factors affecting the utilisation of postnatal services among mothers
TRANSCRIPT
FACTORS AFFECTING THE UTILISATION OF POSTNATAL SERVICES AMONG MOTHERS
ATTENDING KITAGATA HOSPITAL IN SHEEMA DISTRICT
KATUSIIME AGNES
10/BSU/BNS/006
A DISSERTATION SUBMITTED TO THE FACULTY OF APPLIED SCIENCES IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF BACHELOR
OF NURSING SCIENCE DEGREE OF BISHOP STUART UNIVERSITY
SUPERVISOR: Ms. KATUSHABE EVE
JULY, 2014
ii
Declaration
I hereby declare that the work presented in this dissertation is my own and has not been wholly or partially
presented with any other institution before. All sources that I have used or quoted have been fully
acknowledged by means of complete references
Signature………………. Date………………..
KATUSIIME AGNES
(Researcher)
Supervisor’s Approval
This dissertation has been Produced by Katusiime Agnes under my supervision and is ready to be submitted
with my approval.
Signature …………………………… Date………………………….
Ms: KATUSHABE EVE
(Supervisor)
iii
Dedication
I dedicate this work to Rev. Fr. John Baptist Bashobora and Almighty God
iv
Acknowledgement
I would like to acknowledge the staff and Department of Nursing Bishop Stuart University for providing me
with an academic atmosphere that made it possible for me to successfully complete the degree’s program
without any stresses. Special thanks go to the Rev. Fr. John Baptist Bashobora who gave me the scholarship
grant to study.
Extremely special thanks go to my supervisor Ms. Katushabe Eve for the time she spent guiding me in this
research
I thank my mother Ms. Kyomuhendo Betty for her support in my academics, my aunt Christine, my brother
Akampurira Allan, the family of Mr. katungye Jude, my cousin sisters Anita, Cynthia, Clare and Elizabeth, my
cousin brother Cuthbert, Eng. Rachael, Rev .Fr. Deus Twesigyeomwe, my Late uncle Bakunda, my friends
Mwesigwa Chrispas, Nimusiima Komukama, Mr. Kafuko Joshua, Dn.Katusiime Hillary and Dn. Elipidius for
their advice and support.
Furthermore, heartfelt thanks go to classmates Moses, Esther, Kenyonzi, Benard, Komukama, Asterio, Jonan
and Justus for working tirelessly towards my success.
.
v
Definition of Terms
Knowledge
Knowledge refers to a state of awareness. (According to Oxford Dictionary)
Maternal mortality; refers to maternal death during pregnancy, labor or puerperium or within 42 days of
termination of pregnancy from any cause related to or aggravated by pregnancy or its management but not
accidental and incidental causes (Kozier.et.al,2008,WHO, 2011)
Postpartum
Postpartum is the period beginning from one hour upto six weeks after delivery, (According to Myles textbook
for Midwives 11th
edition)
Utilization
Utilisation refers to the process of using something (Oxford English Dictionary).
Reproductive health
This is a state of complete physical, mental, emotional and social well-being in all matters related to the
reproductive system, its functions and processes, (MOH, 2001, 2002).
vi
Table of Contents
Declaration .............................................................................................................................................................. ii
Dedication .............................................................................................................................................................. iii
Acknowledge ........................................................................................................................................................ iiv
Definition of Terms................................................................................................................................................. v
Table of Contents ................................................................................................................................................... vi
List of Tables ......................................................................................................... Error! Bookmark not defined.
List of Figures ......................................................................................................................................................... x
List of Abbreviations ............................................................................................................................................ xii
Abstract………………………………………………………………………………………………………….xiii
CHAPTER ONE ..................................................................................................................................................... 1
INTRODUCTION .................................................................................................................................................. 1
1.0 Background of the Study ............................................................................................................................... 1
1.1 Statement Problem ........................................................................................................................................ 2
1.2Justification of the Study: ............................................................................................................................... 2
1.3 Objectives of the Study ................................................................................................................................. 2
1.3.1 General Objective ................................................................................................................................... 2
1.3.2 Specific Objective ................................................................................................................................... 2
1.4 Research Question ......................................................................................................................................... 2
1.5 Scope of the study ......................................................................................................................................... 3
1.5.1 Geographical scope ................................................................................................................................. 3
1.5.2 Content of the scope ............................................................................................................................... 3
1.5.3 Time scope .............................................................................................................................................. 3
vii
CHAPTER TWO .................................................................................................................................................... 4
LITERATURE REVIEW ....................................................................................................................................... 4
2.0 Introduction ................................................................................................................................................... 4
2.1 Level of Knowledge regarding postnatal services ........................................................................................ 4
2.2 Level of Utilization of Postnatal Services ..................................................................................................... 5
2.3 Factors Affecting Utilization of Postnatal Services ...................................................................................... 6
2.4.1 Conceptual framework ........................................................................................................................... 6
CHAPTER THREE ................................................................................................................................................ 8
METHODOLOGY ................................................................................................................................................. 8
3.0 Study Design ................................................................................................................................................. 8
3.1 Study Area ..................................................................................................................................................... 8
3.3 Study Population ........................................................................................................................................... 8
3.4 Sample Size ................................................................................................................................................... 8
3.5. Sampling Techniques ................................................................................................................................... 9
3.6 Inclusion Criteria ........................................................................................................................................... 9
3.61 Exclusion Criteria .................................................................................................................................... 9
