Research | Open Access | Volume 8 (3): Article 49 | Published: 08 Jul 2025
Menu, Tables and Figures
Table 1: Postnatal consultation coverage, Central Region, Togo, 2020
Table 2: Sociodemographic and economic characteristics among women aged 15 to 49 who had live births, Central Region, Togo, 2020
Table 3: Obstetric and health system-related characteristics among women aged 15 to 49 who had live births, Central Region, Togo, 2020
Table 4: Crude association between sociodemographic and economic characteristics and low postnatal consultation use among women aged 15 to 49 who had live births, Central Region, Togo, 2020
Table 5: Crude association between obstetric and health system-related characteristics and low postnatal consultation use among women aged 15 to 49 who had live births, Central Region, Togo, 2020
Table 6: Characteristics independently associated with low use of postnatal consultation among women aged 15 to 49 who had live births, Central Region, Togo, 2020
Péléké Mawaba Hilim1,&, Jean Kaboré2, Agballa Mébiny-Essoh Tchalla Abalo3, Pauline Yanogo2, Kassouta N’tapi4, Hamadi Simon-Pierre Assane5, Nicolas Meda3, Ghislain Sopoh6
1Direction Préfectorale de la Santé de Tône, Togo, 2Coordination du Programme de formation en épidémiologie et laboratoire de terrain du Burkina Faso (BFELTP) Université Ouaga 1, Professeur Joseph KI–ZERBO, Burkina Faso, 3Direction de la Santé et de la Protection Sociale, Département du Développement Humain, Commission de l’Union Economique et Monétaire Ouest Africaine, 4Direction régionale de la santé-Région Centrale, Togo, 5Direction de la Lutte contre la Maladie et des Programmes de Santé Publique, Ministère de la Santé, Togo, 6Institut Régional de Santé Publique Comlan Alfred Quenum, de Ouidah, Bénin.
&Corresponding author: Péléké Mawaba HILIM, Directeur Préfectoral de la Santé de Tône, Togo, Rue Nassablé BP 57, Dapaong, Togo. Email: hilimalain@yahoo.fr ORCID: https://orcid.org/0009-0004-5277-7441
Received: 03 Jan 2024, Accepted: 08 Jul 2025, Published: 08 Jul 2025
Domain: Maternal and Child Health
Keywords: Postnatal consultation, Low use, Central region, Togo
©Péléké Mawaba Hilim et al Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Péléké Mawaba Hilim et al Factors associated with low uptake of postnatal care in the Central Region, Togo, 2020: case-control study. Journal of Interventional Epidemiology and Public Health. 2025;8:49. https://doi.org/10.37432/jieph-d-25-00004
Introduction: Postnatal care (PNC) helps reduce maternal and neonatal mortality. In the Togo Central Region, PNC coverage is low at less than 50% and the explanatory factors are not documented. We aimed to determine the factors associated with low PNC coverage among women aged 15 to 49 in the region.
Method: We conducted a case-control study with 171 cases and 342 controls. A case was any woman who performed none or only one PNC visit within 42 days of leaving the health facility after a live birth, between December 26, 2019, and November 12, 2020, while a control was any woman who had carried out at least two PNC visits during the same period. The women were selected by systematic sampling. By multivariate logistic regression analysis, factors independently associated with low uptake of postnatal care were identified.
Results: Adequate PNC coverage was 37.4% (95% CI: 36.0 – 38.8). The median age of cases was 25 years (IQR=20-30) and that of controls was 26 years (IQR=21-30), (p=0.056). Lower level education of the partner (aOR=1.82, 95% CI=1.09-3.04), unwanted pregnancy (aOR=2.07, 95% CI=1.32-3, 25), incomplete prenatal consultations (ANC) a(OR=3.14, 95% CI=2.02-4.88), having chronic diseases (aOR=4.89, 95% CI=1.25 -19,14) were independently associated with low uptake of postnatal care.
Conclusion: The study confirmed the low uptake of postnatal care, and associated factors are sociodemographic and clinical. The implementation of strategies to promote universal access to education and universal health coverage will help improve uptake of postnatal care.
