Factors associated with non-utilization of postnatal care among newborns in the first 2 days after birth in Pakistan: a nationwide cross-sectional study

Figures & data

Figure 1. The study theoretical framework was adapted from Andersen’s behavioral model

Table 1. Distribution of characteristics, unadjusted and adjusted odd ratios (OR) for factors associated with non-utilisation of postnatal care services in Pakistan, 2017–18 Demographic and Health Survey (PDHS)

			Unadjusted‡	Adjusted‡
Variable	N	%*(95%CI)	OR (95%CI)	OR (95%CI)
Community factor
Residence type
Urban	1285	24.4(20.9–28.4)	Ref
Rural	2602	43.4 (39.2–47.7)	2.37 (1.81–3.11)
Region
Punjab	2049	32.5 (27.2–38.3)	Ref	Ref
Sindh	903	27.3 (22.8–32.4)	0.78 (0.55–1.11)	0.64 (0.45–0.91)
Khyber Pakhtunkhwa	620	55.6 (49.3–61.7)	2.60 (1.82–3.71)	2.33 (1.65–3.30)
Balochistan	197	60.8 (53.5–67.6)	3.22 (2.18–4.76)	1.43 (0.92–2.20)
Islamabad (ICT)	31	21.5 (15.7–27.2)	0.57 (0.38–0.85)	0.82 (0.55–1.22)
FATA	87	68.3 (60.2–75.4)	4.46 (2.89–6.89)	3.36 (2.19–5.15)
Socio-demographic factor
Household wealth index
Rich	752	13.8 (10.6–17.9)	Ref
Middle	1558	33.0(29.0–37.3)	3.07 (2.19–4.29)
Lower	1578	52.3 (47.5–57.1)	6.83 (4.74–9.82)
Mother’s education
Secondary or higher	1436	21.0 (17.7–24.6)	Ref	Ref
Primary	613	36.4 (30.7–42.5)	2.16 (1.59–2.93)	1.49 (1.06–2.09)
No education	1839	50.0 (45.7–54.3)	3.77 (2.88–4.94)	1.72 (1.28–2.30)
Mother’s working status
Working	486	35.0(28.7–42.0)	Ref
Not-working	3401	37.4 (34.0–41.0)	1.11 (0.82–1.50)
Mother’s age
<20	355	46.0 (39.1–53.1)	Ref
20–34	3118	35.2 (31.8–38.8)	0.82 (0.68–0.99)
35–49	415	44.2 (37.0–51.6)	1.27 (0.92–1.75)
Marital status
Currently married	3851	37.3(34.0–40.6)	Ref
Formerly/never married	36	23.9 (9.8–47.5)	0.52 (0.18–1.53)
Father’s education
Secondary/higher	2109	28.2 (24.8–31.8)	Ref
Primary	630	42.1 (35.7–48.7)	1.85 (1.43–2.40)
No education	1102	51.6 (47.1–56.1)	2.72 (2.15–3.43)
Birth rank and birth interval
2 or 3 child, interval >2	1245	32.3(28.1–36.7)	Ref	Ref
First child	927	31.8 (26.9–37.2)	0.98 (0.76–1.25)	1.37(1.01–1.85)
2 or 3 child, interval≤2	817	35.2 (30.7–39.9)	1.14 (0.90–1.44)	1.25 (0.94–1.67)
4 or more child, interval>2	595	51.1 (45.6–56.6)	2.19 (1.69–2.85)	1.62 (1.16–2.28)
4 or more child, interval≤2	302	51.4 (43.7–58.9)	2.22 (1.54–3.20)	1.41 (0.87–2.27)
Child sex
Male	1955	35.9 (32.1–40.0)	Ref
Female	1932	38.3(34.8–42.0)	1.11 (0.94–1.30)
Health knowledge factor
Frequency of reading newspaper or magazine
At least once a week	186	14.3(8.83–22.3)	Ref
Less than once a week	334	24.2(19.1–30.2)	1.92(1.07–3.44)
Never	3365	39.7(36.3–43.2)	3.95 (2.23–6.98)
Frequency of listening to radio
At least once a week	147	28.5(20.7–37.8)	Ref
Less than once a week	178	33.6(24.2–44.5)	1.27(0.72–2.25)
Never	3563	37.7(34.3–41.2)	1.52 (0.98–2.37)
Frequency of watching TV
At least once a week	1819	26.8(23.2–30.8)	Ref
Less than once a week	436	29.4(23.2–36.5)	1.14(0.81–1.60)
Never	1632	50.7(46.4–55.0)	2.81 (2.19–3.60)
Enabling factor
Seek permission to visit health services
Not a big problem	2975	33.8(30.1–37.6)	Ref
Big problem	909	48.3 (43.4–53.2)	1.83 (1.45–2.32)
Getting money to pay for health services
Not a big problem	2637	31.7 (28.1–35.5)	Ref
Big problem	1247	48.7(44.6–52.9)	2.05 (1.67–2.51)
Distance to health facility
Not a big problem	2111	30.8 (27.1–34.7)	Ref
Big problem	1773	44.7 (40.3–49.3)	1.82 (1.44–2.31)
Want to be accompanied to health facility
Not a big problem	1370	32.5(28.1–37.2)	Ref
Big problem	2515	39.7(35.9–43.7)	1.37 (1.08–1.74)
Need factor
Wanted pregnancy at the time
Wanted then	3363	37.1(33.6–40.6)	Ref
Wanted later	308	34.0 (27.4–41.4)	0.88 (0.63–1.23)
Unwanted	216	42.6 (33.7–52.0)	1.26 (0.87–1.83)
Perceived baby size by their mother
Large	239	31.1(24.5–38.7)	Ref	Ref
Average	2780	35.3(32.0–38.8)	1.21(0.86–1.70)	1.19(0.79–1.79)
Small	857	44.0(39.0–49.2)	1.74 (1.24–2.43)	1.65 (1.10–2.47)
Previous use of health services factor
Delivery assistance
Health professional⸇	2602	21.1 (18.6–23.8)	Ref
Non-health professional±	1243	70.4 (65.8–74.7)	8.21 (6.33–10.7)
Mode of delivery
Non-caesarean	2884	47.6 (44.1–51.2)	Ref
Caesarean section§	68	6.8 (4.8–9.5)	0.08 (0.06–0.12)
Place of delivery
Healthcare facility	2761	21.3 (18.9–23.9)	Ref	Ref
Non-healthcare facility¥	1114	76.5 (72.0–80.5)	12.1 (9.25–15.7)	10.4 (7.78–13.9)

