FACTORS INFLUENCING UTILISATION OF POSTNATAL CARE SERVICES IN IBADAN SOUTHWEST LOCAL GOVERNMENT AREA, OYO STATE, NIGERIA

Abstract

Postnatal Care (PNC) is the essential care given to mothers and neonates after childbirth to promote their survival. Despite the importance of PNC, its utilisation is poor in Nigeria. Several factors influence its utilisation and having knowledge of them is important in helping women understand why they need to utilise these services. However, there is dearth of knowledge about factors influencing its utilisation in Ibadan Southwest Local Government Area. Therefore, this study assessed factors influencing utilisation of PNC services among women of reproductive age in Ibadan Southwest Local Government Area. The study was cross-sectional in design. A five stage sampling technique was used to randomly select wards, communities, streets, houses, and 401 consenting respondents. A semi-structured, interviewer-administered questionnaire was used to collect data on socio-demographic characteristics of respondents, barriers and facilitators of PNC utilisation. An 11-point scale measured knowledge of postnatal care with scores <4 categorised as poor, 4-7 fair and >7 as good, while a 5-point scale measured at with scores of >2 rated as positive. Six Focus Group Discussions (FGDs) were conducted among mothers in the selected communities who had an index child less than 5 years of age. Quantitative data were analysed in descriptive statistics. Chi-square tests and logistic regression at p=0.05, while qualitative data were analysed using thematic approach. Age of respondents was 31.6±6.9 years, 63.6% had secondary education while 62.6% were artisans. The knowledge score was 7.1±1.8 with 46.6%, 43.9% and 9.5% having good, fair and poor knowledge of PNC, respectively. Majority (79.9%) of the respondents were aware of facilities offering PNC services. Nurses (63.6%) and doctors (53.1%) were their main sources of information on postnatal services. Only 38.8% knew when to revisit a health facility for PNC after delivery. Access to health education (95.9%), family planning (86.3%) and immunization (60.3%) were regarded as benefits of postnatal care utilisation. Majority (69.9%) had positive attitude towards utilisation with with a score of 3.2±1.9. Most (90.0%) had attended antenatal care while 57.9% had utilised PNC services. Among those who received PNC, 93.9% attended orthodox facilities. Women who had poor knowledge of PNC were less likely to have positive attitude to its utilisation (OR=0.5, 95% CI= 0.3-0.8). Women who delivered in a health facility were more likely to utilise PNC services (OR=1.7, 95% CI= 1.0-2.8). Factors promoting the use of PNC services among respondents included prompt service delivery (89.1%), health worker's attitude to (88.4%) and affordability of services (84.4%). Distance of residence to health facility (63.1%), inadequate information on PNC sessions (61.9%) and negative influence of significant others (57.2%) were factors hindering the use of PNC services. The FGDs revealed that those who perceived themselves as healthy saw no need for PNC. Prompt service rendition, affordability of services and positive attitude of health care providers promoted the utilisation of PNC services in Ibadan Southwest Local Government Area. However, inaccessibility and non-disclosure by health care providers were barriers to the utilisation of PNC services. Health education, advocacy and public enlightenment are needed to address these challenges.