3.7 Data Collection .............................................................................................................................................. 9
3.7.1 Data Collection Instrument ..................................................................................................................... 9
3.7.2 Data Collection Procedure ...................................................................................................................... 9
3.8 Data Quality Control ................................................................................................................................... 10
3.9 Data Analysis .............................................................................................................................................. 10
3.10 Ethical Considerations............................................................................................................................... 10
3.11 Limitations of the study……………………………………………………………………………………11
viii
CHAPTER FOUR: Presentation of Findings ....................................................................................................... 12
4.0 Introduction ................................................................................................................................................. 12
4.1 Biographic Characteristic of Respondents .................................................................................................. 12
4.3 Postnatal Services known by the Respondents ......................................................................................... 14
4.5 Importance of Postnatal Services ................................................................................................................ 15
4.6 Complications during Postpartum Period ................................................................................................... 16
4.7 Factors Affecting Utilization of Postnatal Services .................................................................................... 18
CHAPTER FIVE: DISCUSSION OF STUDY RESULTS, , CONCLUSION,NURSING IMPLICATIONS AND
RECOMMENDATIONS ...................................................................................................................................... 19
5.0 Introduction ................................................................................................................................................. 19
5.1 Biographic Information of ........................................................................................................................... 19
5.2 Level of Knowledge Regarding Postnatal Services .................................................................................... 20
5.3 Level of Utilization of Postnatal Services ................................................................................................... 20
5.4 Factors Affecting Utilization of Postnatal Services .................................................................................... 21
5.5 Ways to Increase the Uptake of PNC services……………………………………………………………21
5.6 Conclusion ...................................................................................................................................................... 22
5.7 Nursing Implications ................................................................................................................................... 22
5.7.0 To Nurses in Practice ............................................................................................................................... 22
5.7.1 To Nurse Educators .................................................................................................................................. 22
5.8 Recommendations ....................................................................................................................................... 22
5.8.1 Recommendation to the Government ....................................................................................................... 22
5.8.2 Recommendations to the Hospital Management ...................................................................................... 22
5.8.3 Recommendations to Service Providers ................................................................................................... 23
5.9 Areas for further Research; ......................................................................................................................... 23
ix
References ......................................................................................................................................................... 23
Appendices ........................................................................................................................................................ 27
Appendix 1: CONSENT FORM ....................................................................................................................... 28
Appendix 11: QUESTIONAIRE FOR MOTHERS .......................................................................................... 29
Appendix III: A letter to and permission from Kitagata hospital ................................................................... 32
Appendix IV: A map of Sheema District .......................................................................................................... 33
Appendix v: A receipt for research ................................................................................................................... 34
List of Tables
Table 1: Biographic Characteristics of Respondents
Table 2: Showing Factors Affecting Utilization of Postnatal Services
Table 4: Checklist on Factors Affecting Utilization of Postnatal Services
x
List of Figures
Figure 1: Health Belief Model
Figure 2: Showing the Level of Knowledge regarding Postnatal Service
Figure 3: Showing Postnatal Services known by Respondents
Figure 4: Showing whether Respondents have ever Received Postnatal Services
Figure 5: Reasons why Postnatal Services are Important.
Figure 6 : Shows Complications that can be acquired during Postpartum Period
Figure 7: Showing the Ways to Increase the Uptake of Postnatal Services
xi
List of Abbreviations
ANC ANTENATAL CARE
BSU BISHOP STUART UNIVERSITY
DISH DELIVERY OF IMPROVED SERVICES FOR HEALTH
HBM HEALTH BEHAVIOURAL MODEL
LMICS LOW- MIDDLE INCOME COUNTRIES
MOH MINISTRY OF HEALTH
PNC POSTNATAL CARE
REC RESEARCH ETHNICAL COMMITTEE
RH REPRODUCTIVE HEALTH
SSA SUB-SAHARAN AFRICA
UBOS UGANDA BEREAU OF STATISTICS
UNHCO UGANDA NATIONAL HEALTH CONSUMERS ORGANISATION
WHO WORLD HEALTH ORGANISATION
xii
Abstract
Postnatal services refer to measures undertaken after birth to ensure good health of the mother and child,
(UNHCO, 2008). The objective of this study was to assess factors affecting utilization of postnatal services
among mothers attending Kitagata Hospital in Sheema district. This study was conducted at Kitatagata Hospital.
Methodology: The study employed Quantitative methods of inquiry using a descriptive cross-sectional survey
design. The study involved 96 mothers who responded to a questionnaire that was used to find out the factors
affecting utilization of postnatal services. Questions that were asked generated demographic information about
the mothers, mothers’ knowledge about postnatal services, mothers’ socio-economic status and factors affecting
utilization of the postnatal services. The participants included all mothers with babies two years and below and
those who consented.
Data coding and analysis: The data was coded and analyzed using Statistical Package for Social Scientists
(SPSS).
Results: Some of the key findings of the study were that most women lacked awareness about postnatal
services and those who knew about these services only knew about immunisation and family planning services.
The majority of the mothers did not know about other services, such as physiotherapy, counseling and physical
examination. Lack of money for transport or service costs, attitude of health workers, time for waiting for the
services to be provided, distance to the health care facility, not being aware of the services, others included, low
level of education, Low parity, occupation and age.
Health education should be priority to nurses inorder to create awareness among mothers regarding PNC
services.
Recommendation: The service providers need to be sensitized more on the value of listening to the clients, and
that they should create a supportive environment in which clients are sufficiently informed, confident and
encouraged to voice their opinions as well. This will help to strengthen the client-service provider relationship,
enhance client’s satisfaction and therefore help to improve the use of postnatal services.
Conclusion: Therefore, the factors that affect utilization of postnatal services differ from mother to mother at
Kitagata hospital. Strategies to promote utilization of PNC services should focus on the relevant factors.
