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.

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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