Determinants of postnatal care non-utilization among women in adama district, East Shwoa Ethiopia a community-based unmatched case-control study

Determinants of postnatal care non-utilization among women in adama district, East Shwoa Ethiopia a community-based unmatched case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF comment Determinants of postnatal care non-utilization among women in adama district, East Shwoa Ethiopia a community-based unmatched case-control study Yohanes Abera Belachwe, Befikad Assefa Seifu, Beka Teressa Meka This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4997729/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Maternal and neonatal mortality remain a significant problem across much of the developing world, especially in sub-Saharan Africa countries. In Ethiopia, most maternal and neonatal deaths occur during the postpartum period; this is a critical time for monitoring the health of women and newborns, but the most neglected period for care. In rural communities of Ethiopia, the utilization of postnatal care service is very low and evidence on which factors contribute to the non-utilization of postnatal care (PNC) is insufficient. Consequently, this study was designed to identify the determinants of postnatal service non-utilization among women who gave birth in Adam district, East central Ethiopia. Methods A community-based unmatched case-control study was conducted among 186 cases (postnatal care non-utilizers) and 186 controls (postnatal care utilizers) in Adama district from January 1 to February 10, 2024. A previously tested interviewer-administered structured questionnaire was used for data collection. Binary logistic regression analysis was performed. In the final multivariable logistic regression analysis model, a p-value of less than 0.05 and an Adjusted Odd Ratio (AOR) with a 95% confidence interval was used to determine variables for postnatal care non-utilization. Result Educational status (no formal education) (AOR = 2.70; 95% CI: 1.23–1.75. Inadequate knowledge of post-natal (AOR = 4.6; 95% CI; 1.80–5.90). Having no ANC attended (AOR = 2.00; CI: 1.30–5.20).home delivery (AOR = 1.7; 95% CI: 1.40–4.50). And distance from the nearest health facility were independent determinants of postnatal non utilization Conclusions This study revealed that educational statues, home delivery, no ANC non-attendance, inadequate knowledge on post-natal care, home delivery found to be the determinants of PNC service non utilization. Therefore, encouraging ANC, institutional delivery, along with integrated and improving awareness on postnatal care services, will improve postnatal care service utilization in the districts of Ethiopia. Determinants postpartum care non-utilization Adama District Introduction Postnatal period, from birth to the first six weeks, is the most crucial period for survival in which the majority of maternal and newborn deaths are the highest, particularly in the first week[ 1 ] According to the World Health Organization. later to an uncomplicated vaginal birth in a health facility, mothers should receive care in the facility for at least 24 hours after birth [ 1 , 2 ]. and for home delivery, the first postnatal contact should be as early as possible within 24 hours. Besides, an additional three postnatal contacts (on 48 to 72 hours, between 7th and 14th days, and six weeks after birth) are recommended for all mothers and newborns[ 1 – 3 ]. Globally, there were an estimated 289,000 maternal deaths in 2013 and developing countries account for 99% of the global maternal deaths [ 4 ].The Sub-Saharan Africa region alone accounted for 62% of global deaths. Obstetric causes, notably, hemorrhage (27%), hypertensive diseases of pregnancy (14%), and sepsis (11%) account for a large proportion of maternal deaths An estimated 2.8 million neonates died worldwide in 2013, 1 million of these occurred on the first day [ 1 , 3 , 4 ] Complications from preterm birth (35%), intra partum related causes (24%) and severe infections (15%) are the leading direct causes of neonatal deaths. Inappropriate feeding and cultural practices following delivery may pose further risks to the life of the new born. Majority of the neonatal deaths also occur in developing countries, with the highest rate in sub-Saharan Africa (39% of global neonatal deaths) [ 2 , 4 ] According to the NDHS (2013), more than half (56 percent) of women did not receive any postnatal care [ 5 ] The survival and well-being of a woman and her new-born depends substantially on the care received during pregnancy, delivery and the postnatal period as a large number of maternal and neonatal deaths occur during the first 24 h after delivery [ 6 ] Neonatal mortality in the first week of life accounts for approximately 75 percent of all neonatal death and majority of these deaths occur in developing countries. Most of these new-born deaths are due to sepsis, asphyxia and problems associated with low birth weight [ 3 , 6 ] Studies show that deaths within the first week of life account for almost 40% of all deaths among children under the age of five [ 1 , 7 ] Also, about 700 babies die (around 30 every hour) on a daily basis in sub-Saharan Africa which has the highest number of new-born deaths in Africa, and the second highest in the world [ 8 ]. The health of mothers has been regarded as an indicator of the health of society The provision of services to the mother and their newborn has been set up for the prevention and reduction of maternal and neonatal deaths worldwide3.Postnatal care services help to safeguard women from complications and provide essential opportunities to assess the infant’s development[ 4 , 9 ]. Evidence shows that the use of maternal and newborn health services during the postpartum period is influenced by many of socio-demographic, health service-related, and cultural factors [ 4 , 10 , 11 ].Multiple studies find parity, mother’s education, and a woman’s economic status are significant predictors for the utilization of maternity care [ 12 , 13 ].Researchers also indicate that PNC utilization is affected by distance to facilities, area of residence, place and type of delivery [ 14 – 16 ].Studies indicated that the extent of PNC services utilization was associated with factors like maternal age, educational level, occupation, place and mode of delivery, number of pregnancies, awareness about obstetric-related danger sign, and awareness about PNC services. The determinants of utilization of PNC services are not also the same across different cultures and socioeconomic status within a society [ 4 , 17 – 19 ]. Despite its importance, the postnatal period is generally the most neglected and underutilized services in developing countries, particularly Ethiopia, and most mothers do not receive care from a skilled health care provider during the first few days after delivery[ 3 , 20 ]. A large proportion of maternal deaths occur during the first 48 hours after delivery that can be averted with crucial PNC services [ 4 ]. In developing countries, a fully functioning mother-baby package intervention has been estimated to have the postnatal cumulative effect of averting 75 to 85% of maternal death[ 21 ].Lack of PNC utilization may result in a number of complications. Of those, maternal and neonatal infections, incomplete immunization, frequent and mistimed pregnancies, severe postpartum hemorrhage which claims at least 22% of maternal deaths and which kills a woman within two hours in the absence of medical interventions were identified [ 22 ]. Methods Study design, area, and period A community-based unmatched case-control study was conducted in Adama district, central Ethiopia, from January 1 to February 30, 2024. Adama district is bordered by the Arsi zone to the south, the Lome district to the west, the Boset district to the east, and the Amhara Regional State to the north. The district is comprised of 4 urban and 36 rural kebeles, situated approximately 100 km from Addis Ababa, the capital of Ethiopia. According to the regional health office, the estimated total population is 229,237 (115,567 males and 113,673 females). Among this population, women of reproductive age account for 49,614, and under-five children account for 36,083. Study population, and eligibility criteria All women of selected kebeles who were between 6 weeks to 12 months after they gave birth and who fulfill inclusion criteria. Case were women who were between 6 weeks to 12 months after they gave birth and didn’t utilize postnatal care service for their recent delivery. Controls were women who were between 6 weeks to 12 months after they gave birth and utilized postnatal care service for their recent delivery. Women who were seriously ill, unable to communicate, or mentally ill during the data collection period were excluded from the study. Sample size, and sampling procedure The sample size was calculated using Epi info version 7.2 statistical software, employing an unmatched case-control formula. This was done under the assumptions of 80% power, a 95% confidence interval [ 23 ], and a 1:1 case-to-control ratio. Among factors considered Antenatal Care [ 4 ] distance [ 24 ] maternal education [ 25 ]and knowledge of