N, weighted total number of babies eligible for postnatal care services across each of the categories between 2012–13 and 2017–18 as reported by mothers interviewed during the survey; OR, odd ratio; CI, confidence interval; Ref, reference category; *, weighted prevalence of babies who did not receive any postnatal check during the first 2 days after birth; FATA, Federally Administered Tribal Areas; TV, television; ICT, Islamabad capital territory; §, Caesarean section is a combination of elective and emergency procedures; ‡,missing values were excluded from the mode;. ¥, refers to home facility; ±, Dai or traditional birth attendant; ⸇, doctor, nurse, midwife, lady health visitor, or community midwife.

Table 2. Population attributable risk (PAR) for adjusted significant factors

Variable	%~	Adjusted‡† OR	PAR**	PAR (95%CI)
Region
Punjab	0.46	1.00
Sindh	0.17	0.64	–
Khyber Pakhtunkhwa	0.24	2.33	0.14	0.14 (0.0–70.20)
Balochistan	0.08	1.43	–	–
Islamabad (ICT)	0.05	0.82	0.03	0.03 (0.0–20.05)
FATA	0.04	3.36	–
Mother’s education
Secondary or higher	0.21	1.00
Primary	0.15	1.49	0.05	0.05 (0.01–0.10)
No education	0.64	1.72	0.27	0.27 (0.13–0.38)
Birth rank and birth interval
2 or 3 child, interval >2	0.28	1.00
First child	0.20	1.37	0.05	0.05 (0.00–0.11)
2 or 3 child, interval≤2	0.20	1.25	–	–
4 or more child, interval>2	0.21	1.62	0.08	0.08 (0.02–0.13)
4 or more child, interval≤2	0.11	1.41	–	–
Perceived baby size by their mother
Large		1.00
Average	0.69	1.19	–
Small	0.26	1.65	0.10	0.10 (0.22–0.29)
Place of delivery
Healthcare facility⸇	0.41	1.00
Non-healthcare facility¥	0.59	10.4	0.53	0.53 (0.47–0.59)

~, weighted proportion of babies who did not receive postnatal check-up between 2012–13 and 2017–18 PDHS; OR, odd ratio; CI, confidence interval; FATA, Federally Administered Tribal Areas; ICT, Islamabad capital territory; ‡, missing values were excluded from the model; –, PAR was not obtained because factors were not significantly associated with non – utilization of postnatal care; **, PAR was calculated using similar formula described by previous studies [11,13,21], that is, PAR = ~ × ((adjusted OR−1)/adjusted OR); †, the adjusted model included place of residence; region; household wealth index; mother’s education, working status, age, marital status, father’s education, birth order and birth interval, child sex, frequency of (reading newspaper/magazine, listening to radio, watching television), permission to visit health services, money to pay for health services, distance to health facility, want to be accompanied to health facility, desire for pregnancy; place of birth; delivery assistance; mode of delivery and child’s body size at birth; ¥, refers to home facility; ⸇, doctor, nurse, midwife, lady health visitor, or community midwife.

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