Early postnatal care uptake and its associated factors following childbirth in East Africa: a Bayesian hierarchical modelling approach

Provisionally accepted

The postnatal period is crucial for the health of both mothers and newborns. Lack of early postnatal care (PNC) within the first two days can be life-threatening. Despite its importance, there is limited data on PNC utilization in East Africa. This study aimed to investigate the pooled prevalence and factors influencing PNC usage among women after delivery in East African countries using a Bayesian multilevel modeling approach.
We retrieved secondary data from the Kids Record demographic and health surveys conducted from 2015 to 2022 across 10 East African countries, involving 77,052 weighted women. Data analysis was performed using R 4.3.2 software, employing Bayesian multilevel logistic regression models. Various techniques, including Rhat and effective sample size, were used to estimate model parameters through Hamiltonian Monte Carlo (HMC) methods. An adjusted odds ratio with a 95% credible interval was utilized to identify significant associations with PNC.
The overall pooled prevalence of PNC within 48 hours of delivery was about 52% (95% CrI: 39-66). Higher rates of PNC utilization were observed among women aged 25-34 years (AOR=1.21) and 35-49 years (AOR=1.61) compared to those aged 15-24 years. Women with primary (AOR=1.96) and secondary/higher education (AOR=3.19) showed increased PNC usage compared to uneducated women. In contrast, divorced or widowed women (AOR=0.83), working women (AOR=0.90), and wealthier women had lower rates of PNC.

At the community level, rural women (AOR=0.76) and those from communities with lower media exposure also faced barriers to accessing PNC.
Addressing the underutilization of PNC remains a significant public health priority in East Africa. Enhancing maternity and child health services, collaborating with stakeholders, and educating mothers about child health are essential steps in reducing health disparities.