1
CHAPTER ONE: Introduction
1.0 Background of the Study
Postnatal services refer to measures undertaken after birth to ensure good health of the mother and child,
(UNHCO, 2008). There are different types of services that are offered to the mother and baby. These include
health education, physiotherapy, physical examination, immunization, growth monitoring, counseling and
family planning services along with diagnosing postpartum depression, often much neglected in LMICs. Many
women do not receive these essential healthcare services, yet they need these services following delivery,
(WHO, 2010)
The World Health Organization (WHO, 2010) stated that the postnatal period begins immediately after the birth
of the baby and extends up to six weeks (42 days) after birth. The principal objectives of PNC services are to
evaluate, maintain and promote the health of the birthing woman and the newborn and to foster an environment
that offers help and support for diverse health and social needs. Follow-up visits include the evaluation of the
parturient health status including screening, diagnosis and treatment of various conditions including
Tuberculosis, malaria, vaginal infections, anemia or malnutrition.
According to the World Programme of Action, postnatal care is regarded as one of the most important maternal
health care services for the prevention of impairments and disabilities resulting from childbirth (United Nations,
2002).
Complications following childbirth are more common and aggravated in developing countries. The long-term
maternal complications in the postnatal period include chronic pain, impaired mobility, damage to the
reproductive system and infertility, (Safe Motherhood by WHO, 2002). Some women suffer genital prolapses
after bearing several children. This condition is extremely uncomfortable and can lead to other complication in
future pregnancies if not properly addressed in the postnatal period (Ashford 2004).
Postnatal care services include the services rendered by the different health institutions to assist mother and
baby until six weeks after delivery (Bandolier 2007).Postnatal services are carried out at Heath Centre II (HCII)
by midwives, HC III clinical officers and midwives offer the services, HCIV clinical officers, doctors,
midwives and at hospital level by obstetricians, midwives and doctors, according (UNHCO, 2008).
According to the World Health Organization (1998), only a small proportion of women in developing countries,
less than 30%, receive postnatal care. In very poor countries and regions, as few as 5% of women receive such
care. Despite the efforts made through DISH to improve the quality of postnatal services in Uganda, the use of
these services still remains very low (MOH, 2001). It is within this context that this study will be carried out to
assess factors affecting utilization of postnatal services.
2
1.1 Problem Statement
According to a report from Safe Motherhood (2002) the majority of women in developing countries receive
almost no postpartum care after delivery. For example, in very poor countries and regions such as those in the
Sub-Saharan Africa, only 5% of women receive postnatal care.
It is reported that only 23 % of the mothers who had had live births received postpartum care within the critical
first two days after delivery; and overall, 74 % of the women did not receive postpartum care at all (UBOS
2007). This high percentage is as a result of several factors impeding PNC services; these include cost of
services, distance to health services, high transportation costs and many others. Studies have not been conducted
in Kitagata hospital to ascertain why women do not utilize these services.
Therefore this inspired the researcher to assess the factors affecting utilization of postnatal services at kitagata
hospital.
1.2Justification of the Study
The research information will add to the existing body of knowledge and the information generated may be
used by Kitagata hospital administrators to formulate strategies to improve on the uptake of postnatal services.
Findings from this study may help practicing nurses to create awareness of the utilization of postnatal services
to mothers attending Kitagata hospital then improve on quality and setup of the facility services.
For upcoming researchers the study findings may provide information to be used in their research and
information may be disseminated to the hospital, which may help to provide quality services and care.
1.3 Objectives of the Study
1.3.1 General Objective
To assess factors affecting utilization of postnatal services among mothers attending Kitagata Hospital in
Sheema district.
1.3.2 Specific Objective
1. To assess the level of knowledge about postnatal services among mothers attending Kitagata hospital.
2. To estimate the level of utilization of postnatal services among mothers attending Kitagata hospital.
1.4 Research Question
What are factors affecting the utilization of postnatal services by mothers attending kitagata hospital
3
1.5 Scope of the study
1.5.1 Geographical scope
This study was carried out at Kitagata hospital Sub-country in Sheema district.
1.5.2 Content of the scope
The study aimed at establishing the factors affecting the utilization of postnatal services by mothers attending at
Kitagata hospital, to indentify strategies so that to reduce complications and risks of maternal health and
increase the chances of maternal survival.
1.5.3 Time scope
The study took a period of three months which enabled the research to obtain an appropriate and realistic
investigations.
4
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
Many researches carried out elsewhere have identified factors that affect utilization of post natal services. In
this chapter, the researcher attempts to review the related literature that has been documented by other
researchers in other studies related to factors affecting utilization of postnatal services among mothers. The
information will be obtained from internet, articles and Journals.
2.1 Level of Knowledge regarding postnatal services
It is essential for health workers to provide information to women about PNC services as in regards to what it is,
why it is important and the services offered. Full information regarding PNC will enable women to make
informed decisions about utilizing the MCH services. The Adelaide conference in Australia on public health
policy for the promotion of women’s health, recommended that, women should have access to information
network and funds to enable them to effectively participate in issues concerning their health. All women have
the right to self determination about their health and should be partners in the formulation of public health
policy so that it is culturally relevant and acceptable (WHO, 1991)
Sulochana et al. (2007), in their study titled utilization of postnatal care among rural women in Nepal revealed
that, out of the 150 women who had delivered, 66% had no knowledge or were not aware of postnatal services
and this did not make use of the services which could have helped improve on their health. Only 34% of the
mothers had knowledge or aware and thus made use of the facility.
Findings from the study conducted at Mengo and Mulago hospitals in Uganda, (Nankwanga,2004), showed
that most women lacked awareness about postnatal services and those who knew about these services only
knew about immunization and family planning services. The majority of the mothers did not know about other
services, such as physiotherapy, counselling, growth monitoring, and physical examination.
