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Background: The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia., Methods: A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively., Results: The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization., Conclusion and Recommendation: The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia., Competing Interests: No author has competing interest.

Background: Postpartum depression explains various groups of depressive symptoms and syndromes that can take place during the first 6 weeks following birth. The postpartum period is a critical time where both mild and severe mood disorders can occur. The familiar forms are baby blues and postpartum depression. Understanding the prevalence and associated factors of postpartum depression is mandatory for early detection and treatment., Methods: Institution based cross-sectional study was conducted from 1st May to June 30, 2018. The study participants were eligible women who came to Debre Berhan referral hospital and health centers for postnatal care and vaccination service. The Edinburgh postnatal depression scale was used to assess postpartum depression. A systematic random sampling technique was used to collect the data after determining the skip fraction (k = 2). The collected data were coded and entered into Epi-info version 7 and transported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression were done to identify associated factors. During bivariate analysis, variables with p-value < 0.05 were included in multivariate analysis. Odds ratios and their 95% confidence intervals were computed and variables with p-value less than 0.05 were considered to declare significantly associated factors (multivariate analysis)., Results: A total of 308 mothers who attended postpartum care we're included, which was a 100% response rate. The prevalence of postpartum depression was found to be 15.6% (95%CI = 11.7, 19.8). Being widowed/widower, having poor social support, having a current hospitalized child, and experienced a death of family member or close relative were significantly associated with postpartum depression., Conclusions: The prevalence of postpartum depression was lower than most studies done in different areas. Major life events and traumas are associated with an increased risk of postpartum depression. Health professionals should be aware of the mother's circumstances during the puerperium, they should initiate support to reduce the risk of depression in the postpartum period. Health care professionals working postpartum care clinics should give special attention to mothers who are widowed/widower, have poor social support, have a current hospitalized children, and experienced a death of family member or close relative.

Introduction: Above half of mothers in Ethiopia give birth at home. Home based care within the first week after birth as a complementary strategy to facility-based postnatal care service is critical to increase the survival of both mothers and newborns. However, evidence on utilization of postnatal care and location of service among mothers who delivered at home in Ethiopia is insufficiently documented. Therefore, this study assessed the magnitude and determinants for place of postnatal care service utilization among mothers who delivered at home in Ethiopia., Methods: We used the 2016 Ethiopian Demographic and Health Survey, and extracted data from 4491 mothers who delivered at home during 5 years preceding the survey. A multinomial logistic regression model was applied to examine the determinants of both facility and home -based postnatal care service utilization. Likelihood ratio test was used to see the model fitness and p-value of < 0.05 was used to determine statistical significance at 95% confidence interval., Results: From the total 4491 mothers who delivered at home, only 130(2.9%) and 236(5.3%) of them utilized postnatal service at home and at a health facility respectively. Being from an urban region (AOR = 0.378, 95%CI: 0.193-0.740), ever using the calendar method to delay pregnancy (AOR = 0.528, 95%CI: 0.337-0.826), receiving four and above antenatal care visits (AOR = 0.245, 95%CI: 0.145-0.413) and having a bank account (AOR = 0.479, 95%CI: 0.243-0.943) were the factors associated with utilizing home- based postnatal care. Similarly being a follower of the orthodox religion (AOR = 1.698, 95%CI: 1.137-2.536), being in the rich wealth index (AOR = 0.608, 95%CI: 0.424-0.873), ever using the calendar method to delay pregnancy (AOR = 0.694, 95%CI: 0.499-0.966), wantedness of the pregnancy (AOR = 0.264, 95%CI: 0.352-0.953), receiving four and above antenatal care visits (AOR = 0.264, 95%CI: 0.184-0.380) and listening to radio at least once a week (AOR = 0.652, 95%CI: 0.432-0.984) were the determinants of facility-based postnatal care utilization., Conclusion: The coverage of postnatal care service utilization among mothers who delivered at home was very low. Living in urban region, following the Orthodox religion, having higher wealth index, having a bank account, ever using calendar method to delay pregnancy, wantedness of the pregnancy, receiving four and above antenatal care visit and listening to radio at least weakly were associated with postnatal care service utilization. Therefore, targeted measures to improve socio-economic status, strengthen the continuum of care, and increase health literacy communication are critically important to increase postnatal care service utilization among women who deliver at home in Ethiopia.

