assessment of factors affecting utilization of antenatal and postnatal care services in kasese district of western uganda

Description

Background: Utilization of antenatal care (ANC) and postnatal care (PNC) services can greatly impacts on major causes of infant death and significantly affects trends of mortality in women and children. Antenatal care plays an indirect role in reducing maternal mortality by encouraging women to deliver with assistance of a skilled birth attendant or in a health facility. In most rural settings of Uganda, there are challenges in increasing utilization of both ANC and PNC mainly due to the fact that the decisions that lead women to use these services seem to occur within the context of their education level, income level, proximity of health facilities, ways how health workers handle mothers and of course level of community awareness on the importance of these services. It is against this background that this study attempted to investigate how issues relating to socio demographics, health facilities and communities dynamics influence utilization of these vital maternal health services. Broader objective: To assess factors influencing utilization of both ANC and PNC services in Kasese district. Study site: The study was carried out in Kasese District in mid western Uganda a district covering eight sub-counties. Methodology: This was a cross-sectional and analytical study that used both quantitative and qualitative approaches in eight sub-counties of Kasese district, Midwestern Uganda. The data were collected from a representative sample of 364 women drawn from the study population using simple random sampling techniques. Two dependent variables were used in the analysis: The ANC, measured by whether a woman got the service (at least once) from a health facility or not during her last pregnancy and PNC which was approximated by whether the woman and her last born child completed the required PNC visits or not and how many visits were made. Socio demographic, health facilities and community characteristics were used as descriptive variables for both ANC and PNC dependent variables. Data analysis: Data analysis started with computing the percentages of mothers who got antenatal care services from the health facilities which formed the first dependent variable, and also computed the proportion of mothers and their newborn children less than 24 months attended to services like immunization, postnatal checkups as per WHO definition formed the second dependent variable (PNC). Multivariate analysis using categorical regression analysis was used to examine the association between the dependant variables and the independent socio demographic, health facility and community characteristics. In the logistic regression analysis, the first response variable (ANC) had four outcomes; whether a woman attended zero, one, two, three or four or more ANC from health facilities during her last pregnancy. Similarly, the second dependent variable was framed to have four outcomes; whether the woman and her last born child completed the required PNC services (like immunization, postnatal checkup) or not and how many visits were made. Since the interest is in identifying the probability of facing the outcome variable, the dependent variables were coded as 1, 2, 3, and 4+ if the event happened and zero if the event didn’t happen. The logistic regression coefficients were used to inform association between the independent variable whether it increased or decreased the chance of ANC/ PNC given a 5 percent level of significance. Independent variables with p-values were less than 0.05 were considered predictive within the study. Results: The study revealed that the level of ANC and PNC service utilizations is 94.8 % and 38.2% respectively but only 16.8% completed the required four ANC visits. The predicted probabilities, using multinomial logistic regression, showed that women who were highly literate, with high income levels, and with low parity are more likely to use both ANC and PNC services. Conclusion: Although antenatal care service utilization seemed generally good, more utilized than PNC services, even then very few women completed the required four visits during pregnancy. Postnatal utilization was very low compared to the sub-regional figures. Key determinants of utilization include mother’s level of education, parity, age and opportunities for awareness on the need for ANC and PNC services within the communities Recommendations: The study recommended that promoting women's education, improving unmet needs for family planning, increasing awareness on the importance of use of the services to women at grass root level, provision of the services at both home and health facilities, and improving the quality and capacity of the health providers to provide friendly services can go a long way in improving the gap that exists in the utilization of these services. Keywords: Antenatal Care, postnatal care, service utilization.