QUALITY AND SPATIAL DISTRIBUTION OF IMMEDIATE POSTPARTUM CARE IN ETHIOPIA: A MULTILEVEL ANALYSIS USING PERFORMANCE MONITORING FOR ACTION ETHIOPIA 2023 DATA

Abstract

The immediate postpartum period is associated with a significantly increased risk of morbidity and mortality for both the mothers and newborns. Providing quality immediate postpartum care helps reduce negative outcomes. Most studies conducted in Ethiopia have identified factors associated with postnatal care utilization. However, no evidence links household and community data to service delivery points and their geographic distribution, which are necessary to assess the quality of immediate postpartum care. To assess the quality and spatial distribution of immediate postpartum care in Ethiopia, 2024. We used a cohort of household and facility data from the National Performance Monitoring for Action Ethiopia study, which was conducted in 2023 across four major regions (Amhara, Oromia, South Ethiopia, and Addis Ababa). A total of 1,351 postpartum women and their newborns were linked to the nearest 264 health facilities. A multilevel binary logistic regression analysis was employed to assess contextual factors. The adjusted odds ratio with a 95% confidence interval (CI) was used to measure the associations between variables, with statistical significance set at P<0.05. The SaTScan V.10.2.5 and ArcGIS V.10.8 geostatistical software were used to explore the spatial distribution and interpolation of the quality of immediate postpartum care. The quality of immediate postpartum care among women and their newborns was 29.8% (95% CI 27%- 32%), ranging from 14.1% in Southern Ethiopia to 40.9% in Addis Ababa. In the multivariable multilevel analysis, religion (AOR=0.51; 95% CI 0.31-0.83), antenatal care visits (AOR=1.78; 95% CI 1.08-2.95), cesarean delivery (AOR=0.45; 95% CI 0.27-0.76), being attended by a nurse/midwife (AOR=1.96; 95% CI 1.26-3.03), urban residence (AOR=1.85; 95% CI 1.05-3.25), birth at private hospitals/clinics (AOR=4.12; 95% CI 2.07-8.51), and higher community media exposure (AOR=2.99; 95% CI 1.76-5.06) were significant predictors of the quality of immediate postpartum care. The spatial distribution of the quality of care varied significantly across regions, with a global Moran’s I = 0.99, P=0.001. Significant hotspots of good-quality care were detected in Addis Ababa. The quality of immediate postpartum care was low in Ethiopia, with significant spatial variation across the country. Therefore, public health interventions should be designed for areas where the quality is low to reduce maternal and newborn mortality by increasing antenatal care visits, increasing community media exposure, and strengthening health systems in rural areas.