Maternal mortality has reached an unacceptable level globally [1,2] and remains a major public health problem [3]. Complications related to pregnancy and childbirth still account for the deaths of approximately 810 women every day worldwide [1], and the majority of these deaths occur in the postnatal period [4–6]. Postnatal care (PNC) consultations are essential to preserve or restore the woman’s health and monitor the condition of the newborn and infant after delivery; it is therefore a health service which contributes to the survival and development of the mother, the newborn and the infant. Togo has made good progress in the use of postnatal care, with initial postnatal care coverage outside the health centre, which increased from 40.37% to 58.6% between 2018 and 2019 [7,8]. However, adequate coverage of these services is still low at 28.13% in 2018 and 45.2% in 2019 [7–10]. Togo recorded a maternal mortality ratio of 401 per 100,000 live births in 2014, [11] while it was 216 maternal deaths per 100,000 live births in 2015[12,13] at the world level.
The World Health Organization (WHO) defines the postnatal period as the first six weeks after giving birth. This is a crucial period for the mother and her newborn [5,14,15]. Several serious complications can occur during this period and lead to maternal, neonatal and infant deaths, particularly in low- and middle-income countries. To overcome these risks, WHO recommends four postnatal visits. Two visits in the immediate postpartum period; the first visit during the first 24 hours and the second in the 48 to 72 hours before leaving the health center. Two visits after leaving the health center; the first between the seventh and fourteenth day after delivery and the second to the sixth week after delivery[16,17]. Studies conducted in other contexts have identified factors associated with the use of postnatal care. Region, place of residence, age group, mother’s education level, mother’s occupation, media exposure, prenatal visits (ANC), place of delivery and access to health centers were determinants of the use of postnatal care in sub-Saharan Africa[18]. A cross-sectional study carried out in Burkina Faso revealed that the woman’s educational level, economic level and decision-making power are factors associated with the use of postnatal consultation [19]. In Nigeria, in a cross-sectional study using the 2013 Demographic and Health Survey, the distance between the locality of residence and the health center, the level of education, the place of delivery, the region and the level of household income was associated with non-utilization of postnatal care services[4].
Although PNC coverage has increased in Togo[7,8], its continued use remains low and the maternal mortality ratio is 6 times higher than the 70 maternal deaths per 100,000 live births recommended by Objective No. 3 of the Sustainable Development Goals (SDGs) [20]. In Togo, no study has addressed the reasons for no or low use of PNC in general and specifically in the Central Region.
Knowledge of these factors in the Central Region will make it possible to reorient, adjust the policy and strategies in place and identify specific ones whose implementation will contribute to reducing maternal, neonatal and child mortality in the Central Region. This study aims to identify the adequate coverage of the use of PNC and the sociodemographic, economic as well as health care system factors associated with the low use of PNC among women aged 15 to 45 in the Central Region of Togo in 2020.
Study setting and study area
Togo’s health system is organised into six health regions: Savanes Kara , Central, Plateaux, Maritime and Greater Lomé Regions. The management of the health system is based on a pyramidal organization at three levels: central, intermediate and peripheral[7]. Togo has retained in its protocol on reproductive health, two postnatal visits apart from the two immediate postpartum visits: the 8th day and the 42nd day after delivery[21]. The Central Region is subdivided into five health districts, namely Blitta, Sotouboua, Tchamba, Mo and Tchaoudjo, with a total population estimated at 777,509 inhabitants in 2019, distributed in 904 villages[7]. With a workforce of 108 health centres in 2019, of public, private and religious, geographical accessibility is 61%. Each health district has a district hospital playing the reference role and a regional hospital in the regional capital. Postnatal care is an integral part of the minimum primary health care package in health centers. The proportion of literate women aged 15 to 49 in the region is 41% and the poverty index is 47.3%[22]. The source of financing for health care comes from households, whose income comes mainly from agriculture and small businesses[23].
Study design and population
An unmatched case control study was conducted among women aged 15-49 in a third of the health centres chosen by simple random sampling in all health districts, i.e. 35 health centres included in the study. The study population included women aged 15-49 whose last live birth occurred between December 26, 2019 and November 12, 2020.
Operational definitions
A case was any woman aged 15 to 49 who gave birth to a live child between December 26, 2019 and November 12, 2020, who did not carry out any PNC consultation or had only one within 42 days following leaving the health centre after childbirth. The control was any woman of the same age group who performed at least two PNC consultations during the same period. The socioeconomic level of the household was determined from 10 items to construct a subjective poverty score[24,25]. Adequate postnatal care coverage was defined as the proportion of women who had given birth who attended at least 2 PNC contacts after discharge from the health center, among all women reported to have given birth during the period. Initial coverage was defined as the proportion of women who had given birth and had a single health care contact (PNC) after discharge from the health centre among all women reported to have given birth during the period.
