Award Date

12-1-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Committee Member

Rebecca Benfield

Second Committee Member

Jennifer Vanderlaan

Third Committee Member

Jinyoung Kim

Fourth Committee Member

Jennifer Pharr

Abstract

Purpose: This study aimed to identify potential factors associated with immediate postnatal care in Laotian women. Background: The World Health Organization recognizes that approximately half of all maternal deaths occur in the immediate postnatal period or 24 hours after birth. One crucial step to improving maternal mortality is a postnatal check during the first 24 hours following birth. Forty-seven percent of Lao women aged 15-49 who delivered a baby in the last two years received a postnatal health check in the first two days after delivery. Of these, 46.5% of postnatal checks were conducted prior to discharge from the facility or before the provider left the home. After leaving the presence of a provider, 98.5% of these women never received another postnatal check. The conceptual framework underpinning the selection of factors included in this study draws from The Behavioral Model of Health Services Use. The study's predisposing, enabling, and need variables are based on previous research and the conceptual model. Identifying factors associated with Laotian women who do not receive immediate postnatal care (PNC) will allow health officials to develop targeted interventions to decrease maternal mortality. Methods: A secondary data analysis of the Lao PDR MICS 2017 data set was completed to identify factors associated with immediate PNC. Immediate postnatal care is defined as the care provided in the first 24 hours from birth. Participants were eligible if they were women between the ages of 15-49 who had a live birth two years before the study. Participants were excluded if they had a stillbirth or miscarriage. Pearson's chi-square identified differences in factors associated with women receiving immediate PNC. Univariate and multivariate analyses identified factors associated with immediate PNC utilization. Results: The sample included 4,460 participants, 2,451 (55.2%) did not receive immediate PNC, while 1,999 (44.8%) did receive immediate postnatal care. The predisposing and enabling factors, age, head of household education, religion, region, media exposure, and wealth were associated with decreased immediate PNC utilization. Need factors, including parity, delivery location, and delivery assistant, identified target populations for intervention. Women with four or more births were less likely to receive immediate PNC than a first birth (OR=0.58, 95% CI [0.42-0.79]). Women delivering in a government health center were less likely to receive immediate PNC than those delivering in a private facility (OR= 0.14, 95% CI [0.04-0.47]). Women delivering with a nonskilled attendant (OR=0.33, 95% CI [0.22-0.51]) were less likely to receive immediate PNC than those delivering with a doctor. Implications: Identified populations from this study should be the foundation for targeted interventions to improve immediate postnatal care in Lao PDR. Multiparous women could be a target population for intervention to obtain a higher rate of immediate PNC, secondarily decreasing the likelihood of postpartum hemorrhage and infection. The Lao PDR government could increase the number of providers providing immediate PNC in government health centers and hospitals. This intervention will increase facility births and skilled birth attendance two-fold. This data supports these targeted interventions for decreasing maternal mortality and morbidity in Lao PDR.

Keywords

immediate postnatal care; MICS; secondary data analysis; women's health

Disciplines

Nursing

File Format

pdf

File Size

1354 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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