Moges Tadesse Borde^1,2,3*, Eskindir Loha^1,4, and Bernt Lindtjørn^1,2

¹School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; ²Centre for International Health, University of Bergen, Bergen, Norway; ³School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia; ⁴Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Introduction: The burden of postpartum illness in rural communities in Ethiopia is poorly characterized. Therefore, we assessed the incidence of and risk factors for postpartum illnesses and measured utilisation of health services in these areas.

Methods: This prospective cohort study enrolled 784 women in three randomly selected kebeles in rural southern Ethiopia. Trained data collectors visited each woman at home eight times during the first 42 postpartum days. The Prentice-Williams-Peterson total time survival model was used for analysis.

Results: The incidence of postpartum illness was 31 episodes per 100 women-weeks (95% confidence interval [CI]: 30.0%, 32.3%). Anaemia occurred in 19% of women (95% CI: 16.4%, 21.9%), and hypertension in 2.4% (95% CI: 2.3%, 4.9%). Common symptoms included foul-smelling vaginal discharge (3.4%; 95% CI: 2.3%, 4.9%) and painful, engorged breasts (2.8%; 95% CI: 1.8%, 4.2%). Associations existed between hypertension during pregnancy and postpartum (χ² (1) = 2734.5, p < 0.001), between excessive vaginal bleeding and anaemia (χ² (1) = 9.4, p < 0.002), and between high fever and foul-smelling vaginal discharge (χ² (1) =161.8, p < 0.001). Only 5% of participants reported utilising health services (95% CI: 3.8%, 6.6%). Women who walked over 60 minutes to access health care had a high adjusted hazard ratio (AHR) of 2.61 (95% CI: 1.98, 3.43). Older first-time mothers utilised health care more often than younger first-time mothers (AHR = 1.40; 95% CI: 1.03, 1.89). Reasons for not using health care included a belief that the illness was not serious or would resolve on its own, little confidence in the health institutions, or an inability to afford the cost.

Conclusions: We observed a high burden of postpartum illnesses in rural communities in southern Ethiopia. Unfortunately, few women sought treatment through health services.

Keywords: postpartum; illness; utilisation of health services; cohort; rural; Ethiopia