Data sources
The data sources for the study were delivery registers, prenatal consultation (ANC) registers, PNC registers in health centres and women interviewed at home as well as their pregnancy monitoring diary.
Data collection and study variables
We extracted from the records variables that were related to the study objectives using a predefined questionnaire. Age, mode of delivery, parity, occurrence of delivery complications and number of PNC visits were the main independent variables. The dependent variable in this study was low uptake of PNC, with a maximum of one PNC visit. It was classified as a dichotomous variable in relation to the number of PNC visits carried out within 42 days following discharge from the health centre after delivery. We included any woman meeting the definition of case or control, whose study data were available, and who consented to the study. Randomly selected women were interviewed individually using an interview guide during a community survey. Other sociodemographic, economic and sociocultural explanatory variables such as district of residence, area of residence, sex of the child, educational level of the mother and that of the spouse, marital status, type of marriage, professional category of the mother and that of the spouse, socio-economic level of the household, maternal health decision-making, knowledge of PNC services, knowledge of childbirth complications, and considering PNC necessary were collected. Obstetric variables and those linked to the health system such as desire for pregnancy, place of delivery, time to access the health center, medical insurance, history of abortion and chronic diseases were also collected. Data collection was digitized using the kobocollect® application v2021.2.4.
Sampling and sample size
The study included all health districts in the Central Region. In each district, one-third of healthcare facilities were selected by simple random sampling. In each selected health centre, we established a sampling frame of cases and controls using the delivery and postnatal consultation register, and we then carried out systematic sampling. In each of the sampling frames of cases and controls, we calculated a sampling step, then, using the “ALEA” formula in Microsoft Excel, we selected the required list of cases and controls. The mother’s educational level was chosen as the main independent variable based on the literature review[3,5,18,26–28]. The minimum sample size of 495 women was estimated using the “Statcalc” function of Epi-Info® software version 7.2.1. The calculation elements were: a ratio of one case for two controls, a confidence interval (CI) of 95%, an odd ratio (OR) of 2, a power of 95%, an alpha risk of 5% and an literacy rate of women aged 15 to 49 in the central region in 2019 of 41%[22]. With a non-response rate estimated at 20%, 513 women were surveyed including 171 cases.
Data processing and analysis
An Excel database was extracted from the kobocollect® application v2021.2.4. The cleaning of this database consisted of ridding it of all erroneous data. We verified the completeness of the records, searched for and removed duplicates, completed missing data and checked the consistency of the data. After processing, data analysis was carried out using SAS® version 9.4 software.
Descriptive phase
We calculated the median with its interquartile range (IQR) for the continuous variables and frequencies and proportions with 95% CI for categorical variables. We used the chi-square test to express the degree of significance of the difference between cases and controls. To determine the initial coverage of the PNC, we calculated the proportion between the number of women with live births who performed at least one PNC visit after leaving the health centre and the number of women with live births over the period. For adequate coverage of PNC, we calculated the proportion between the number of women delivered with a live birth who had achieved at least two PNC visits and the number of women delivered with a live birth.
Analytical phase
The identification of factors associated with the low PNC use led us to perform logistic regression (univariate and multivariate analysis) on the complete data. For model adjustment, the independent variables associated with the low use of PNC with a p-value≤0.20 were retained. Since the variable mother’s educational level is our main independent variable, whatever its p-value of association with low PNC use, it was included in all models. All other explanatory variables found in the literature were also forced into the final model. Multivariate regression was performed to identify independent variables associated with low PNC use. We analysed the odds ratio with its 95% CI as well as the p-value associated with the 5% significance threshold. To check the adequacy of the model, we used the Hosmer-Lemeshow test.
Ethical considerations
The study was approved by the Central Region health office and the coordinator of the field epidemiology and laboratory training program of Burkina Faso. Anonymity was maintained by using identification numbers instead of respondents’ names. Written informed consent was obtained from the respondents before participating in the study. Women and their spouses from the concessions visited were talked to about the importance of PNC.