postpartum danger signs[ 26 ],thus taking a 37.5% encountered problem during pregnancy [ 19 ] 80% power, 95% confidence level [ 23 ], one-to-one ratio, 1.5 design effect, and 10% non-response rate that yielded a sample of 430 (215 cases and 215 controls). Initially, 16 kebeles (40% of the total kebeles) were selected using the lottery method the survey was conducted to obtain PNC service utilizers and non-utilizers in the last six months (January 1 to February 30, 2024). A sampling frame was prepared for cases and controls separately from the health post-registration. Then, the sample was proportionally allocated to the 16 kebeles based on the estimated number of mothers, who gave birth for the last six months. The final participants were selected using the simple random sampling technique (lottery method) from the delivery registries of the health posts. Then, home visits and interviews were conducted using household numbers Study variables Dependent variable Postnatal care non-utilization (yes/no) Independent variables Socio-demographic age, family size, educational status of the mother and her husband, marital status, religion, occupational status of the mother and her husband, and household wealth index Obstetrics and services utilization factor parity, ANC utilization, place of delivery, encountered problem during delivery, previse post-natal care utilization Health facility factor Distance from health facility, access of transportation Maternal factors Knowledge on PNC, Decisions on services utilization Operational definitions Postnatal care utilization In this study, a mother who had at least one post-natal check-up for the recent delivery by health workers or health extension workers within six weeks after delivery was considered as utilized postnatal care service. Knowledge Adequate knowledge Score of greater than or equal to 50% knowledge question on postnatal care services and danger signs of postpartum period. Inadequate knowledge a Score of less than 50% knowledge question on postnatal care services and danger signs of postpartum period Data collection procedure and quality control Data were collected using a pretested, structured, interviewer-administered questionnaire. The questionnaires were adapted from various relevant literature with necessary modifications tailored to the specific context of the study. A team of 12 trained data collectors and 2 supervisors was enlisted for the data collection process. Throughout this phase, continuous supervision of data collectors took place, and regular meetings were convened among the data collectors, supervisors, and investigators. Additional visits were conducted for participants who were unavailable during the initial visit. The collected data were reviewed and checked for completeness before data entry. Data processing and analysis Following the coding and inputting of data into Epi-Info version 7.2, the data were exported to the Statistical Package for Social Sciences (SPSS) Version 26 for cleaning and analysis. Descriptive statistics were employed to present key characteristics of the study population. The association between independent variables and post-natal non utilizers was modeled using binary logistic regression analysis. In the bivariable logistic regression model, a significance level of 0.25 was set as a threshold to select variables for multivariable logistic regression analysis, aiming to control confounding effects. The existence of multicollinearity among explanatory variables was explored using the variance inflation factor along with standard error. The multivariable logistic regression utilized adjusted odds ratios (AOR) with a 95% confidence interval to identify factors independently associated with the postnatal non utilizer. The model was fitted using the standard model-building approach. Hosmer and Lemeshow's goodness-of-fit test was used to assess the model's fitness in the final model, variables with a p-value less than 0.05 were deemed statistically significant. Results Socio-demographic Characteristics A total of 430 mothers (215 case and 215 control) were responded to the interviewer-administered questionnaire. The mean age of mothers among cases and controls was 27.6 (SD ± 5) and 28.0 years (SD ± 5.67), respectively. The majority of cases 177(82.3%) and controls 193 (89.2%) were rural residents, educationally, 30.6% of cases and 20.2% of controls were no formal education. Regarding occupation, 45.1% of cases and 51.0% controls were housewives. The wealth index of households revealed that 134 cases (62.1%) and 128 controls (59.7%) were in lower-wealth states ( Table 1 ). Table 1 Sociodemographic and economic characteristics of participants in Adama district, central Ethiopia, May 2024 Variables Category Case Control Number (%) Number (%) Age of the mother 15–19 38(17.6) 31(14.4) 20–24 45(20.9) 66(30.6) 25–29 75(34.4) 70(32.5) 30–34 30(13.9) 39(18.1) < 35 27(12.7) 9(4.1) Residence Rural 177(82.3) 193(89.2) Urban 38(17.7) 22(10.2) Marital status Married 160(74.4) 176(81.6) Widowed 21(9.7) 19(8.8) Divorced 34(15.8) 20(9.3) Religion Orthodox 115(72.2) 121(56.2) Protestant 63(29.3) 55(25.6) Muslim 22(10.2) 29(13.4.1) Catholic 15(6.9) 10(4.6) Ethnicity Oromo 183(85.1) 174(80.9) Amhara 19(8.8) 26(12.2) Other* 13(6.0) 15(6.9) Educational status of the mother No formal education 66(30.6) 45(20.9) Primary school 104(48.3) 97(45.1) High school and preparatory 37(17.3) 51(23.7) Diploma and above 8(3.7) 22(10.2) Educational status of the husband No formal education 27(12.5) 24(11.1) Primary school 103(47.9) 114(53.3) High school & preparatory 50(23.1) 39(18.1) Diploma &above 35(16.2) 36(17.6) Occupation of the mother Housewife 98(45.5) 110(51.1) Merchant 54(25.1) 63(29.3) Government employee 51(18.0) 29(13.4) Other 32(14.8) 13(6.0) Occupation of the husband Farmer 134(62.3) 146(67.9) Merchant 44(20.5) 18(8.9) Government employee 31(14.0) 44(20.2) Other* * 6(2.7) 7(3.2) Wealth index Lowest quartile 134(62.3) 128(59.7) Middle quartile 52(24.1) 72(33.4) Highest quartile 29(13.4) 15(6..9) Obstetrics and services utilization factor In this study, majority 38.6% from the case and 41.3% from the control were multipara, Regarding ANC visits, 47.1 and 57.0% of cases and controls did not received ANC during their last pregnancy, respectively. Of the total participants, 30.0% of cases and 36.8% of controls had an encounter problem during pregnancy. Fifty two percent of cases and thirty one percent of controls gave their recent birth at home. Furthermore 41.9% of cases and 34.0% of controls had privies post-natal care utilization of their last child ( Table 2 ). Table 2 Obstetrics and services utilization factor characteristics of participants in Adama district, central Ethiopia, May 2024 Variables Category Case Control Number (%) Number (%) Parity 1–2 74(34.4) 96(44.6) Multipara 83(38.60) 89(41.3) Grand para 58(26.9) 30(13.9) ANC utilization Yes 113(52.5) 97(45.1) No 102(47.4) 118(54.8) Place of delivery Home 113(52.3) 68(31.7) Health institution 102(47.7) 147(68.3) Encountered problem during pregnancy Yes 65(30.0) 79(36.8) No 150(69.7) 136(63.2) Previous post-natal care utilization Yes 90(41.9) 73(34.0) No 125(58.1) 142(66.0) Plan to utilize PNC Yes 94(43.7) 122(56.7) No 121(56.3) 93(43.3) Health facility factor In this study 64.4% from case and 85.9% from control grouped had traveled > one hrs. To get health facility furthermore 74.4% from case and 84.4% from the control group had no access of transportation ( Table 3 ). Table 3 Health facility factor characteristics of participants in Adama district, central Ethiopia, May 2024 Variables Category Case Control Number (%) Number (%) Distance from the nearest health facility 1 hrs. 139(64.6) 184(85.5) Access of transportation Yes 35(16.2.) 64((29.7) NO 180(83.3) 151(70.3) Maternal factor In this study 151 cases (70.2. %) and 67controls (31.7%) had inadequate knowledge, regarding decision on services utilization 113 from the case group and 134 from the control group mothers decided alone. ( Table 4 ). Table 4 Maternal factor characteristics of participants in Adama district, central Ethiopia, May 2024 Variables Category Case Control Number (%) Number (%) Knowledge on PNC Inadequate 151(70.2) 67(31.1) adequate 64(29.9) 148(68.3) Decision on services utilization Mother alone 113(52.5) 134(62.3) Mother and husbands 23(10.6) 35(16.2) Husband alone 79(36.7) 46 (21.3) Determinants of post-natal non utilization After conducting binary logistic regression analysis, factors such as knowledge of post-natal, educational statues, wealth index, decision for service utilization, place of delivery, plan to utilize PNC, ANC utilization, access of transportation, place of residence and distance from the nearest health facility showed statistically significant associations with post-natal non utilization at a p-value < 0.25. In the multivariable analysis, the educational status of the mother, knowledge on post-natal care utilization ,ANC utilization ,home delivery, distance from health facility were identified as independent determinants of post-natal care non utilization at a p-value < 0.05. Accordingly, the odds of post-natal non utilization were 2.7times higher among mothers with no formal education