Abstract:
BACKGROUND : Achieving World Health Organization (WHO) recommendations
for postnatal care (PNC) within the first few weeks of life is vital
to eliminating early mother–to–child transmission of HIV (MTCT) and
improving infant health. Almost half of the annual global deaths among
children under five occur during the first six weeks of life. This study
aims to identify uptake of three PNC visits within the first six weeks of
life as recommended by WHO among South African mother–infant
pairs, and factors associated with uptake.
METHODS : We analyzed data from three facility–based, nationally representative
surveys (2010, 2011/12 and 2012/13) primarily designed to
determine the effectiveness of the South African program to prevent
MTCT. This analysis describes the proportion of infants achieving the
WHO recommendation of at least 3 PNC visits. Interviews from 27 699
HIV–negative and HIV–positive mothers of infants aged 4–8 weeks receiving
their six week immunization were included in analysis. Data
were analyzed using STATA 13.0 and weighted for sample ascertainment
and South African live births. We fitted a multivariable logistic regression
model to estimate factors associated with early PNC uptake.
RESULTS : Over half (59.6%, 95% confidence interval (CI) = 59.0–60.3)
of mother–infant pairs received the recommended three PNC visits during
the first 6 weeks; uptake was 63.1% (95% CI = 61.9–64.3) amongst
HIV exposed infants and 58.1% (95% CI = 57.3–58.9) amongst HIV unexposed
infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the
pooled data, controlling for survey year, demonstrated that number of
antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95%
CI = 1.04–1.23), timing of initial antenatal visits (≤12 weeks vs >12
weeks, aOR = 1.13, 95% CI = 1.04–1.23), place of delivery (clinic vs hospital
aOR = 1.5, 1.3–1.6), and infant HIV exposure (exposed vs unexposed
aOR = 1.2, 95% CI = 1.1–1.2) were the key factors associated with
receiving recommended PNC visits.
CONCLUSIONS : Approximately 40% of neonates did not receive three or
more postnatal care visits in the first 6 weeks of life from 2010–2013. To
improve uptake of early PNC, early antenatal booking, more frequent antenatal
care attendance, and attention to HIV negative women is needed.