PNC coverage
Of the 4,721 live births delivered during the period, adequate coverage was 37.4% (1767/4721) 95% CI: [36.0 – 38.8] (Table 1).
Sociodemographic, economic and sociocultural characteristics
The median age of cases and controls was 25 years (IQR=20-30) and 26 years (IQR=21-30), respectively, p=0.056. The male newborn accounted for 59.7% of cases and 51.2% of controls. Mothers with at least a secondary education level were 28.1% among cases and 27.8% controls, p=0.111. Women who resided in rural areas represented 88.9% of cases and 78.4% of controls, p=0.004. The socioeconomic level was low in 45.6% of cases and 32.8% of controls, p=0.017 (Table 2).
Obstetric characteristics and those linked to the health system
Seventy per cent of cases had an unwanted pregnancy compared to 55.3% controls, p<0.001. The four recommended PNC visits were performed by 26.9% of cases and 54.4% of controls, p <0.001. Home births occurred in 5.3% cases and 2.9% controls, p=0.186. Women who did not have health insurance coverage represented 97.1% of cases and 91.2% of controls, p=0.013 (Table 3).
Factors associated with low PNC use
In univariate logistic regression analysis (Table 4, 5), of sociodemographic factors, women whose spouses had a primary education level had a higher probability of low uptake of PNC ( crude odds ratio (cOR)=2.04, 95% CI: 1.32–3.15) compared to those whose spouses had a secondary education and above. Women residing in rural areas had 2.21 higher odds of low uptake of PNC than those residing in urban areas (cOR=2.21, 95% CI: 1.29–3, 80).
For economic factors, women from households with a low socioeconomic level were almost twice as likely to have low PNC use than those with a high socioeconomic level (cOR=1.69, 95% CI: 1.04 –2.76). Not knowing about the existence of PNC had higher odds of low uptake of PNC compared to those who were knowledgeable (cOR=1.91, 95% CI: 1.06–3.42).
For obstetric and clinical factors, women who did not want their pregnancy had higher odds of low uptake of PNC (cOR=1.96, 95% CI: 1.32–2.90). Performing less than 4 recommended antenatal care (ANC) before delivery represented higher odds of low uptake of PNC (cOR=3.24, 95% CI: 2.17–4.83). The presence of history of chronic diseases in the mother represented higher odds of low uptake of PNC (cOR=3.31, 95% CI: 1.07–10.27).
Regarding health care system factors, lack of health insurance coverage represented higher odds of low uptake of PNC (cOR=3.19, 95% CI: 1.22–8.38).
In multivariate logistic regression (Table 6) the factors independently associated with low uptake of PNC were low level of education of spouse (Adjusted OR (aOR)=1.82, 95% CI=1.09-3.04); non-desire for pregnancy (aOR=2.07, 95% CI=1.32-3.25), having performed less than 4 ANC (aOR=3.14, 95% CI=2.02-4, 88), and presence of a history of chronic illnesses (aOR=4.89, 95% CI=1.25-19.14).
Uptake of PNC is lowest in Togo Central Region. This case-control study aimed at investigating correlates of low PNC uptake among women aged 15–49 in this region. In the multivariate regression model, four variables showed significant association with low PNC uptake and these are low education level of spouse, non-desire for pregnancy, having attended less than the recommended 4 ANC visits and presence of chronic illnesses history.. The results show low adequate coverage of postnatal care utilization in the Central Region of Togo, as has already been documented in the country[7].
Our study reported a low adequate PNC coverage at 37.4% in 35 health centers in the Central Region of Togo. This coverage is lower than the 50.6% reported for the entire Central Region in 2020[8]. This is probably because our sampling is drawn from health center registers; the results could be different if sampling was done at households to record births. The selection of 35 health centers out of 108 (32%) could also explain this difference given that the health centers with very high PNC coverage and those with very low coverage could have been overlooked hence study sites were not representative.
Our study revealed an initial PNC coverage of 78.6% which is slightly higher than results from other studies in sub-Saharan Africa[5,18,25]. These differences could be attributed to the varying coverage of countries in healthcare infrastructure, health policies and strategies to combat maternal, neonatal and infant mortality in place, cultural aspects and the design of the different studies.