5
2.2 Level of Utilization of Postnatal Services
In a population- based study about ANC and PNC services revealed that the level of ANC and PNC service
utilizations is 77.4 % and 37.2% respectively. The predicted probabilities, using logistic regression, showed that
women who are literate, have exposure to media, and women with low parity are more likely to use both ANC
and PNC services, ( Regassa N, 2011).
According to ( Khanal et.al, 2011), in a study factors associated with the utilization of postnatal care services
among the mothers of Nepal , 43.2% reported attending postnatal care within the first six weeks of birth, while
40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families,
who were educated, whose partners were educated, who delivered in a health facility, who had attended a four
or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report
attending at least one postnatal care visit.
Furthermore, mothers who reported agricultural occupation and whose partners performed the same job as the
mothers were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the
urban areas, rich families, educated plus the partners attended four or more antenatal visits, delivered in a health
facility and those in presence of a skilled birth attendant were more likely to report attending immediate
postnatal care. Mothers who reported agricultural occupa8tion, and whose partners performed same job as the
mothers were less likely to attend immediate postnatal care, (Khanal et.al, 2011).
In a study conducted by Hailerman et al. 2012, titled utilization and associated factors of postnatal care in
Adwa Town , Tigray, Ethiopia, showed that 264 (78.3%) mothers had attended postnatal care service while 73
(21.7%) hadn’t attended postnatal care. About 265 (78.6%) of the mothers attended ANC service. From those
who had attended ANC service 50.7% had attended 4 times and above. Self employed mothers were 9.1 times
more likely to have had postnatal care than women who hadn’t any job. The utilization of postnatal services in
Adwa town is good as compared to other developing countries.
According to (Twaha et al ,2007), Uganda has poor indicators of reproductive health (RH) services uptake; 10%
postnatal care attendance, 23% contraceptive prevalence, and 38% skilled attendance at delivery. For antenatal
attendance, attendance to one visit is 90%.
6
2.3 Factors Affecting Utilization of Postnatal Services
Astudy conducted at Mabuku district hospital and Research Urban clinic in Zambia by Jacobs and Choolwa
Nkwemu, (2012), about factors associated with underutilization of PNC services among postpartum women,
found out inadequate information education and communication, some traditional beliefs and cultural practices
of mothers, poor attitudes of nurses towards the health services were associated with underutilization of PNC
services in Mabuku district. Other factors included; age of mothers, level of education, parity and social
economic status were contributing factors to underutilization of PNC services in the district.
Low levels of education of mothers, lack of knowledge of pregnancy –related complications, distance from
health facility, few ANC checkups , use of untrained birth attendants and births outside health facilities were
factors associated with underutilization of PNC services,
(Christiana R Titaieyi et al., 2008).
Mengistu and James,( 2011), in their study about ANC and PNC services utilization in the Arsi zone of centra
Ethopia found maternal age, parity, lack of time, marital status, and women’s economic status to be significant
predictors to utilization of PNC services.
Myriad studies in Uganda and elsewhere in Sub- Saharan Africa (SSA) have identified physical or geographical
access to health care as major factor for women not to seek delivery services from formal hospitals specifically(
Kasolo et al.; 2000).
According to study conducted at Mulago and Mengo hospitals in Kampala Uganda by (Nankwanga Annet,
2004), lack of awareness about PNC services, level of education , unemployment, lack of decision making
power by mothers, distance from the healthcare facility, transport cost and lack of time to go back for the
services were found to influence the utilization of PNC services at these hospitals.
7
2.4.1 Conceptual framework
For the purpose of this study the Health Belief Model (HBM) of Becker and Janz, (1984) will be used as the
conceptual frame work. This model is appropriate for the study because it is an approach – orientated model
which can be used to predict a wide range of health-related behaviors, (Ogden, 2000).
The model indicated the variables that have been shown to have an influence on health behavior. It also
provides a framework for understanding people’s perceptions and their decisions concerning their health
(Forshaw, 2002, & Dunn, 2007). Thus, the purpose of the model is to discover the factors that affect utilization
of postnatal service
Figure 1: Health Belief Model
Demograpics
Age
Parity
Level of education
Marital status
Social-economic
Reduced
maternal
mortality and
infant mortality
Individual’s choice of behavioral options depends on their perception of benefits and barriers. Therefore, a cost
benefit analysis allows an individual to evaluate the outcome expectations and assess whether the expected
benefit of a behavior outweigh the perceived expenditure incurred by engaging in the behavior, (Rosenstock
1974).
Awareness of PNC
services
Accessibility of PNC
services
Affordability of
PNC services
Quality of PNC
services
Utilization of
PNC services
8
CHAPTER THREE: Methodology
3.0 Study Design
The study employed Quantitative methods of inquiry using a descriptive cross-sectional survey design. A cross-
sectional design is appropriate to determine the factors utilization of postnatal services. This study design saved
time and resources for the researcher. Quantitative obtained quantifiable data towards under utilization of PNC
services among mothers .The cross-sectional design helped researcher to obtain information in different
contexts at the same time during the study.
3.1 Study Area
The study was carried out at Kitagata hospital and is located in Sheema District in South Western Uganda.
Kitagata town lies on the Kasese- Ntungamo Highway, approximately 18 kilometres , south of Ishaka,
Bushenyi district, the nearest large town. This location lies approximately 33 kilometre north of Ntungamo
district.
Kitagata hospital is the main district hospital and serves a big population of 21000 people. Different services are
offered which include; Antenatal services, family planning services, immunization services, medical services,
surgical services, pediatric services, orthopedic services and postnatal services which are at the different clinics.