compared to those with a diploma and above school level of education (AOR = 2.70; 95% CI: 1.23–1.75).Mothers who had inadequate knowledge of post-natal care utilization had 4.6 times greater odds of post-natal non utilization compared to mothers with adequate knowledge (AOR = 4.6; 95% CI; 1.80–5.90). women who did not attend ANC had two times more chance of not getting postnatal services utilization compared to mothers who were attended ANC (AOR = 2.00; CI: 1.30–5.20). Mothers who gives birth at home had 1.7 times post-natal none utilize than those mothers who gives birth at health institution (AOR = 1.7; 95% CI: 1.40–4.50). Mother who traveled gather than one hour to reach the nearest health institution was 2.9 times ( AOR 95% CI :( 1.9–4.2) more likely to non-utilize postnatal care services compared to mother who traveled less than one hour ( Table 5 ). Table 5 Determinants post-natal non utilizers Adama district, Central Ethiopia, 2024 Variables Category Case (N) Control (N) COR (95%CI) AOR (95%CI) Educational status of the mother No formal education 86 35 3.1 (1.5–5.9) * 2.7 (1.2–1.7) ** Primary 84 107 1.08 (1.5–4.8) 0.9 (0.8–3.9) Secondary 37 51 1.9 (1.1–5.9) 0.9 (0.9–3.7) Diploma and above 8 22 1 1 Wealth index Lower quartile 134 128 1.4 (1.4–1.8) * 1.3 (0.9–1.9) Medium quartile 52 72 0.3(1.0-1.9) 0.2 (0.6–1.4) Highest quartile 29 15 1 1 ANC utilization Yes 83 127 1 No 132 88 2.2(1.4–9.4) 2(1.3–5.7) Place of delivery Home 113 68 2.3(1.9–6.3) 1.7(1.4–4.5) Health institution 102 147 1 Knowledge of PNC Inadequate 151 67 5.2 (2.1–9.2) 4.6(1.8–5.9) ** Adequate 64 148 1 1 decision for service utilization Mother alone 113 134 1.2(1.3–1.9) 0.9(0.6–1.1) Mother and husband 23 35 0.3(0.7–1.3) 0.3(0.5–1.1) Husband alone 79 46 1 Plan to utilize Yes 94 122 1 1 No 121 93 1.6 (1.4.2.7) * 1.6 (1.1–2.5) ** Access of transportation Yes 35 64 1 1 No 180 151 2.1(1.3–1.9) 1.4(0.5–1.3) Distance from nearest health facility 1 hrs. 139 184 1 1 Place of residence Urban 38 22 1 Rural 177 193 1.8(1.1–2.3) 0.9(0.6–0.9 Notes : *Significant at p-value < 0.25 in unadjusted logistic regression analysis, **significant at p < 0.05 in adjusted logistic regression analysis, 1 = Reference Discussion This study tried to assess determinants of postnatal care service non utilization among mothers who gave birth in the past 6 months prior to the study in Adama district, central Ethiopia. Educational level of mother, maternal knowledge of postnatal care, ANC follow up during pregnancy, place of delivery and distance from health institution were found to be determinants of postnatal service utilization. This study showed that educational status of the mother has positive association with postnatal care service utilization. This finding is in line with the findings of previous study conducted in Nepal [27] .report of Ethiopian Demographic Health Survey 2011 [20]and Jabtine district, Ethiopia [25].This is may be due to the reason that better education increases access to information and risk perception which in turn increase health-seeking behavior. Knowledge of mother on postnatal care was found to be determinant of postnatal care service utilization. Where mother who had adequate knowledge on postnatal care utilized postnatal care service better than mother who had inadequate knowledge of postnatal care. This can be explained by the fact that awareness on postnatal care is an important factor that motivates a woman and her families to attend health care services at the earliest opportunities with the intention of prevention, early detection and getting managed for postpartum danger signs. In this study, utilization of ANC service during pregnancy was one of the determinants of postnatal care service utilization. Postnatal care services utilization was higher among mothers who visit ANC during pregnancy as compared to mothers who had not visit ANC. This is consistent with the analysis of the 2011 EDHS [27] and with study conducted in This result was comparable with those of studies finding in Diga, Amigna, and Lemo district, Ethiopia [17-19, 27]. this may be explained by the reason that attending ANC provides a pregnant woman to obtain necessary health information on possible preparation for childbirth, and also on postnatal service utilization after delivery. The study finding showed that the odds of PNC care non-utilization was more than one times higher among women who gave birth at home compared to those who gave birth in the health facility. The result is in agreement with studies conducted in Gondar zuria, Amhara region[22]. and Diga district, Oromiya region[18].This finding is also supported by a study conducted in Nigeria [28] .The possible reason could be if a mother gave birth at home, the adequacy of receiving advice and knowing the postnatal care benefits is low that can significantly reduce the services seeking behavior. This might be attributed to the fact that women who gave their last birth at home have lesser opportunities to get exposed to health education-related to PNC services at the time of delivery and thus get no access to learn about the types, benefits, and availabilities of PNC services. In this study, a woman who traveled at most one hour to reach the nearby health institution is more likely utilized postnatal care services than those who traveled more than one hour. This finding is in agreement with reports of other studies [22, 24].where distance from health institution remains a problem in postnatal care service utilization. This might be because having nearby health facility increases access to health information and reduces distance barriers leading to better utilization of services. Limitations of the study The source of data for this study was based on the self-reporting of respondents; this might have some limited validation of information obtained from the subjective source. Moreover, the women might have experienced recall bias, particularly regarding the services they received during their previous postnatal services Conclusion In conclusion, the educational status of the mother, ANC utilization during pregnancy, inadequate knowledge of post-natal care utilization, Distance from nearest health facility and having home delivery were all determinants of post-natal care non utilization Abbreviations AOR: Adjusted Odds Ratio ANC: Antenatal Care CI: Confidence Intervals COR: Crude Odds Ratio OR: Odds Ratio PNC: Postnatal Care SPSS: Statistical Package for Social Sciences. Declarations Ethical Approval and Consent to Participate Ethical approval was obtained from the Institutional Ethical Review Board of Adama general Hospital Medical College The study’s proposal was formally presented to both the Oromia Regional Health Office and the Adama District Health Office to secure official approval for carrying out research activities within the selected kebeles. Participants were informed of the study's purpose and benefits during the data collection period and informed written consent was obtained to ensure their decision to participate or refuse. To uphold respondents' rights and ensure confidentiality, anonymity, and privacy, safeguards were enacted, and all of the study's procedures followed the principles outlined in the Helsinki Declaration [12]. Consent for publication Not applicable Availability of data and material All data and materials are available from the corresponding author without undue reservation. Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding from any funding agency. Acknowledgments The authors extend their sincere appreciation to Adam Hospital Medical College, along with the Adama district health office, for their invaluable assistance throughout the study. Special thanks are also extended to the dedicated team of data collectors, supervisors, and all the study participants for their crucial contributions. Authors’ contributions YAB contributed to the conception and design of the study, as well as the data curation, and analysis. YA, YMN, MSG, and BLS drafted the manuscript. YMN critically reviewed the draft manuscript and wrote the final version. MAK and WDG advised the study. All authors read and approved the final manuscript. References Organization WH. World Health Statistics 2016 [OP]: Monitoring Health for the Sustainable Development Goals (SDGs). World Health Organization; 2016. Organization WH. Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, world bank group and the United Nations population division. World Health Organization; 2015. Organization WH. WHO recommendations on postnatal care of the mother and newborn. World Health Organization; 2014. Mwangi A et al. Strength postnatal care Serv including postpartum family Plann Kenya 2008. Commission NP. Nigeria demographic and health survey 2013. National Population Commission, ICF International; 2013. Lawn JE et al. Newborn survival. Disease Control Priorities in Developing Countries. 2nd edition, 2006. Paudel M, et al. Determinants of postnatal service utilization in a western district of Nepal: community based cross sectional study. J Women’s Health Care. 2013;2(126):2167–0420. Storeng KT, Béhague DP. Lives in the balance: The politics of integration in the Partnership for Maternal, Newborn and Child Health. Health Policy Plann. 