Factors associated with low PNC use
The partner’s low level of education is associated with low uptake of PNC use. This indicates that a higher level of education positively influences the PNC use. These results once again affirm the constancy of the association between this factor and PNC. In our study, the odds of low PNC use were 1.8 times more pronounced among mothers whose spouses had a low level of education. This result added to the previous one shows that the high level of education of the members of the couple predisposes to adequate use of postnatal care. These results coincide with the findings of other studies in Nigeria, Indonesia, Ethiopia, Malawi and Tanzania[28–30]. Education serves as a foundation for information about the benefits of using health services, and more educated spouses are more motivated to encourage their wives to use these services. The decision-making power of spouses regarding household health is quite important in our context.
In contrast to the partners, mothers’ level of education was not associated with low uptake of PNC use in our study. This observation is corroborated by a study in Nepal[15]. However, most studies in the literature show the opposite[5,28-30]. This could be due to chance or the potentially unique context of our study site.
Unwanted pregnancy had twice higher risk of low PNC use. The conditions of occurrence and the status of the pregnancy determine the use of postnatal care of the children resulting from it. This observation has been reported in studies carried out in rural areas in Tanzania[30–32] and Ethiopia[32]. Indeed, women with an unwanted pregnancy may initially attempt to deny their pregnancy[32]. As a result, they are less motivated to use PNC services.
Our results showed that women who completed fewer than four recommended prenatal consultation (ANC) had three times higher odds of not completing the two PNC required. This result is comparable to studies conducted in three districts in Ethiopia[12,33,34], Uganda[35] and Malawi[28]. Indeed, women who have not benefited from complete ANC follow-up may not have been sufficiently informed of the benefits of postnatal services for themselves and their newborn.
Our results showed that mothers with a history of chronic diseases were 4.9 times more likely to have low PNC use. A study in Nepal showed, on the contrary, that previous health problems were significantly associated with PNC use[36]. Our results could be explained by the fact that, in the absence of complications, chronic pathologies do not constitute a health concern for patients. In addition, chronic pathologies lead to exorbitant expenses, which affect the use of other health services.
Study limitations
The limitations of this study are firstly related to the non-probability sampling of health centres, which did not grant all women giving birth during the study period an equal chance of being selected, hence not generalizable. The fact of having selected the controls from the register and not from the community in the vicinity of the cases could affect the difference between cases and controls, which should only be based on the low or adequate use of postnatal care. Some data sources in this study were based on respondents’ self-reporting, which may have introduced information biases affecting the validity of the information obtained.
Perceptives
Togo reported its first case of COVID-19 in May 2020, which is why we propose to assess the impact of this pandemic on the use of maternal care after this period..
Adequate PNC coverage is low among women aged 15 to 49 in the central region of Togo. The low use of these postnatal services was influenced by sociodemographic factors including the spouse’s education level, desire for pregnancy, obstetric factors including the number of prenatal consultations and history of chronic illnesses. No economic factors or those relating to the healthcare system have been identified. Improving PNC use in the Central Region can be achieved by implementing measures to promote access to education for all, such as primary and secondary education subsidies, and increasing the coverage of the region in educational establishments. It could also improve by increasing the region’s coverage of maternal, newborn and child care infrastructure and creating favourable conditions for access and care use. These conditions could be the subsidy of ANC, childbirth and postnatal care, and the creation of universal health coverage. These actions should be permanently supported by a local communication strategy on the importance of school education and also on the advantages of care for mothers, newborns and children. Local authorities should also draw inspiration from the national health policy for mothers, newborns, children, young people and adolescents to develop municipal strategic plans and mobilise resources for their implementation.
What is already known about the topic
Around 810 women die every day worldwide from complications related to pregnancy and childbirth and the majority of these deaths occur in the postnatal period, predominantly in low- and middle-income countries.
Adequate use of postnatal care in these countries remains low and education level, access to health centers, place of delivery, wealth level were associated with PNC non-use.
What this study adds
Very first study on the factors which explain the low PNC use specific to the Central Region of Togo.
It confirmed the continued low utilisation of PNC in this region.
The low PNC use was more reported among women who did not want to become pregnant, who carried out less than four ANC and whose spouses have a lower education.
These results will be used to adjust and/or develop action plans specific to the central region on maternal, newborn and child health.