The hospital has the maternal and child health clinic where postnatal care services are offered.
3.3 Study Population
The study population consisted of mothers attending Kitagata hospital, Kitagata sub-county of reproductive age
who gave birth within a period of 2 years from the time of study because they are direct beneficiaries of
improved maternal health services.
3.4 Sample Size
The sample size was calculated using the formula;
No= Z2
PQ/D2 (Kish and Leslie, 1995)
No= sample Size
Z= Z-Score for (Normal distribution curve, corresponding with two standard deviations at 95% confidence
interval) =1. 96
P= Estimated proportion of population with characteristics under study= 50%
9
Q= 1-P 2
D=the level of error accepted, which is 10%= 0.1
No= 1.962 X 0.5 (1-0.5)/ 0.1
No =3.8416 X 0.25/0.01
No=96
The sample size will be 96 respondents.
The total of 96 women was considered in this study.
3.5. Sampling Techniques
In selecting the women, the researcher used purposive sampling where the sample represented others basing on
a certain purpose that is selection was made on grounds of having delivered within a period of two years from
the time of study.
3.6 Inclusion Criteria
1. Mothers with babies two years and below.
2. Mothers who consented.
3.61 Exclusion Criteria
1. Mother with babies above two years
2. Mothers who do not consent
3.7 Data Collection
3.7.1 Data Collection Instrument
A questionnaire was used to find out the factors affecting utilization of postnatal services. The questionnaire
consisted of both open and close ended questions. It was written in English and translated in Runyankole which
is the commonly spoken language in the study area.
3.7.2 Data Collection Procedure
The researcher administered a questionnaire to collect data from mothers and confidentiality was ensured. The
responses were written down by the researcher. The period for data collection took two weeks
10
3.8 Data Quality Control
The data collection instruments were designed and pretested in the field for two days to check; validity and
reliability of the instruments and adjustments were made accordingly before the actual data collection or
distributing the tools.
Validity
The researcher fluent in English and Runyankole presented during the interviewing of mothers. The
questionnaire was pre-tested on five mothers in the area of study, to determine whether the constructed
questions are clear, suitable and easy to understand by mothers any unclear questions were modified to yield a
better questionnaire.
Reliability
The researcher administered the questionnaire as this did not allow participants to discuss questions with other
mothers. Collected data was cleaned at end of each working day to ensure completeness and accuracy in
recording and consistency in information given by the respondents. The researcher cross checked all
instruments on daily basis to ensure completeness before data entry.
3.9 Data Analysis
Coding and analysis was done using Statistical Package for Social Scientists (SPSS). Presentation of findings
was in form of tables, graphs and pie charts.
3.10 Ethical Considerations
Approval to carry out this study was got from research ethical committee (REC), BSU. An introductory letter
from Head of Department was taken to LC authorities seeking for permission to conduct this study in the area.
All respondents were informed that their participation was voluntary and that the collected data only was used
for the purpose of the study, as well as for their benefit.
Respondents were consented before being involved in the study. The participants assured of anonymity;
confidentiality and they were assured of their ability to withdraw from the study at any time.
11
3.11 Limitations of the Study
The study was limited by the area of study due to lack of sufficient funds to collect data at the Kitagata in
Sheema district. The method of data collection used in the study did not explore the unknown aspects of
utilization of postnatal services. It is recommended that in future, a qualitative research with the aid of focus
group discussions to explore more of these factors that affect the utilization of postnatal services should be
carried out.
12
CHAPTER FOUR: Presentation of Findings
4.0 Introduction
Ninety six (96) mothers consented to participate in this study. Their responses are presented in two sections of
biographic data and factors. This chapter summarizes the data collected inform of pie charts, graphs and tables.
4.1 Biographic Characteristic of Respondents
In the study, respondents were made to state their age, parity, occupation, marital status and their level of
education.
Table 1: Biographic Characteristics of Respondents
Age of
respondents
Frequency
(n)
Percentage
(%)
Received PNC
services
Never received
PNC services
15-25 48 50.0 20(41.7%) 28(58.3%)
26-36 41 42.7 21(51.2%) 20(48.8%)
37-47 7 7.3 04(57.1%) O3(42.9%)
Total 96 100
Parity Frequency
(n)
Percentage
(%)
1-2 42 43.8 14(33.3%) 28(66.7%)
3-4 34 35.4 20(58.8%) 14(41.2%)
5-7 16 16.7 07(43.8%) 09(56.3%)
8-10 4 4.2 02(50%) 02(50%)
Total 96 100
Occupation Frequency
(n)
Percentage
(%)
Peasant 48 50.0 17(35.4%) 31(64.6%)
House wife 8 8.3 03(37.5%) 05(62.5%)
Business
woman 25 26.0
15(60%) 10(40%)
13
Others 15 15.6 11(73.3%) 04(26.7%)
Total 96 100
Marital status Frequency
(n)
Percentage
(%)
Single 14 14.6 06(42.9%) 09(64.3%)
Married 67 69.8 35(52.2%) 32(47.8%)
Cohabiting 5 5.2 02(40%) 03(60%)
Widow 5 5.2 02(40%) 03(60%)
Separated 5 5.2 03(60%) 02(40%)
Total 96 100
Highest
Education
level
Frequency Percentage
Secondary 33 34.4 17(51.5%) 16(48.5%)
Primary 38 39.6 12(31.6%) 26(68.4%)
Tertiary 16 16.7 12(75%) 04(25%)
None 9 9.4 02(22.2%) 07(77.8%)
Total 96 100.0
Source: Field data, 2014
Majority of the respondents 48(50%) were between 15 and 25, of which 28(58.3%) had never utilized PNC
services, 28(66.7%) had 1to2 had never received postnatal services. Peasant represented 48(50.0%) out of
which 31(64.6%) had never received PNC services, 67(69.8%) respondents were married, 35(52.2%) had never
received the services. Most of the respondents had attained primary level of education represented by
38(39.6%) of which 26(68.4%) had never received postnatal services.