2016;31(8):992–1000. Liu L, et al. District-level health management and health system performance: the Ethiopia primary healthcare transformation initiative. Int J Health Policy Manage. 2022;11(7):973. Darega B, et al. Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study. BMC Pregnancy Childbirth. 2016;16:1–7. Kaba M, et al. Maternal health service utilization in urban slums of selected towns in Ethiopia: qualitative study. Ethiop J Health Dev. 2017;31(2):96–102. Schmidt H, Mehring S, McMillan J. Interpreting the Declaration of Helsinki (2008): Must, Should and Different Kinds of Obligation. Med L. 2010;29:565. Worku AG, Yalew AW, Afework MF. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int health Hum rights. 2013;13:1–11. Berhe A, et al. Determinants of postnatal care utilization in Tigray, Northern Ethiopia: A community based cross-sectional study. PLoS ONE. 2019;14(8):e0221161. Limenih MA, Endale ZM, Dachew BA. Postnatal care service utilization and associated factors among women who gave birth in the last 12 months prior to the study in Debre Markos Town, Northwestern Ethiopia: a community-based cross‐sectional study. Int J reproductive Med. 2016;2016(1):7095352. Munabi-Babigumira S, et al. Factors that influence the provision of postnatal care by health workers: a qualitative evidence synthesis. The Cochrane Database of Systematic Reviews; 2021. 2021(7). Belachew T, Taye A, Belachew T. Postnatal care service utilization and associated factors among mothers in Lemo Woreda, Ethiopia. J Women’s Health Care. 2016;5(104172):2167–0420. Heyi WD, Deshi MM, Erana MG. Determinants of postnatal care service utilization in diga district, east wollega zone, wester Ethiopia: case-control study. Ethiop J Reproductive Health, 2018. 10(4). Kifle A, Sena L, Jarso H. Determinants of postnatal care service utilization, Amigna District, Arsi Zone, Southeast Ethiopia: a case-control study. J Women’s Health Care. 2018;7(448):2167–0420. Aseweh Abor P, et al. The socio-economic determinants of maternal health care utilization in Ghana. Int J Soc Econ. 2011;38(7):628–48. Tumbure A et al. Assessment of postnatal care service utilization and associated factors in Asella town, Arsi zone, Oromiya regional state, Ethiopia. Glob J Reprod Med, 2018. 6(1). Tesfahun F, et al. Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District, Ethiopia: a cross-sectional study. Matern Child Health J. 2014;18:2341–51. Kuruvilla S, et al. Success factors for reducing maternal and child mortality. Bull World Health Organ. 2014;92:533–44. Hordofa MA, et al. Postnatal care service utilization and associated factors among women in Dembecha District, Northwest Ethiopia. Sci J Public Health. 2015;3(5):686–92. Workineh YG, Hailu DA. Factors affecting utilization of postnatal care service in Jabitena district, Amhara region, Ethiopia. Sci J Public Health. 2014;23(3):169–76. Alemayeh H, Assefa H, Adama Y. Prevalence and factors associated with post natal care utilization in Abi-Adi Town, Tigray, Ethiopia: a cross sectional study. IJPBSF Int J Pharm Biol Sci Fundamentals. 2014;8(01):23–35. Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14:1–13. Somefun OD, Ibisomi L. Determinants of postnatal care non-utilization among women in Nigeria. BMC Res Notes. 2016;9:1–11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4997729","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"comment","associatedPublications":[],"authors":[{"id":347951666,"identity":"48a831ff-c7e4-4134-8a8d-3d8247d792b8","order_by":0,"name":"Yohanes Abera Belachwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYFACHghlACI+VNgAScbGA0RrYZxxJg1ENRCvhZm37TCYg1eLwfHeg58LKurkzdl7H37mbTtvt7b9MNCWGptonFrOnEuWnnHmsOHOnuPGknPO3U7ediYRqOVYWm4DLi03cgykedsOMG64kcYg8absdrLZAaAWxobD+LQY/+b9V2e/4f4z5h88bOeSzc4/JKjFTJq3gTlxww02NkmetgN2ZjcI2CJ55oyZNc+xw8k7e9LYLGecSU4wuwG0JQGPX/iO9xjf5qmps93Ofoz5xocKO3uz8+kPH3yoscGpReEAmkAiWGUCDuUgII9ulj0exaNgFIyCUTBCAQAaGmk03MZCegAAAABJRU5ErkJggg==","orcid":"","institution":"Adama General Hospital Medical College","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yohanes","middleName":"Abera","lastName":"Belachwe","suffix":""},{"id":347951667,"identity":"22b74eba-3406-4d06-aeda-820c5018db00","order_by":1,"name":"Befikad Assefa Seifu","email":"","orcid":"","institution":"Adama General Hospital Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Befikad","middleName":"Assefa","lastName":"Seifu","suffix":""},{"id":347951668,"identity":"9596ec26-2b37-43cc-9a9e-4ede864ab233","order_by":2,"name":"Beka Teressa Meka","email":"","orcid":"","institution":"Adama General Hospital Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Beka","middleName":"Teressa","lastName":"Meka","suffix":""}],"badges":[],"createdAt":"2024-08-29 12:40:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4997729/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4997729/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63974263,"identity":"67e8351e-ef15-4e05-abbf-993476727d6c","added_by":"auto","created_at":"2024-09-04 11:53:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":869685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4997729/v1/888c1999-5816-4e9f-abd1-647ee2ada122.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of postnatal care non-utilization among women in adama district, East Shwoa Ethiopia a community-based unmatched case-control study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostnatal period, from birth to the first six weeks, is the most crucial period for survival in which the majority of maternal and newborn deaths are the highest, particularly in the first week[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] According to the World Health Organization. later to an uncomplicated vaginal birth in a health facility, mothers should receive care in the facility for at least 24 hours after birth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. and for home delivery, the first postnatal contact should be as early as possible within 24 hours. Besides, an additional three postnatal contacts (on 48 to 72 hours, between 7th and 14th days, and six weeks after birth) are recommended for all mothers and newborns[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, there were an estimated 289,000 maternal deaths in 2013 and developing countries account for 99% of the global maternal deaths [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].The Sub-Saharan Africa region alone accounted for 62% of global deaths. Obstetric causes, notably, hemorrhage (27%), hypertensive diseases of pregnancy (14%), and sepsis (11%) account for a large proportion of maternal deaths An estimated 2.8\u0026nbsp;million neonates died worldwide in 2013, 1\u0026nbsp;million of these occurred on the first day [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Complications from preterm birth (35%), intra partum related causes (24%) and severe infections (15%) are the leading direct causes of neonatal deaths. Inappropriate feeding and cultural practices following delivery may pose further risks to the life of the new born. Majority of the neonatal deaths also occur in developing countries, with the highest rate in sub-Saharan Africa (39% of global neonatal deaths) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to the NDHS (2013), more than half (56 percent) of women did not receive any postnatal care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] The survival and well-being of a woman and her new-born depends substantially on the care received during pregnancy, delivery and the postnatal period as a large number of maternal and neonatal deaths occur during the first 24 h after delivery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Neonatal mortality in the first week of life accounts for approximately 75 percent of all neonatal death and majority of these deaths occur in developing countries. Most of these new-born deaths are due to sepsis, asphyxia and problems associated with low birth weight [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Studies show that deaths within the first week of life account for almost 40% of all deaths among children under the age of five [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Also, about 700 babies die (around 30 every hour) on a daily basis in sub-Saharan Africa which has the highest number of new-born deaths in Africa, and the second highest in the world [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe health of mothers has been regarded as an indicator of the health of society The provision of services to the mother and their newborn has been set up for the prevention and reduction of maternal and neonatal deaths worldwide3.Postnatal care services help to safeguard women from complications and provide essential opportunities to assess the infant\u0026rsquo;s development[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Evidence shows that the use of maternal and newborn health services during the postpartum period is influenced by many of socio-demographic, health service-related, and cultural factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].Multiple studies find parity, mother\u0026rsquo;s education, and a woman\u0026rsquo;s