Postnatal care in Nigeria: a multilevel analysis of community contextual factors

Dorothy Ononokpono, University of Uyo
Clifford O. Odimegwu, University of the Witwatersrand
Eunice N. S. Imasiku, University of Zambia
Sunday Adedini, University of the Witwatersrand

Most maternal and neonatal deaths occur in the first week after delivery, yet majority of women in Nigeria deliver at home unattended by skilled professional and without adequate postnatal care. Previous studies on postnatal care focus on individual and household level influences, but the role of community attributes has been largely ignored. This study builds on previous studies and examines the influence of community contextual factors on the decisions to seek postnatal care in Nigeria. We used data from the 2008 Nigeria Demographic and Health Survey and a sample of 17,635 women age 15-49 years who had most recent delivery in the five years preceding the survey. Using multilevel regression analysis, preliminary results indicate that individual, household and community contextual factors were important in explaining individual differences in the decisions to seek postnatal care. Religion, parity, exposure to family planning messages and economic status were significant predictors of postnatal care (p<0.001). Community contextual factors including community women’s education (AOR=1.2, 95% CI=1.13-1.54; p<0.001), community hospital delivery (AOR=4.5; 95% CI=3.91-5.33), ethnic diversity (AOR=1.3; 95% CI=1.13-1.55; p<0.001) and distance to health facility (AOR=1.3; 95% C1=1.23-1.47) were significantly associated with postnatal care. Women from communities with high female education, hospital delivery and ethnic diversity were more likely to seek postnatal care than their counterparts. Regional variations were observed with women from south west 1.3 times more likely to seek postnatal care than those from north west. Findings suggest that community interventions to increase the use of postnatal care services should target the uneducated, poor and those women who live in disadvantaged regions. Results also indicate the need for mass media programmes that will educate women about the importance of postnatal care; and provision of social infrastructure in disadvantaged communities to alleviate the problem of distance which is a major barrier to seeking postnatal care.