P.M.H. developed the study protocol, carried out data collection, processing and analysis, and manuscript development and revision. J. K., P. Y., A. M. T, H. A., N. M, G. S. participated in the drafting of the protocol, the processing and analysis of the data, and the development and revision of the manuscripts. K. N, participated in data collection and revision of the manuscript. All authors read and approved the final manuscript.
| Number of PNC visits | Number of births | Percentage (95% CI) |
|---|---|---|
| None | 1012 | 21.4 (20.2 – 22.6) |
| One | 1942 | 41.2 (39.7 – 42.5) |
| Two and more | 1767 | 37.4 (36.0 – 38.8) |
| Total | 4721 | 100 |
| Variables | Case n (%) n=171 | Controls n (%) n=342 | p-value |
|---|---|---|---|
| Age of mother (Years) | |||
| 15 – 24 | 85 (49.7) | 133 (38.9) | 0.056 |
| 25 – 34 | 64 (37.4) | 162 (47.4) | |
| 35 and over | 22 (12.9) | 47 (13.7) | |
| Gender of child | |||
| Male | 102 (59.7) | 175 (51.2) | 0.069 |
| Female | 69 (40.3) | 167 (48.8) | |
| Mother’s educational level | |||
| Secondary and above | 48 (28.1) | 95 (27.8) | 0.111 |
| Primary | 71 (41.5) | 114 (33.3) | |
| None | 52 (30.4) | 133 (38.9) | |
| Spouse’s education level | |||
| Secondary and above | 62 (36.3) | 152 (44.4) | <0.001 |
| Primary | 69 (40.3) | 83 (24.3) | |
| None | 40 (23.4) | 107 (31.3) | |
| Marital status | |||
| Bachelor | 12 (7.0) | 19 (5.6) | 0.512 |
| Married/Living together | 159 (93.0) | 323 (94.4) | |
| Residence area | |||
| Urban | 19 (11.1) | 74 (21.6) | 0.003 |
| Rural | 152 (88.9) | 268 (78.4) | |
| Type of marriage/Union | |||
| Polygamy | 57 (33.3) | 115 (33.6) | 0.947 |
| Monogamy | 114 (66.7) | 227 (66.4) | |
| Mother’s occupation | |||
| With Occupation | 33 (19.3) | 92 (26.9) | 0.058 |
| Without Occupation | 138 (80.7) | 250 (73.1) | |
| Occupation of spouse | |||
| With Occupation | 158 (92.4) | 302 (88.3) | 0.151 |
| Without Occupation | 13 (7.6) | 40 (11.7) | |
| Socioeconomic level | |||
| High | 35 (20.5) | 85 (24.8) | 0.017 |
| Medium | 58 (33.9) | 145 (42.4) | |
| Low | 78 (45.6) | 112 (32.8) | |
| Variables | Case n (%) N=171 | Controls n (%) N=342 | p-value |
|---|---|---|---|
| Health district residence | |||
| Tchaoudjo | 49 (28.7) | 109 (31.9) | 0.457 |
| Out of Tchaoudjo | 122 (71.3) | 233 (68.1) | |
| Health decision | |||
| Independent | 150 (87.7) | 289 (84.5) | 0.328 |
| Not independent | 21 (12.3) | 53 (15.5) | |
| Knowledge of PNC existence | |||
| Yes | 147 (86.0) | 315 (92.1) | 0.028 |
| No | 24 (14.0) | 27 (7.89) | |
| Knowledge of birth complications | |||
| Yes | 142 (83.0) | 290 (84.8) | 0.607 |
| No | 29 (17.0) | 52 (15.2) | |
| Considers PNC necessary | |||
| Yes | 159 (93.0) | 330 (96.5) | 0.076 |
| No | 12 (7.0) | 12 (3.5) | |
| Desire for pregnancy | |||
| Yes | 50 (29.2) | 153 (44.7) | <0.001 |
| No | 121 (70.8) | 189 (55.3) | |
| Parity | |||
| 5+ | 37 (21.6) | 66 (19.3) | 0.530 |