economic status are significant predictors for the utilization of maternity care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].Researchers also indicate that PNC utilization is affected by distance to facilities, area of residence, place and type of delivery [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Studies indicated that the extent of PNC services utilization was associated with factors like maternal age, educational level, occupation, place and mode of delivery, number of pregnancies, awareness about obstetric-related danger sign, and awareness about PNC services. The determinants of utilization of PNC services are not also the same across different cultures and socioeconomic status within a society [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite its importance, the postnatal period is generally the most neglected and underutilized services in developing countries, particularly Ethiopia, and most mothers do not receive care from a skilled health care provider during the first few days after delivery[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A large proportion of maternal deaths occur during the first 48 hours after delivery that can be averted with crucial PNC services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In developing countries, a fully functioning mother-baby package intervention has been estimated to have the postnatal cumulative effect of averting 75 to 85% of maternal death[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Lack of PNC utilization may result in a number of complications. Of those, maternal and neonatal infections, incomplete immunization, frequent and mistimed pregnancies, severe postpartum hemorrhage which claims at least 22% of maternal deaths and which kills a woman within two hours in the absence of medical interventions were identified [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, area, and period\u003c/h2\u003e \u003cp\u003eA community-based unmatched case-control study was conducted in Adama district, central Ethiopia, from January 1 to February 30, 2024. Adama district is bordered by the Arsi zone to the south, the Lome district to the west, the Boset district to the east, and the Amhara Regional State to the north. The district is comprised of 4 urban and 36 rural kebeles, situated approximately 100 km from Addis Ababa, the capital of Ethiopia. According to the regional health office, the estimated total population is 229,237 (115,567 males and 113,673 females). Among this population, women of reproductive age account for 49,614, and under-five children account for 36,083.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population, and eligibility criteria\u003c/h2\u003e \u003cp\u003eAll women of selected kebeles who were between 6 weeks to 12 months after they gave birth and who fulfill inclusion criteria. Case were women who were between 6 weeks to 12 months after they gave birth and didn\u0026rsquo;t utilize postnatal care service for their recent delivery. Controls were women who were between 6 weeks to 12 months after they gave birth and utilized postnatal care service for their recent delivery. Women who were seriously ill, unable to communicate, or mentally ill during the data collection period were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size, and sampling procedure\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using Epi info version 7.2 statistical software, employing an unmatched case-control formula. This was done under the assumptions of 80% power, a 95% confidence interval [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and a 1:1 case-to-control ratio. Among factors considered Antenatal Care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] distance [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] maternal education [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]and knowledge of postpartum danger signs[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e],thus taking a 37.5% encountered problem during pregnancy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] 80% power, 95% confidence level [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], one-to-one ratio, 1.5 design effect, and 10% non-response rate that yielded a sample of 430 (215 cases and 215 controls).\u003c/p\u003e \u003cp\u003eInitially, 16 kebeles (40% of the total kebeles) were selected using the lottery method the survey was conducted to obtain PNC service utilizers and non-utilizers in the last six months (January 1 to February 30, 2024). A sampling frame was prepared for cases and controls separately from the health post-registration. Then, the sample was proportionally allocated to the 16 kebeles based on the estimated number of mothers, who gave birth for the last six months. The final participants were selected using the simple random sampling technique (lottery method) from the delivery registries of the health posts. Then, home visits and interviews were conducted using household numbers\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003ePostnatal care non-utilization (yes/no)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSocio-demographic\u003c/strong\u003e \u003cp\u003eage, family size, educational status of the mother and her husband, marital status, religion, occupational status of the mother and her husband, and household wealth index\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eObstetrics and services utilization factor\u003c/strong\u003e \u003cp\u003eparity, ANC utilization, place of delivery, encountered problem during delivery, previse post-natal care utilization\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHealth facility factor\u003c/strong\u003e \u003cp\u003eDistance from health facility, access of transportation\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMaternal factors\u003c/strong\u003e \u003cp\u003eKnowledge on PNC, Decisions on services utilization\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePostnatal care utilization\u003c/strong\u003e \u003cp\u003eIn this study, a mother who had at least one post-natal check-up for the recent delivery by health workers or health extension workers within six weeks after delivery was considered as utilized postnatal care service.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eAdequate knowledge\u003c/strong\u003e \u003cp\u003eScore of greater than or equal to 50% knowledge question on postnatal care services and danger signs of postpartum period.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInadequate knowledge\u003c/strong\u003e \u003cp\u003ea Score of less than 50% knowledge question on postnatal care services and danger signs of postpartum period\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure and quality control\u003c/h2\u003e \u003cp\u003eData were collected using a pretested, structured, interviewer-administered questionnaire. The questionnaires were adapted from various relevant literature with necessary modifications tailored to the specific context of the study. A team of 12 trained data collectors and 2 supervisors was enlisted for the data collection process. Throughout this phase, continuous supervision of data collectors took place, and regular meetings were convened among the data collectors, supervisors, and investigators. Additional visits were conducted for participants who were unavailable during the initial visit. The collected data were reviewed and checked for completeness before data entry.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eFollowing the coding and inputting of data into Epi-Info version 7.2, the data were exported to the Statistical Package for Social Sciences (SPSS) Version 26 for cleaning and analysis. Descriptive statistics were employed to present key characteristics of the study population. The association between independent variables and post-natal non utilizers was modeled using binary logistic regression analysis. In the bivariable logistic regression model, a significance level of 0.25 was set as a threshold to select variables for multivariable logistic regression analysis, aiming to control confounding effects. The existence of multicollinearity among explanatory variables was explored using the variance inflation factor along with standard error. The multivariable logistic regression utilized adjusted odds ratios (AOR) with a 95% confidence interval to identify factors independently associated with the postnatal non utilizer. The model was fitted using the standard model-building approach. Hosmer and Lemeshow's goodness-of-fit test was used to assess the model's fitness in the final model, variables with a p-value less than 0.05 were deemed statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e \u003cp\u003eA total of 430 mothers (215 case and 215 control) were responded to the interviewer-administered questionnaire. The mean age of mothers among cases and controls was 27.6 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;5) and 28.0 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67), respectively. The majority of cases 177(82.3%) and controls 193 (89.2%) were rural residents, educationally, 30.6% of cases and 20.2% of controls were no formal education. Regarding occupation, 45.1% of cases and 51.0% controls were housewives. The wealth index of households revealed that 134 cases (62.1%) and 128 controls (59.7%) were in lower-wealth states \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and economic characteristics of participants in Adama district, central Ethiopia, May 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNumber (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNumber (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge of the mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(30.