4.2 Level of Awareness about Postnatal Services
Figure 2: Showing the Level of Knowledge regarding Postnatal Service
14
The results showed that 66% of the respondents were aware of postnatal services while 34% were not aware of
postnatal services.
4.3 Postnatal Services known by the Respondents
Figure 3: Showing Postnatal Services known by Respondents
Source: Field data, 2014
According to figure 3, immunization is the most postnatal service known with 71(54.2%) respondents, followed
by family planning with 32(24.4%) respondents, health education with 17(1.0%), counseling with 9 (6.9%)and
lastly HIV screening with 1(0.8%) respondent.
4.4 Level of Utilization of Postnatal Services
Figure 4: Showing whether Respondents have ever Received Postnatal Services
15
4.4 Factors Affecting Utilization of Postnatal Services
Table 2: Showing Factors Affecting Utilization of Postnatal Services
The majority of the respondents, 24 (29.6%) revealed that long distance to health centers is one of the factors,
followed by 7 (8.6%) who supported lack of awareness, 8 (9.9%) supported long waiting time as a factor and 6
(7.4%) revealed no money for transport while 14 (17.3%) revealed that it was their first child. Furthermore, 17
(21%) supported health workers attitude, 1 (1.2%) revealed that use of local herbal is among the factors
affecting utilization of PNC services while 03 (3.7%) supported fewer health workers and another 03 (3.7%)
supported others.
4.5 Importance of Postnatal Services
Respondents in the field were asked to mention whether postnatal services are important. Results found were
that majority of the respondents, 62 (64.6%) of them revealed that postnatal services are important while the
minority 34 (35.4%) disagreed with the question.
238% of the respondents have ever received postnatal services while 62% of the respondents have never
received the postnatal services.
Factors Frequency percentage
Long distance to health facility 30 31.3
Lack of awareness 10 10.4
Long waiting time 11 11.4
No money for transport 7 7.3
First child 14 14.6
Health workers attitude 17 17.7
Use of herbal products 1 1.0
Fewer health workers 3 3.1
Others 3 3.1
Total 96 100
16
Figure 5: Reasons why Postnatal Services are Important.
Most of the mothers 33(54.1%) reported postnatal services are important in protecting against illness,11 (18.0%
)of them reported of child spacing, 6 (9.8%)of the mothers reported acquiring knowledge,4 (6.6%) to promote
health,3 ( 4.9%) mothers reported to reduce both maternal and infant death and only 1( 1.6%)reported creating
mother to child relationship
4.6 Complications during Postpartum Period
The percentage highest (57.3%) of the mothers said one can acquire Complications during postpartum period
whereas 42.7% of the mothers reported that one cannot acquire complications during postpartum period.
Figure 6: Shows Complications that can be acquired during Postpartum Period
Source: Field data, 2014
17
From results, uterine prolapse and depression were the least complications that can be acquired during
postpartum period while over bleeding is the highest followed by chronic pain.
Figure 7: Showing the Ways to Increase the Uptake of Postnatal Services
To increases the uptake of postnatal services, results show that health education of mothers should be mostly
done as 48 (58.5%) mothers responded then services to be brought near mothers’ homes with17 (20.7%)
respondents.
18
4.7 Factors Affecting Utilization of Postnatal Services
Table 4: Checklist on Factors Affecting Utilization of Postnatal Services
Response Yes No Total Percentage
Distance to the health
facility 68(70.8%) 28(29.2%)
96 100.0
Cost of the services 43(44.8%) 53(55.2%) 96 100.0
Time for waiting for
the services to be
provided
69(21.9%) 27(28.1%)
96 100.0
Attitude of health
workers 78(81.3%) 18(18.7%)
96 100.0
Transport cost 59(61.5%) 37(38.5%) 96 100.0
Decision making 31(32.3%) 65(67.7%) 96 100.0
Each respondent was interviewed using a checklist about factors affecting utilization of PNC services 78
(81.3%)agreed to attitude of health workers, 69 (71.9%),68 (70%) ,59(61.5%) and 43(44.8%) agreed to time for
waiting for the services to be provided, distance to the health facility, transport cost and cost of the services
respectively. The least were 31 (32.3%) who agreed to lack of decision making.
19
CHAPTER FIVE: DISCUSSION OF STUDY RESULTS, CONCLUSIONS, NURSING
IMPLICATIONS AND RECOMMENDATIONS.
5.0 Introduction
The purpose of the study was to assess factors affecting utilization of postnatal services among mothers
attending Kitagata hospital in Sheema. It involved 96 mothers, Data collected for the study was presented and
analyzed in chapter four in form of descriptive statistics in this chapter; this section presents a discussion of the
results obtained.
5.1 Biographic Information of Respondents
Majority of the respondents 48(50%) were between 15 and 25, of which 28(58.3%) had never utilized PNC
services. The age of mothers’ at birth affect their decision to seek health care. This is in line with Aminah,
(2009), in her study reported that there is a significant relationship between the age at first birth of mothers and
utilization of postpartum care services. The mother’s age may sometimes have a positive influence on PNC
services because older women have increased reasoning capacity (Chakraborty et al, 2002; Jonazi, 2008)
Most of the respondents 48(50.0%) were peasants of which 31(64.6%) had never received PNC services. This
could have been due to the fact that economic status of mothers is likely to affect their utilization of PNC
services. This is in agreement with (Khanal et.al, 2011) who revealed that similarly, mothers who reported
agricultural occupation, and whose partners performed same job as the mothers were less likely to attend
immediate postnatal care. It is also anticipated that increased income has a positive effect on the utilization of
modern healthcare services (Chakraborty et al., 2002). Women who are working have better financial status and
ability to access postnatal services since they are empowered to make decisions on when to go for PNC (Dhakal
et al, 2007, Nankwanga, 2004; Mullany et al, 2006).
