Utilization Of Postnatal Care Services In Homa Bay Sub-County Of Homa Bay County

ABSTRACT

Postnatal care (PNC) is vital for the life of both mother and child as it reduces both marternal and infant morbidities and mortalities. However, in Kenya and Homa Bay County PNC utilization is low (48%) but the cause is not known. This Study determined factors influencing PNC utilization by 377 mothers having children aged 6-8 weeks old. Specifically, the study assessed knowledge, attitude and PNC health seeking behaviour of mothers in Homa Bay Town Sub County. A community based cross sectional study using quantitative complemented by qualitative methods of data collection was employed. Quantitative data collection involved structured questionnaires administered to mothers proportionately and systematically randomly sampled. Qualitative data was collected through Key informant interview guide from 10 purposively selected health care providers and 11 lead community volunteers (CHVs). The questionnaires were checked for completeness before data entry. Data was entered into SPSS version 17.0 for statistical analysis. Chi square tested for independence of variables at 5% level of significance. Logistic regression was used to measure relationship between variables and odds ratio was determined at multivariate level. Thematic approach was used to analyse qualitative data to complement the findings. 80% understood PNC and utilized such services within 6-8 weeks. 81% of mother received information from skilled health workers. 80% of women received immunization and was significant (χ² =12.635, p=0.027) to Utilization of PNC. 64% of women attended PNC services between two and three times. 67% mothers mentioned haemorrhage as the likely risk after delivery. Main attitude-related reason for low utilization of PNC service was lack of awareness (50.5%) of PNC, experience, expectation and perception that was significant (χ² =11.688, p=0.039) to access to PNC services. Majority who accessed PNC services expected physical examination (49.1%) and immunization of their babies (44.5%) and said the quality was good. On health seeking behaviours, 84% delivered in a health facility and 10.8% delivered home and was significant (χ² =11.354, p=0.003) to utilization of PNC. 89% accessed some form of PNC service was significant (χ² =21.515, p=0.000). There was a gap between knowing and understanding PNC as majority of the respondents had knowledge of PNC but attended twice and late between 4 and 6 weeks for purposes of immunization and sickness (hemorrhage). The study also revealed that positive attitude regarding reception by health providers, quality of service, expectation, experience and perception of PNC services increased utilization of PNC services. However, Mothers mostly sought PNC services whenever there was need of immunization or sickness hence showed a gap between knowledge and PNC health seeking behaviour. There was need to address the gap between knowledge and understanding, knowledge and health seeking behavior that are linked to utilization of PNC by the respondents as informed by the health care providers that are key informants. The policy implementers should find a method of linking other components to the most sought preventive component like immunization to increase access to PNC. Since cost was found to influence health seeking behavior of PNC, the County government should reassess the effectiveness of the free maternity policy, waiver implementation in provision of PNC services in Homa Bay Town Sub –County.