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70(32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(18.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177(82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193(89.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160(74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176(81.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115(72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(56.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(25.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(13.4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOromo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183(85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174(80.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(12.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status of the mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(20.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97(45.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school and preparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51(23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status of the husband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(11.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103(47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114(53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school \u0026amp; preparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(18.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma \u0026amp;above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation of the mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(51.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(13.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation of the husband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134(62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146(67.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(20.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther* *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWealth index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLowest quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134(62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128(59.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72(33.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(6..9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eObstetrics and services utilization factor\u003c/h2\u003e \u003cp\u003eIn this study, majority 38.6% from the case and 41.3% from the control were multipara, Regarding ANC visits, 47.1 and 57.0% of cases and controls did not received ANC during their last pregnancy, respectively. Of the total participants, 30.0% of cases and 36.8% of controls had an encounter problem during pregnancy. Fifty two percent of cases and thirty one percent of controls gave their recent birth at home. Furthermore 41.9% of cases and 34.0% of controls had privies post-natal care utilization of their last child \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetrics and services utilization factor characteristics of participants in Adama district, central Ethiopia, May 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(44.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(38.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89(41.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrand para\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(13.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eANC utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113(52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97(45.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118(54.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113(52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147(68.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEncountered problem during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79(36.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150(69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136(63.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePrevious post-natal care utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73(34.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125(58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142(66.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlan to utilize PNC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122(56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(43.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eHealth facility factor\u003c/h2\u003e \u003cp\u003eIn this study 64.4% from case and 85.9% from control grouped had traveled\u0026thinsp;\u0026gt;\u0026thinsp;one hrs. To get health facility furthermore 74.4% from case and 84.4% from the control group had no access of transportation \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth facility factor characteristics of participants in Adama district, central Ethiopia, May 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDistance from the nearest health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 hrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(14.5.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 hrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139(64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184(85.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAccess of transportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(16.2.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64((29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151(70.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMaternal factor\u003c/h2\u003e \u003cp\u003eIn this study 151 cases (70.2. %) and 67controls (31.7%) had inadequate knowledge, regarding decision on services utilization 113 from the case group and 134 from the control group mothers decided alone. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal factor characteristics of participants in Adama district, central Ethiopia, May 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eKnowledge on PNC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151(70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67(31.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148(68.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDecision on services utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113(52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134(62.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother and husbands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(16.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHusband alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of post-natal non utilization\u003c/h2\u003e \u003cp\u003eAfter conducting binary logistic regression analysis, factors such as knowledge of post-natal, educational statues, wealth index, decision for service utilization, place of delivery, plan to utilize PNC, ANC utilization, access of transportation, place of residence and distance from the nearest health facility showed statistically significant associations with post-natal non utilization at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25. In the multivariable analysis, the educational status of the mother, knowledge on post-natal care utilization ,ANC utilization ,home delivery, distance from health facility were identified as independent determinants of post-natal care non utilization at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Accordingly, the odds of post-natal non utilization were 2.7times higher among mothers with no formal education compared to those with a diploma and above school level of education (AOR\u0026thinsp;=\u0026thinsp;2.70; 95% CI: 1.23\u0026ndash;1.75).Mothers who had inadequate knowledge of post-natal care utilization had 4.6 times greater odds of post-natal non utilization compared to mothers with adequate knowledge (AOR\u0026thinsp;=\u0026thinsp;4.6; 95% CI; 1.80\u0026ndash;5.90). women who did not attend ANC had two times more chance of not getting postnatal services utilization compared to mothers who were attended ANC (AOR\u0026thinsp;=\u0026thinsp;2.00; CI: 1.30\u0026ndash;5.20). Mothers who gives birth at home had 1.7 times post-natal none utilize than those mothers who gives birth at health institution (AOR\u0026thinsp;=\u0026thinsp;1.7; 95% CI: 1.40\u0026ndash;4.50). Mother who traveled gather than one hour to reach the nearest health institution was 2.9 times ( AOR 95% CI :( 1.9\u0026ndash;4.2) more likely to non-utilize postnatal care services