Objective: The aim of this study was to assess the magnitude, patterns and predictive factors of unhealthy practice among mothers during pregnancy, childbirth, postnatal and newborn care in Southern Ethiopia., Results: Among the total participants, 29.0% mothers performed at least one unhealthy practice during pregnancy, childbirth, postnatal period and newborn care. This study identified the following harmful practices such as food prohibition (53.2%), home delivery (41.5%), discarding colostrum (18.6%), application of substance on the cord stump (12.1%), delayed breast feeding (28.4%), prelacteal feeding (43.0%) and early bathing (49.3%). Being grand multiparous (AOR = 2.528, 95% CI 1.037-6.166), being illiterate (AOR = 7.611, 95% CI 2.375-24.396) and lack of awareness on the effect of unhealthy practice (OR = 4.673, 95% CI 1.163-18.774) were independent predictors of outcome variable.

Introduction: Globally, 289,000 women die from complications related to pregnancy, childbirth, or the postnatal period every year. Two-thirds of all maternal deaths occur during the first six weeks following birth and more than two thirds of newborn deaths occur during the first week of life, These statistics underscore the importance of postnatal care, an often neglected service according to the World Health Organization (WHO). The purpose of this study was to assess the factors associated with postnatal service utilization in the Tigray region of Ethiopia., Methods: The study was a community-based, cross-sectional study. A multi-stage sampling method was used to select study districts randomly from the entire region. A total of 1,690 participants were selected using systematic random sampling. Participants were 18-49 years old, had given birth within the last six months, and were residents of the district for at least six months. Using SPSS version 20 means, frequencies, and percentages were calculated for the sub-group of participants who did attend postnatal care. Barriers to non-attendance of postatal care were analyzed using descriptive statistics. Bivariate analysis was undertaken to assess the association between demographic, obstetric, and knowledge regarding PNC and attendance at antenatal care. Variables with a P value, <0.05 were included in the multivariate logistic regression analysis to identify the determinant factors of postnatal care utilization., Result: Of the women surveyed, 132 (8%) obtained postnatal care. Women who did not receive postnatal care reported lack of awareness of the services (n = 1110, 73.3%). Most mothers who received postnatal care reported that they were aware of the service prior to the birth of their child (n = 101, 76.5%). Women were more likely to receive postnatal services if they lived in an urban area (odds ratio 1.96, 95% confidence interval 1.07, 3.59), had greater than a secondary education (OR 3.60, 95% CI 1.32,9.83), delivered by cesarean section (OR 2.88 95% CI 1.32,6.29), had four or more antenatal visits (OR 4.84, 95% CI 1.57,14.9), or had a planned pregnancy (OR 6.47, 95% CI 2.04,20.5)., Conclusion: Postnatal care service utilization is very low in Tigray region. Interventions targeted at increasing women's awareness of the importance of postnatal services and improving accessibility, particularly in rural areas, is needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Postnatal period presents the highest risk of death for mothers and newborns. Although progress has been made in expanding the coverage for most of maternal health services, national prevalence of postnatal care service utilization in Ethiopia is still extremely limited. Hence, this study aims to determine the prevalence and factors associated with complete postnatal care service utilization in Northern Shoa, Ethiopia., Methods: Community based cross-sectional survey was conducted between November 2016 and February 2017. A total of 510 mothers were included in the study using multistage sampling technique. The data were collected through face-to-face interview. Bivariate and multivariate logistic regression models were fitted to identify factors associated with complete postnatal care utilization at p value of < 0.05. SPSS version 20 was used to analyze the data., Results: The prevalence of complete postnatal care utilization was found to be 28.4% in the study area. Mode of delivery (AOR=5.7, 95% CI = 3.9, 19), number of children (AOR= 2.5 95% CI, 1.4, 14.2), and level of education (AOR=3.2 95% CI, 1.1, 9.2) were the factors statistically associated with complete postnatal service uptake. Being healthy was the major (48.8%) reason mentioned for not complying with the recommended three postnatal visits., Conclusion: The prevalence of complete postnatal care service in the study area was found to be low, and it is far less than the targeted zonal and regional plan. Reinforcing the existing policies and strategies to increase women level of awareness about postnatal care and intensive counseling during antenatal care and delivery are the recommendations based upon the current finding.