| 3–4 | 54 (31.6) | 98 (28.6) | |
| 1–2 | 80 (46.8) | 178 (52.1) | |
| Number of ANC visits | |||
| 4+ | 46 (26.9) | 186 (54.4) | <0.001 |
| 0–3 | 125 (73.1) | 156 (45.6) | |
| Health center access time | |||
| ≤ 1 hour | 112 (65.5) | 220 (64.3) | 0.794 |
| > 1 hour | 59 (34.5) | 122 (35.7) | |
| Medical insurance coverage | |||
| Yes | 5 (2.9) | 30 (8.8) | 0.013 |
| No | 166 (97.1) | 312 (91.2) | |
| Mode of delivery | |||
| Normal/Spontaneous | 169 (98.8) | 340 (99.4) | 0.478 |
| Cesarean/Instrumental | 2 (1.2) | 2 (0.6) | |
| Place of delivery | |||
| Health center | 162 (94.7) | 332 (97.1) | 0.186 |
| Home | 9 (5.3) | 10 (2.9) | |
| History of abortion | |||
| Yes | 21 (12.3) | 35 (10.2) | 0.483 |
| No | 150 (87.7) | 307 (89.8) | |
| History of chronic illnesses | |||
| No | 163 (95.3) | 337 (98.5) | 0.028 |
| Yes | 8 (4.7) | 5 (1.5) | |
| Variables | Case n (%) n=171 | Controls n (%) n=342 | Crude OR | 95% CI | p-value |
|---|---|---|---|---|---|
| Age of mother (year) | |||||
| 15–24 | 85 (49.7) | 133 (38.9) | 1 | – | |
| 25–34 | 64 (37.4) | 162 (47.4) | 0.61 | 0.41–0.92 | |
| 35 and over | 22 (12.9) | 47 (13.7) | 0.73 | 0.41–1.30 | 0.057 |
| Gender of child | |||||
| Male | 102 (59.7) | 175 (51.2) | 1 | – | |
| Female | 69 (40.4) | 167 (48.8) | 0.70 | 0.48–1.02 | 0.069 |
| Mother’s educational level | |||||
| Secondary and above | 48 (28.1) | 95 (27.8) | 1 | – | |
| Primary | 71 (41.5) | 114 (33.3) | 1.23 | 0.78–1.94 | |
| None | 52 (30.4) | 133 (38.9) | 0.77 | 0.48–1.24 | 0.112 |
| Spouse’s education level | |||||
| Secondary and above | 62 (36.3) | 152 (44.4) | 1 | – | |
| Primary | 69 (40.4) | 83 (24.3) | 2.03 | 1.31–3.14 | <0.001 |
| None | 40 (23.4) | 107 (31.3) | 0.91 | 0.57–1.46 | |
| Residence Area | |||||
| Urban | 19 (11.1) | 74 (21.6) | 1 | – | |
| Rural | 152 (88.9) | 268 (78.4) | 2.20 | 1.28–3.79 | 0.004 |
| Mother’s occupation | |||||
| With Occupancy | 33 (19.3) | 92 (26.9) | 1 | – | |
| Without Occupation | 138 (80.7) | 250 (73.1) | 1.53 | 0.98–2.41 | 0.059 |
| Occupation of spouse | |||||
| With Occupancy | 158 (92.4) | 302 (88.3) | 1 | – | |
| Without Occupation | 13 (7.6) | 40 (11.7) | 0.62 | 0.32–1.19 | 0.154 |
| Socioeconomic level | |||||
| High | 35 (20.5) | 85 (24.9) | 1 | – | |
| Medium | 58 (33.9) | 145 (42.4) | 0.97 | 0.59–1.59 | |
| Low | 78 (45.6) | 112 (32.8) | 1.69 | 1.03–2.75 | 0.018 |
| Variables | Case n (%) n=171 | Controls n (%) n=342 | Crude OR | 95% CI | p-value |
|---|---|---|---|---|---|
| Knowledge of PNC existence | |||||
| Yes | 147 (86.0) | 315 (92.1) | 1 | – | |
| No | 24 (14.0) | 27 (7.9) | 1.90 | 1.06 – 3.41 | 0.030 |
| Considers PNC necessary | |||||
| Yes | 159 (93.0) | 330 (96.5) | 1 | – | |
| No | 12 (7.0) | 12 (3.5) | 2.07 | 0.91 – 4.72 | 0.081 |
| Desire for pregnancy | |||||
| Yes | 50 (29.2) | 153 (44.7) | 1 | – | |
| No | 121 (70.8) | 189 (55.3) | 1.95 | 1.32 – 2.90 | <0.001 |
