Policy, Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal.
School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal.
PLoS One. 2024 Sep 6;19(9):e0307772. doi: 10.1371/journal.pone.0307772. eCollection 2024.
The first hours, days, and weeks following childbirth are critical for the well-being of both the mother and newborn. Despite this significance, the postnatal period often receives inadequate attention in terms of quality care provision. In Nepal, the utilization of postnatal care (PNC) services remains a challenging issue. Employing a facility-based concurrent triangulation mixed-method approach, this study aimed to identify factors associated with PNC service utilization, as well as its facilitators and barriers. A quantitative survey involved 243 mothers who had given birth in the six months preceding the survey, selected using a multistage sampling technique from six health facilities of two randomly selected local levels of the Pyuthan district. Weighted multivariate logistic regression was employed to identify predictors of PNC service utilization. Additionally, qualitative analysis using Braun and Clarke's six-step thematic analysis elucidated facilitators and barriers. The study revealed a weighted prevalence of PNC service utilization as per protocol at 38.43% (95% CI: 32.48-44.74). Notably, Socioeconomic status (AOR-3.84, 95% CI: 2.40-6.15), place of delivery (AOR-1.86, 95% CI: 1.16-3.00), possessing knowledge of postnatal care (AOR = 6.75, 95% CI: 3.39-13.45) and access to a motorable road (AOR = 6.30, 95% CI: 3.94-10.08) were identified as predictors of PNC service utilization. Triangulation revealed knowledge on PNC, transportation facilities, PNC home visits, and postpartum weaknesses to visit health facility as areas of convergence. Conversely, divergent areas included the proximity of health facilities and the effect of COVID-19. The study identified a low prevalence of PNC service utilization in the district. To enhance utilization, targeted interventions to increase awareness about postnatal care, appropriate revision of existing policies, addressing wider determinants of service utilization, and ensuring effective implementation of PNC home-visit programs are of utmost importance.
产后的头几个小时、几天和几周对母婴的健康都至关重要。尽管这一阶段意义重大，但在提供高质量的护理方面，产后阶段往往得不到足够的重视。在尼泊尔，利用产后护理（PNC）服务仍然是一个具有挑战性的问题。本研究采用基于机构的同期三角混合方法，旨在确定与 PNC 服务利用相关的因素，以及其促进因素和障碍。一项定量调查涉及 243 名在调查前六个月分娩的母亲，这些母亲是通过多阶段抽样技术从帕坦县两个随机选择的地方级别的六个卫生机构中选择的。采用加权多变量逻辑回归来确定 PNC 服务利用的预测因素。此外，使用 Braun 和 Clarke 的六步主题分析进行定性分析，阐明了促进因素和障碍。研究显示，按照方案，PNC 服务的加权利用患病率为 38.43%（95%CI：32.48-44.74）。值得注意的是，社会经济地位（AOR-3.84，95%CI：2.40-6.15）、分娩地点（AOR-1.86，95%CI：1.16-3.00）、拥有产后护理知识（AOR=6.75，95%CI：3.39-13.45）和可使用机动道路（AOR=6.30，95%CI：3.94-10.08）是 PNC 服务利用的预测因素。三角分析揭示了关于 PNC 的知识、交通设施、PNC 家访以及产后身体虚弱去医疗机构就诊等方面的共识。相反，分歧领域包括医疗机构的距离和 COVID-19 的影响。该研究发现该地区 PNC 服务的利用率较低。为了提高利用率，必须采取有针对性的干预措施，提高对产后护理的认识，适当修订现有政策，解决服务利用的更广泛决定因素，并确保有效实施 PNC 家访计划。
