community, pp. 19(2), 138-147.
[21]	Ganle, J. K., Obeng, B., Segbefia, A. Y., Mwinyuri, V., Yeboah, J. Y., & Baatiema, L. (2015). How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study. BMC pregnancy childbirth pp. 15(1), 173.
[22]	Elo, I. T. (1992). Utilization of maternal health-care services in Peru: the role of women's education. Health transition review, pp. 49-69.
[23]	Becker, S. O., Cinnirella, F., & Woessmann, L. (2013). Does women's education affect fertility? Evidence from pre-demographic transition Prussia. European Review of Economic History, pp. 17(1), 24-44.
[24]	Barman, B., Saha, J., & Chouhan, P. (2020). Impact of education on the utilization of maternal health care services: An investigation from National Family Health Survey (2015-16) in India. Children Youth Services Review, pp. 108, 104642.
[25]	Dimbuene, Z. T., Amo-Adjei, J., Amugsi, D., Mumah, J., Izugbara, C. O., & Beguy, D. (2018). Women’s education and utilization of maternal health services in Africa: a multi-country and socioeconomic status analysis. Journal of biosocial science, pp. 50(6), 725-748.
[26]	Weitzman, A. (2017). The effects of women's education on maternal health: Evidence from Peru. Social science medicine, pp. 180, 1-9.
[27]	EDHS. (2012). Ethiopian demographic and health survey, 2011. Accessed on November, 2020. Available https://www.usaid.gov/sites/default/files/documents/1860/Demogr aphic%20Health%20Survey%202011%20Ethiopia%20Final%20Report.pdf.
[28]	Akunga, D., Menya, D., & Kabue, M. (2014). Determinants of postnatal care use in Kenya. African Population Studies, pp. 28(3), 1447-1459.
[29]	Mukonka, P. S., Mukwato, P. K., Kwaleyela, C. N., Mweemba, O., & Maimbolwa, M. (2018). Household factors associated with use of postnatal care services. African Journal of Midwifery Women's Health, pp. 12(4), 189-193.
[30]	Zhang, S., Chen, Q., & Zhang, B. (2019). Understanding Healthcare Utilization In China Through The Andersen Behavioral Model: Review Of Evidence From The China Health And Nutrition Survey. Risk Management Healthcare Policy, pp. 12, 209.
[31]	Tolera, H., Gebre-Egziabher, T., & Kloos, H. (2020b). Using Andersen’s behavioral model of health care utilization in a decentralized program to examine the use of antenatal care in rural western Ethiopia. PloS one, pp. 15(1), e0228282.
[32]	Mohan, D., Gupta, S., LeFevre, A., Bazant, E., Killewo, J., & Baqui, A. H. (2015). Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey. BMC pregnancy childbirth, pp. 15(1), 282.
[33]	Warren, C., Daly, P., Toure, L., Mongi, P., & Health, C. (2006). Postnatal care: Opportunities for Africa’s Newborns. Cape Town, South Africa: Partnership for Maternal, Newborn. Pp. 79-90.
[34]	Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization. Health services research, pp. 33(3 Pt 1), 571.
[35]	Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly, pp. 83(4), Online‐only-Online‐only.
[36]	Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of health social behavior, pp. 1-10.
[37]	Kim, H.-K., & Lee, M. (2016). Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen's behavioral model. Osong public health research perspectives, pp. 7(1), 18-25.
[38]	Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2010). Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007. BMC public health, pp. 10(1), 485.
[39]	Shahram, M. S., Hamajima, N., & Reyer, J. A. (2015). Factors affecting maternal healthcare utilization in Afghanistan: secondary analysis of Afghanistan Health Survey 2012. Nagoya Journal of Medical Science, pp. 77(4), 595.
[40]	Tesfaye, G., Loxton, D., Chojenta, C., Semahegn, A., & Smith, R. (2017). Delayed initiation of antenatal care and associated factors in Ethiopia: a systematic review and meta-analysis. Reproductive health, pp. 14(1), 150.
[41]	Paul, P., & Chouhan, P. (2020). Socio-demographic factors influencing utilization of maternal health care services in India. Clinical Epidemiology Global Health.