Most of the respondents had attained primary level of education hence low literacy levels,of which 26(68.4%)
had never received postnatal services. Low level of education could have caused mothers’ not utilize the
services. This has been noted in other research studies. Maternal education has a positive impact on the
utilisation of healthcare services (Betty Sakala and Abigail Kazembe ,2011, Kogan & Leary, 1990; Elo, 1992;
Nwakoby, 1994; Delvaux, 2001). According to these authors, maternal education increases women’s perceived
seriousness about maternal morbidities and enhances women’s knowledge about the availability of healthcare
services. Manasi Chakraborty et.al, (2013) also reported that lower literacy level of both the husband and
mothers was a major factor to low utilization of maternal health services.
20
5.2 Level of Knowledge Regarding Postnatal Services
Study findings showed that 66% of respondent had knowledge about PNC services. This perharps indicated that
mothers had information which could have been obtained through ANC visit attendance. This concurs with
Marelign Tilahun Malaju and Getu Degu Alene, (2012), in their study of a total of 400 pregnant women actively
participated and 354 (88.5%) of them knew mother to child transmission of HIV and 334(83.5%) of them knew
mother to child transmission of HIV is preventable. Having knowledge on mother to child transmission of HIV
was positively associated with attending antenatal care visits in hospitals.
Majority of mothers from the area of study had knowledge about postnatal services, but most of them knew
immunization, this was followed by family planning and health education as postnatal services. Immunisation is
not among postnatal care service; therefore, healthcare providers need to sensitize mothers about PNC services.
This is in line with Mohan Paudel.et.al, (2008), who revealed in their study that uptake of postnatal care service
was very low among Nepal women. Home visits of postnatal mothers by health workers could be effective
approach to increase the uptake of PNC services. Through home visits mothers are sensitized about PNC
services hence creating awareness.
From study results, most of the respondents reported that PNC services are important because they help in child
spacing, promote good health, reduce maternal and infant mortality. This showed PNC services utilization
promotes child spacing which enables mothers to have children with safe health and themselves. This in
agreement with Titaley CR.et.al, (2010), who found out that the main reason women attended antenatal and
postnatal care services was to ensure the safe health of b22oth mother and infant .
Results of the study presented that 57.3% respondents had knowledge about complications that can be acquired
during postpartum period. This could have been obtained through health education while on postnatal ward.
This concurs with Jerome K Kabakyenga.et.al, (2011), who found out that 72% of mothers had knowledge
regarding complications acquired during postpartum period.
5.3 Level of Utilization of Postnatal Services
Research findings revealed 62% of the respondents did not utilize the PNC services. Low utilization could be
linked with lack of awareness about the services or inability to access them. Utilization of PNC services is one
of the ways to reduce maternal and child mortality, therefore mothers require information regarding these
services. This is in line with Moore BM.et.al, (2011), who noted that utilization of health care services during
delivery in Nigeria is still poor. Concerted efforts should be made both at community and Government levels to
improve utilization of health facility during delivery. This will go a long way in reducing maternal and child
mortality.
21
5.4 Factors Affecting Utilization of Postnatal Services
The results of the study area showed, there are many reasons affecting utilization of the services but distance to
the health facility was the main reason for not utilizing the services. This indicates that the longer the distance
from the health facility, the more the number of mothers not utilizing the PNC services increases. This is in line
with Billi JE.et.al, (2007) who revealed that disease burden increases as distance is increased, especially among
members selecting Primary care physician in an academic health system.
The factors listed by the respondents were, lack of knowledge, distance to healthy facility, transport cost, time
for waiting for the services to be provided, attitude of health workers, having the first child were associated to
non- utilization of PNC services. In addition, low education levels, occupation were also among the factors to
utilization of the services. Lack of awareness among mothers affects their decision hence utilization. This has
similarity with the findings of, (Nabukera et al, 2006; Jonazi, 2008; Lagro et al, 2006; Dhakal et al, 2007) who
revealed that Lack of awareness of PNC among mothers, distance and lack of transport are some important
factor contributing to low utilization of PNC. In addition, the authors reported that lack of knowledge affects
women’s capabilities to make their own decisions about seeking health care and constrains their ability to
exercise their reproductive rights as well.
Respondents were also asked using a checklist on factors affecting utilization of postnatal services, distance to
the healthy facility, cost of the services, transport cost attitudes of health workers, time for waiting for the
services to be provided and decision making. Respondents agreed with the above factors to be affecting their
utilization of PNC services. In reference to table 2 the number of respondents increased on each factor in the
checklist meaning that they had knowledge on the factors but considered others less important to utilization of
PNC services. This helps health professionals when providing more light to mothers regarding these factors.
5.5 Ways to Increase Uptake of PNC Services
Study findings revealed that health education, extending services near homes of mothers and change of attitude
of health workers could be ways to increase the uptake of PNC services. Continuous and sustained community
education and mobilization is essential so that women and their families learn about the need for special care
during pregnancy, childbirth and after delivery .This concurs with Twaha Mutyaba. Et.al, (2007), whose study
revealed that Knowledge about cervical cancer among Ugandan women is very low. For an effective cervical
cancer-screening programme, awareness about cervical cancer needs to be increased. Health planners need to
note the power of the various authoritative sources of reproductive health knowledge such as paternal aunts
(Sengas) and involve them in the awareness campaign.
