Understanding the determinants of postnatal care uptake for babies: A mixed effects multilevel modelling of 2016–18 Papua New Guinea Demographic and Health Survey

Background

Papua New Guinea (PNG) recorded 22 neonataldeaths out of every 1,000 livebirths in 2019. Some of these deaths are relatedto complications that arise shortly after childbirth; hence, postnatal care(PNC) utilisation could serve as a surviving strategy for neonates asrecommended by the World Health Organisation. National level study ondeterminants of PNC uptake in PNG is limited. Utilising the Bronfenbrenner’sEcological Model of Human Development, the study aimed at assessingdeterminants of PNC utilisation for babies by their mothers aged 15–49 in PNG.

Methods

The study used data from the women’s fileof the 2016–18 PNG Demographic and Health Survey (2016–18 PNGDHS) and a sampleof 4,908 women aged 15–49 who had complete information on the variables ofinterest to the study. Nineteen (19) explanatory variables were selected forthe study whereas PNC for babies within first two months after being dischargedafter birth was the main outcome variable. At 95% confidence interval (95% CI),six multilevel logistic models were built. The Akaike Information Criterion(AIC) was used to assess models’ fit. All analyses were carried out using STATAversion 14.0.

Results

Generally, 31% of the women utilised PNCfor their babies. Women with primary education [aOR = 1.42, CI = 1.13–1.78],those belonging to the middle wealth quintile [aOR = 1.42, CI = 1.08–1.87],working class [aOR = 1.28, CI = 1.10–1.49], women who had the four or more ANCvisits [aOR = 1.23, CI = 1.05–1.43], those with twins [aOR = 1.83,CI = 1.01–3.29], women who belonged to community of medium literate class[aOR = 1.75, CI = 1.34–2.27] and those of moderate socioeconomic status[aOR = 1.60, CI = 1.16–2.21] had higher odds of seeking PNC for their babies.The odds to seek PNC services for babies reduced among the cohabiting women[aOR = 0.79, CI = 0.64–0.96], those at parity four or more [aOR = 0.77,CI = 0.63–0.93], women who gave birth to small babies [aOR = 0.80,CI = 0.67–0.98] and residents in the Highlands region [aOR = 0.47,CI = 0.36–0.62].

Conclusions

Maternal education, wealth quintile,occupation, partner’s education, ANC visits, marital status, parity, child sizeat birth, twin status, community literacy and socioeconomic status as well asregion of residence were associated with PNC uptake for babies in PNG.Variation in PNC uptake for babies existed from one community/cluster to theother. There is the need to strengthen public health education to increaseawareness about the benefits of seeking PNC services for babies among women inPNG. Such programs should consider maternal and community/clustercharacteristics in their design.