compared to mother who traveled less than one hour\u003cb\u003e(\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDeterminants post-natal non utilizers Adama district, Central Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003e(N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational status of the mother\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.1 (1.5\u0026ndash;5.9) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.7 (1.2\u0026ndash;1.7) **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08 (1.5\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9 (0.8\u0026ndash;3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9 (1.1\u0026ndash;5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9 (0.9\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4 (1.4\u0026ndash;1.8) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.9\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedium quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3(1.0-1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2 (0.6\u0026ndash;1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest quartile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eANC utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2(1.4\u0026ndash;9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(1.3\u0026ndash;5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3(1.9\u0026ndash;6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7(1.4\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of PNC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.2 (2.1\u0026ndash;9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.6(1.8\u0026ndash;5.9) **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003edecision for service utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2(1.3\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9(0.6\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother and husband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3(0.7\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3(0.5\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHusband alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlan to utilize\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6 (1.4.2.7) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6 (1.1\u0026ndash;2.5) **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAccess of transportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1(1.3\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4(0.5\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDistance from nearest health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 hrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.2(2.1\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.9(1.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 hrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8(1.1\u0026ndash;2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9(0.6\u0026ndash;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNotes\u003c/b\u003e: *Significant at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in unadjusted logistic regression analysis, **significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in adjusted logistic regression analysis, 1\u0026thinsp;=\u0026thinsp;Reference\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study tried to assess determinants of postnatal care service non utilization among mothers who gave birth in the past 6 months prior to the study in Adama district, central Ethiopia. Educational level of mother, maternal knowledge of postnatal care, ANC follow up during pregnancy, place of delivery and distance from health institution were found to be determinants of postnatal service utilization.\u003c/p\u003e\n\u003cp\u003eThis study showed that educational status of the mother has positive association with postnatal care service utilization. This finding is in line with the findings of previous study conducted in Nepal [27] .report of Ethiopian Demographic Health Survey 2011 [20]and Jabtine district, Ethiopia [25].This is may be due to the reason that better education increases access to information and risk perception which in turn increase health-seeking behavior.\u003c/p\u003e\n\u003cp\u003eKnowledge of mother on postnatal care was found to be determinant of postnatal care service utilization. \u0026nbsp;Where mother who had adequate knowledge on postnatal care utilized postnatal care service better than mother who had inadequate knowledge of postnatal care. This can be explained by the fact that awareness on postnatal care is an important factor that motivates a woman and her families to attend health care services at the earliest opportunities with the intention of prevention, early detection and getting managed for postpartum danger signs.\u003c/p\u003e\n\u003cp\u003eIn this study, utilization of ANC service during pregnancy was one of the determinants of postnatal care service utilization. Postnatal care services utilization was higher among mothers who visit ANC during pregnancy as compared to mothers who had not visit ANC. This\u0026nbsp; is consistent with the analysis of the 2011 EDHS [27] and with study conducted in This result was comparable with those of studies finding in Diga, Amigna, and Lemo district, Ethiopia [17-19, 27]. this\u0026nbsp; may be explained by the reason that attending ANC provides a pregnant woman to obtain necessary health information on possible preparation for childbirth, and also on postnatal service utilization after delivery.\u003c/p\u003e\n\u003cp\u003eThe study finding showed that the odds of PNC care non-utilization was more than one times\u0026nbsp; \u0026nbsp;higher among women who gave birth at home compared to those who gave birth in the health facility. The result is in agreement with studies conducted in Gondar zuria, Amhara region[22]. and Diga district, Oromiya region[18].This finding is also supported by a study conducted in Nigeria [28] .The possible reason could be if a mother gave birth at home, the adequacy of receiving advice and knowing the postnatal care benefits is low that can significantly reduce the services seeking behavior. This might be attributed to the fact that women who gave their last birth at home have lesser opportunities to get exposed to health education-related to PNC services at the time of delivery and thus get no access to learn about the types, benefits, and availabilities of PNC services.\u003c/p\u003e\n\u003cp\u003eIn this study, a woman who traveled at most one hour to reach the nearby health institution is more likely utilized postnatal care services than those who traveled more than one hour. This finding is in agreement with reports of other studies [22, 24].where distance from health institution remains a problem in postnatal care service utilization. This might be because having nearby health facility increases access to health information and reduces distance barriers leading to better utilization of services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source of data for this study was based on the self-reporting of respondents; this might have some limited validation of information obtained from the subjective source. Moreover, the women might have experienced recall bias, particularly regarding the services they received during their previous postnatal services\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the educational status of the mother, ANC utilization during pregnancy, inadequate knowledge of post-natal care utilization, Distance from nearest health facility and having home delivery were all determinants of post-natal care non utilization\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eANC: Antenatal Care\u003c/p\u003e\n\u003cp\u003eCI: Confidence Intervals\u003c/p\u003e\n\u003cp\u003eCOR: Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003ePNC: Postnatal Care\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for Social Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Ethical Review Board of Adama general Hospital Medical College The study\u0026rsquo;s proposal was formally presented to both the Oromia Regional Health Office and the Adama District Health Office to secure official approval for carrying out research activities within the selected kebeles. Participants were informed of the study's purpose and benefits during the data collection period and informed written consent was obtained to ensure their decision to participate or refuse. To uphold respondents' rights and ensure confidentiality, anonymity, and privacy, safeguards were enacted, and all of the study's procedures followed the principles outlined in the Helsinki Declaration [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data and materials are available from the corresponding author without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding from any funding agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere appreciation to Adam Hospital Medical College, along with the Adama district health office, for their invaluable assistance throughout the study. Special thanks are also extended to the dedicated team of data collectors, supervisors, and all the study participants for their crucial contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYAB contributed to the conception and design of the study, as well as the data curation, and analysis. YA, YMN, MSG, and BLS drafted the manuscript. YMN critically reviewed the draft manuscript and wrote the final version. MAK and WDG advised the study. