Abstract:
Background: Postnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in
a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health
facilities in Tanzania.
Methods: This study examined the role of individual and community-level variables on the use of postnatal health
services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression
analysis. We analyzed data of 1931 women, who had delivered in the preceding 2–14 months, from a two-stage
household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included
i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of
antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received.
Community level variables included community levels of family planning, health service utilization, trust,
poverty and education, and distance to health facility.
Results: Less than one in four women in Morogoro reported having visited a health facility for postnatal care.
Individual-level attributes positively associated with postnatal care use were women’s education of primary level or
higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04–1.81], having had a caesarean section or forceps
delivery (2.95, 1.8–4.81), and being counseled by a community health worker to go for postnatal care at a health facility
(2.3, 1.36–3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19–3.15), and
whose partners tested for HIV (1.41, 1.07–1.86). High community levels of postpartum family planning usage (2.48,
1.15–5.37) and high level of trust in health system (1.77, 1.12–2.79) were two significant community-level predictors.
Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33–0.76), health center (0.57, 0.38–0.85),
or dispensary (0.48, 0.33–0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43–0.97).
Conclusions: In the context of low postnatal care use in a rural setting, programs should direct efforts
towards reaching women who do not avail themselves of postnatal care as identified in our