| Parity | |||||
| 5+ | 37 (21.6) | 66 (19.3) | 1 | – | |
| 3–4 | 54 (31.6) | 98 (28.7) | 0.98 | 0.58 – 1.65 | |
| 1–2 | 80 (46.8) | 178 (52.1) | 0.80 | 0.49 – 1.29 | 0.531 |
| Number of ANC visits | |||||
| 4+ | 46 (26.9) | 186 (54.4) | 1 | – | |
| 0–3 | 125 (73.1) | 156 (45.6) | 3.24 | 2.17 – 4.83 | <0.001 |
| Health center access time | |||||
| ≤ 1 hour | 112 (65.5) | 220 (64.3) | 1 | – | |
| > 1 hour | 59 (34.5) | 122 (35.7) | 0.95 | 0.64 – 1.39 | 0.794 |
| Medical insurance coverage | |||||
| Yes | 5 (2.9) | 30 (8.8) | 1 | – | |
| No | 166 (97.1) | 312 (91.2) | 3.19 | 1.21 – 8.38 | 0.018 |
| Mode of delivery | |||||
| Normal/Spontaneous | 169 (98.8) | 340 (99.4) | 1 | – | |
| Cesarean/Instrumental | 2 (1.2) | 2 (0.6) | 2.01 | 0.28 – 14.40 | 0.486 |
| Place of delivery | |||||
| Health center | 162 (94.7) | 332 (97.1) | 1 | – | |
| Home | 9 (5.3) | 10 (2.9) | 1.84 | 0.73 – 4.62 | 0.192 |
| Occurrence of complications during childbirth | |||||
| Yes | 21 (12.3) | 34 (9.9) | 1 | – | |
| No | 150 (87.7) | 308 (90.1) | 0.78 | 0.44 – 1.40 | 0.420 |
| History of chronic illness | |||||
| No | 163 (95.3) | 337 (98.5) | 1 | – | |
| Yes | 8 (4.7) | 5 (1.5) | 3.30 | 1.06 – 10.27 | 0.038 |
| Variables | Adjusted OR | 95% CI | p-value |
|---|---|---|---|
| Age of mother (year) | |||
| 25-34 vs. 15-24 | 0.66 | 0.42 – 1.04 | 0.194 |
| 35 and over vs 15-24 | 0.73 | 0.38 – 1.38 | |
| Gender of child | |||
| Female vs Male | 0.68 | 0.44 – 1.04 | 0.079 |
| Health district residence | |||
| Excluding Tchaoudjo vs Tchaoudjo | 1.25 | 0.78 – 2.00 | 0.351 |
| Mother’s educational level | |||
| Primary vs Secondary and more | 0.94 | 0.55 – 1.60 | 0.479 |
| None vs Secondary and more | 0.70 | 0.38 – 1.29 | |
| Spouse’s educational level | |||
| Primary vs Secondary and more | 1.82 | 1.09 – 3.03 | 0.023 |
| None vs Secondary and more | 0.92 | 0.50 – 1.70 | |
| Residence Area | |||
| Rural vs Urban | 1.33 | 0.67 – 2.62 | 0.403 |
| Mother’s occupation | |||
| Without Occupancy vs With Occupancy | 1.30 | 0.77 – 2.18 | 0.320 |
| Occupation of spouse | |||
| Without Occupancy vs With Occupancy | 0.92 | 0.42 – 2.00 | 0.841 |
| Socioeconomic level | |||
| Medium vs High | 0.70 | 0.39 – 1.27 | 0.050 |
| Low vs High | 1.28 | 0.70 – 2.32 | |
| Considers PNC necessary | |||
| No vs Yes | 0.97 | 0.32 – 2.90 | 0.967 |
| Knowledge of PNC existence | |||
| No vs Yes | 1.48 | 0.68 – 3.19 | 0.317 |
| Health center access time | |||
| >1 hour vs ≤1 hour | 0.85 | 0.54 – 1.32 | 0.473 |
| Medical insurance coverage | |||
| No vs Yes | 2.55 | 0.87 – 7.47 | 0.085 |
| Desire for pregnancy | |||
| No vs Yes | 2.07 | 1.31 – 3.25 | 0.001 |
| Number of ANC | |||
| Less than 4 vs 4 and more | 3.13 | 2.01 – 4.87 | <0.001 |
| Place of delivery | |||
| Home vs Health Center | 1.57 | 0.53 – 4.66 | 0.413 |
| History of chronic illness | |||
| Yes vs No | 4.89 | 1.25 – 19.14 | 0.022 |