Background: Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia., Methods: A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance., Results: The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services., Conclusions: Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Background: Neonatal danger has become a substantial problem in many developing countries like Ethiopia. More specifically, neonatal rates in Ethiopia are among the highest in the world. In this regard, health-seeking behavior of mothers for neonatal care highly relies on their knowledge about neonatal danger sign, and it has been hardly investigated. Therefore, this study was intended to determine the level of mother's knowledge about neonatal danger signs and to identify factors associated with good mother's knowledge., Methods: Community-based cross-sectional study was conducted from February to May 2014. A multi-stage sampling technique was used to select 603 mothers. A structured, pre-tested, and interview-administered questionnaire comprehending 13 neonatal danger signs was employed to collect the data. Data were entered into EPI-Info 3.5.2 and analyzed by SPSS version 16. Binary logistic regression model was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength and significant level of the association., Results: All mothers expected to participate in the study were interviewed. The results of the study showed that mothers who had knowledge of three or more neonatal danger signs (good knowledge) were found to be 18.2% (95% CI 15.1, 21.3%). The odds of having good knowledge was positively associated with mother's (AOR = 3.41, 95% CI 1.37, 8.52) and father's (AOR = 3.91, 95% CI 1.23, 12.36) higher educational achievement. Similarly, the odds of having good knowledge about neonatal danger signs was higher among Antenatal care (AOR = 2.28, 95% CI 1.05, 4.95) and Postnatal care attendant mothers (AOR = 2.08, 95% CI 1.22, 3.54). Furthermore, access to television was also associated with mothers' good knowledge about neonatal danger signs (AOR = 3.49, 95% CI 1.30, 9.39)., Conclusion: Maternal knowledge about neonatal danger signs was low. Therefore, intervention modalities that focus on increasing level of parental education, access to antenatal and postnatal care and PNC service, and advocating the use of television was pinpointed.

Background: Traditional perinatal practices may protect against postnatal common mental disorders (CMD) in non-Western societies., Aims: To evaluate the association between perinatal practices and postnatal CMD in rural Ethiopia., Method: A population-based sample of 1065 women was followed up from pregnancy until 2 months postpartum. Qualitative investigation informed the development of scales measuring attitudes towards and adherence to perinatal practices. Postnatal CMD was measured using the Self-Reporting Questionnaire., Results: Endorsement of sociocultural perinatal practices was associated with lower odds of antenatal CMD persisting into the postnatal period (adjusted odds ratio (OR) = 0.66, 95% CI 0.45-0.95). Women who endorsed protective and celebratory perinatal practices but were unable to complete them had increased odds of incident (adjusted OR = 7.26, 95% CI 1.38-38.04) and persistent postnatal CMD (adjusted OR = 2.16, 95% CI 1.11-4.23) respectively., Conclusions: There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

Sociocultural patterning of the postnatal period in non-Western settings has been hypothesised to protect against postnatal depression. In 2004, in a predominantly rural area of Ethiopia, we conducted 25 in-depth interviews and five focus group discussions with purposively selected participants including perinatal women, fathers, grandmothers, traditional and religious leaders, birth attendants and community leaders. Our main objectives were (1) to examine societal recognition of problematic distress states in the postnatal period and relate this to Western conceptualisations of postnatal depression and (2) to relate the occurrence of distress states to sociocultural patterning of the postnatal period. Inductive analysis was employed to identify salient themes. Participants spontaneously described culturally problematic distress states occurring in the postnatal period, although did not consider them to be illness. Vulnerability and danger of the postnatal period was emphasised, with risk of supernatural attack and physical harm leading to distress states. Participants also spoke of how gender disadvantage and economic strain intersect with cultural patterning of the postnatal period, threatening mental health due to the resulting disappointed expectations and exclusion, as well as exacerbation of pre-existing problems. Cultural dissonance, where a person's beliefs or actions are out of kilter with strong prevailing cultural norms, may be an important risk factor for postnatal distress in rural Ethiopia, where the postnatal period is extensively culturally elaborated.