22
5.6 Conclusion
The utilization of postnatal services in Kitagata hospital was low. Only 38% of the mothers utilized postnatal
services. Postnatal HIV screening ranked least among the mentioned postnatal services offered at the health
facility. The significant factors that were found to influence utilisation of postnatal services in Kitagata hospital
include: awareness of postnatal services; long distance to the health facility, long time for waiting at health
facility, attitude of health workers, transport cost among others.
5.7 Nursing Implications
5.7.0 To Nurses in Practice
To increase the utilization of PNC services, nurses need to change their attitudes towards mothers and
should always attend to mothers in time to avoid delays.
Health education should be priority to nurses inorder to create awareness among mothers regarding PNC
services.
5.7.1 To Nurse Educators
Lecturers from the department of nursing BSU should ensure that their students are involved in health
education talks actively on maternity ward and Maternal and Child Health Department.
Through community placement, students need to create awareness regarding utilization of PNC services.
5.8 Recommendations
Based on the results of the study, the following recommendations for improving utilization of postnatal services
were made:
5.8.1 Recommendation to the Government
In order to improve access to maternal health services, government should locate health services as close as
possible to the community where the people live. This could be done by training more midwives who serve as
the critical link between communities, TBAs and clinical resources in Uganda, and post them to the community
level. Training more TBAs and equipping them with appropriate tools and responsibilities to teach the women
about the importance of postnatal services can also improve accessibility.
5.8.2 Recommendations to the Hospital Management
In order to improve utilization of postnatal services in Kitagata hospital, the service providers would benefit
from training in how to improve their social relationships with clients to make the services user-friendlier. This
would possibly and consequently boost the use of postnatal services. The increase in awareness and
understanding by mothers about postnatal services during antenatal clinics so as to improve on the use of
23
postnatal services is necessary. Factors such as long waiting time, attitude of health workers and inadequate
number of staff need to be looked at by the hospital authorities so as to provide a good conducive atmosphere to
the clients.
5.8.3 Recommendations to Service Providers
The service providers need to be sensitized more on the value of listening to the clients, and that they should
create a supportive environment in which clients are sufficiently informed, confident and encouraged to voice
their opinions as well. This will help to strengthen the client-service provider relationship, enhance client’s
Satisfaction and therefore help to improve the use of postnatal services.
5.9 Areas for further Research
Challenges faced by mothers in accessing postnatal Services in Government Hospitals.
24
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Appendices
Appendix 1: CONSENT FORM
Iam Katusiime Agnes, a bachelor of Nursing Science student at Bishop Stuart University and I am
conducting a study to assess the Factors affecting Utilization of Postnatal Services among Mothers
attending at Kitagata Hospital in Sheema District.
You are requested to participate in this research study and this will take at least 30 minutes. You will be asked
questions regarding the above topic. Your participation is purely voluntary, and you have the right to withdraw
at any time. Your identity will not be revealed as names shall not be used. Any information given in this
questionnaire shall remain confidential. If there is anything that is unclear or you need further information
about, you are allowed to ask questions to your satisfaction. Thank you
DECLARATION BY THE PARTICIPANT:
I have read/been read this consent form and I have understood the purpose of the study. I have had the
opportunity to ask and have been answered to my satisfaction. I have understood that I have the right to
withdraw from the study at any time without any effect on my future medical care. I voluntarily consent to
participate in this study.
…………………………………… ……………………
Signature of the participant Date
I declare that I explained the information given in this document to …………………………. She was
encouraged and given ample time to ask me any questions. This conversation was conducted in English and
Runyankole.
…………………………………………………. ……………………
Signature of the researcher (student investigator) Date
29
Appendix 11: QUESTIONAIRE FOR MOTHERS
Title: Factors affecting Utilization of Postnatal Services among Mothers attending at Kitagata Hospital in
Sheema District
Interview number:……………………….
Date of interview:
Section A: Biographic data (Tick appropriately)
1. Age……………
2. Address……………
3. Parity………………
4. Occupation
a) Peasant
b) Housewife
c) Business woman
d) Others (specify)
5. Marital status?
a) Single
b) Married
c) Cohabiting
d) Widow
e) Separated
6. What is the level of education you have attained?
30
a). Secondary
b). Primary
c). Tertiary institution
d). Never went to school
Section B: Factors affecting the utilization of Postnatal services among mothers
1. Have you ever heard about postnatal services?
a) Yes
b) No
2. If yes, what do you understand by the term postnatal services?
………………………………………………………………………………………………………………………
………………………………………………………………………………………
3. List the postnatal services that can be provided at the clinic
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
4. Have you ever received the postnatal services?
a) No
b) Yes
5. If no, why?
……………………………………………………………………………
……………………………………………………………………………
…………………………………………………………………………….
6. Is it important to receive postnatal services?
a) Yes
b) No
7. If yes, why
……………………………………………………………….………
31
…………………………………………………………………………
……………………………………………………………………………
8. Can one acquire complications during postpartum period?
a) No
b) Yes
9. If yes, give examples
………………………………………………………………………………………………………………………
……………………………………………………………………………………
Section C: Others
10. What do you think can be done to encourage use of postnatal services?
………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………....
11. Do you think utilization of postnatal services can be affected by the following factors?
a) Distance to the health facility
b) Cost of the services
c) Time for waiting for the services to be provided
d) Attitude of health workers
e) Transport cost
f) Decision making
g) others
32
Appendix III: A letter to and permission from Kitagata hospital
33
Appendix IV: A map of Sheema District
34
Appendix v: A receipt for research