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. World Health Statistics 2016 [OP]: Monitoring Health for the Sustainable Development Goals (SDGs). World Health Organization; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. Trends in maternal mortality: 1990\u0026ndash;2015: estimates from WHO, UNICEF, UNFPA, world bank group and the United Nations population division. World Health Organization; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. WHO recommendations on postnatal care of the mother and newborn. World Health Organization; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMwangi A et al. Strength postnatal care Serv including postpartum family Plann Kenya 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCommission NP. Nigeria demographic and health survey 2013. National Population Commission, ICF International; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawn JE et al. \u003cem\u003eNewborn survival.\u003c/em\u003e Disease Control Priorities in Developing Countries. 2nd edition, 2006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaudel M, et al. Determinants of postnatal service utilization in a western district of Nepal: community based cross sectional study. J Women\u0026rsquo;s Health Care. 2013;2(126):2167\u0026ndash;0420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoreng KT, B\u0026eacute;hague DP. Lives in the balance: The politics of integration in the Partnership for Maternal, Newborn and Child Health. Health Policy Plann. 2016;31(8):992\u0026ndash;1000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu L, et al. District-level health management and health system performance: the Ethiopia primary healthcare transformation initiative. Int J Health Policy Manage. 2022;11(7):973.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarega B, et al. Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study. BMC Pregnancy Childbirth. 2016;16:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaba M, et al. Maternal health service utilization in urban slums of selected towns in Ethiopia: qualitative study. Ethiop J Health Dev. 2017;31(2):96\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt H, Mehring S, McMillan J. Interpreting the Declaration of Helsinki (2008): Must, Should and Different Kinds of Obligation. Med L. 2010;29:565.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorku AG, Yalew AW, Afework MF. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int health Hum rights. 2013;13:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerhe A, et al. Determinants of postnatal care utilization in Tigray, Northern Ethiopia: A community based cross-sectional study. PLoS ONE. 2019;14(8):e0221161.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLimenih MA, Endale ZM, Dachew BA. Postnatal care service utilization and associated factors among women who gave birth in the last 12 months prior to the study in Debre Markos Town, Northwestern Ethiopia: a community-based cross‐sectional study. Int J reproductive Med. 2016;2016(1):7095352.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunabi-Babigumira S, et al. Factors that influence the provision of postnatal care by health workers: a qualitative evidence synthesis. The Cochrane Database of Systematic Reviews; 2021. 2021(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelachew T, Taye A, Belachew T. Postnatal care service utilization and associated factors among mothers in Lemo Woreda, Ethiopia. J Women\u0026rsquo;s Health Care. 2016;5(104172):2167\u0026ndash;0420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeyi WD, Deshi MM, Erana MG. Determinants of postnatal care service utilization in diga district, east wollega zone, wester Ethiopia: case-control study. Ethiop J Reproductive Health, 2018. 10(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKifle A, Sena L, Jarso H. Determinants of postnatal care service utilization, Amigna District, Arsi Zone, Southeast Ethiopia: a case-control study. J Women\u0026rsquo;s Health Care. 2018;7(448):2167\u0026ndash;0420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAseweh Abor P, et al. The socio-economic determinants of maternal health care utilization in Ghana. Int J Soc Econ. 2011;38(7):628\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTumbure A et al. Assessment of postnatal care service utilization and associated factors in Asella town, Arsi zone, Oromiya regional state, Ethiopia. Glob J Reprod Med, 2018. 6(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfahun F, et al. Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District, Ethiopia: a cross-sectional study. Matern Child Health J. 2014;18:2341\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuruvilla S, et al. Success factors for reducing maternal and child mortality. Bull World Health Organ. 2014;92:533\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHordofa MA, et al. Postnatal care service utilization and associated factors among women in Dembecha District, Northwest Ethiopia. Sci J Public Health. 2015;3(5):686\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorkineh YG, Hailu DA. Factors affecting utilization of postnatal care service in Jabitena district, Amhara region, Ethiopia. Sci J Public Health. 2014;23(3):169\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlemayeh H, Assefa H, Adama Y. Prevalence and factors associated with post natal care utilization in Abi-Adi Town, Tigray, Ethiopia: a cross sectional study. IJPBSF Int J Pharm Biol Sci Fundamentals. 2014;8(01):23\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomefun OD, Ibisomi L. Determinants of postnatal care non-utilization among women in Nigeria. BMC Res Notes. 2016;9:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Determinants, postpartum care, non-utilization, Adama District","lastPublishedDoi":"10.21203/rs.3.rs-4997729/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4997729/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMaternal and neonatal mortality remain a significant problem across much of the developing world, especially in sub-Saharan Africa countries. In Ethiopia, most maternal and neonatal deaths occur during the postpartum period; this is a critical time for monitoring the health of women and newborns, but the most neglected period for care. In rural communities of Ethiopia, the utilization of postnatal care service is very low and evidence on which factors contribute to the non-utilization of postnatal care (PNC) is insufficient. Consequently, this study was designed to identify the determinants of postnatal service non-utilization among women who gave birth in Adam district, East central Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based unmatched case-control study was conducted among 186 cases (postnatal care non-utilizers) and 186 controls (postnatal care utilizers) in Adama district from January 1 to February 10, 2024. A previously tested interviewer-administered structured questionnaire was used for data collection. Binary logistic regression analysis was performed. In the final multivariable logistic regression analysis model, a p-value of less than 0.05 and an Adjusted Odd Ratio (AOR) with a 95% confidence interval was used to determine variables for postnatal care non-utilization.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eEducational status (no formal education) (AOR\u0026thinsp;=\u0026thinsp;2.70; 95% CI: 1.23\u0026ndash;1.75. Inadequate knowledge of post-natal (AOR\u0026thinsp;=\u0026thinsp;4.6; 95% CI; 1.80\u0026ndash;5.90). Having no ANC attended (AOR\u0026thinsp;=\u0026thinsp;2.00; CI: 1.30\u0026ndash;5.20).home delivery (AOR\u0026thinsp;=\u0026thinsp;1.7; 95% CI: 1.40\u0026ndash;4.50). And distance from the nearest health facility were independent determinants of postnatal non utilization\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study revealed that educational statues, home delivery, no ANC non-attendance, inadequate knowledge on post-natal care, home delivery found to be the determinants of PNC service non utilization. Therefore, encouraging ANC, institutional delivery, along with integrated and improving awareness on postnatal care services, will improve postnatal care service utilization in the districts of Ethiopia.\u003c/p\u003e","manuscriptTitle":"Determinants of postnatal care non-utilization among women in adama district, East Shwoa Ethiopia a community-based unmatched case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 11:45:10","doi":"10.21203/rs.3.rs-4997729/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0ca5666b-992b-48fa-bf85-51731e38eac6","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-04T11:45:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-04 11:45:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4997729","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4997729","identity":"rs-4997729","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}