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Spatial patterns and determinants of postnatal care use in Ethiopia: findings from the 2016 demographic and health survey
  1. Malede Mequanent Sisay1,
  2. Tesfahun Taddege Geremew2,
  3. Yeshambel Worku Demlie2,
  4. Asaye Tariku Alem3,
  5. Desalew Kassahun Beyene4,
  6. Melkitu Fentie Melak5,
  7. Kassahun Alemu Gelaye1,
  8. Tadesse Awoke Ayele1,
  9. Asrat Atsedeweyn Andargie1
  1. 1 Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia
  2. 2 West Gojjam Zone Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia
  3. 3 North Gondar Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia
  4. 4 Awi Zone Health, Amhara National Regional Health Bureau, Bahir Dar, Amhara, Ethiopia
  5. 5 Human Nutrition, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia
  1. Correspondence to Malede Mequanent Sisay; maledecsa{at}


Objective Postnatal care (PNC) is essential for preventing maternal and newborn deaths; however, it still remains less well recognised in low-income and middle-income countries. This study was aimed to explore geographical patterns and identify the determinants of PNC usage among women aged 15–49 years in Ethiopia.

Methods A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. A total of 7193 women were included in this analysis. We employed spatial scan statistics to detect spatial inequalities of PNC usage among women. A multilevel binary logistic regression model was fitted to identify factors associated with women’s PNC.

Results The prevalence of PNC usage among women was 6.9% (95% CI 6.3% to 7.5%). The SaTScan spatial analysis identified three most likely clusters with low rates of PNC use namely southwestern Ethiopia (log likelihood ratio (LLR)=18.07, p<0.0001), southeast Ethiopia (LLR=14.29, p<0.001) and eastern Ethiopia (LLR=10.18, p=0.024). Women with no education (Adjusted Odd Ratio (AOR)=0.55, 95% CI 0.37 to 0.84) and in the poorest wealth quantile (AOR=0.55, 95% CI 0.39 to 0.78) were less likely to use PNC, while women aged 35–49 years (AOR: 1.75, 95% CI 1.01 to 3.04) and with at least four antenatal care (ANC) visits (AOR=2.37, 95% CI 1.71 to 3.29) were more likely to use PNC.

Conclusion PNC usage remains a public health problem and has spatial variations at regional levels in the country. Low prevalence of PNC was detected in the Somali, Oromia, Gambella and Southern Nations, Nationalities, and People’s Region (SNNPR) regions. Women with low educational status, old age, being in poorest wealth quantile and history of ANC visits were significantly associated with PNC usage. Hence, it is better to strengthen maternal health programmes that give special emphasis on health promotion with a continuum of care during pregnancy.

  • postnatal care
  • demography and health survey
  • maternal medicine
  • primary care
  • public health

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  • Contributors TTG, YWD, ATA and DK conceptualised and designed the study. MMS, MFM, TTG, YWD, ATA and DK carried out the literature review, data extraction and analysis. MMS drafted the manuscript. KA, TA, AAA and MFM participate in data analysis and reviewed the manuscript. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All relevant data are available within the manuscript. However, the minimal data underlying all the findings in the manuscript will be available upon request.

  • Patient consent for publication Not required.

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