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Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 68-77

A comparative study of postnatal care practices among mothers in rural and urban communities of Kano State, Nigeria

1 Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
2 Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria

Date of Submission14-Aug-2020
Date of Decision14-Feb-2021
Date of Acceptance14-Mar-2021
Date of Web Publication10-Dec-2021

Correspondence Address:
Dr. Hadiza Musa Abdullahi
Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University, Kano
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njbcs.njbcs_25_20

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Context: Postnatal care remains the most neglected component of maternal and child health. It is determined by postnatal practices, which may be beneficial, innocuous or harmful as prevalent in low and middle income countries including Nigeria. Aim: To compare postnatal care practices among mothers in urban and rural communities. Settings and Design: A comparative cross-sectional design was used to assess postnatal care practices among 130 mothers each in urban and rural communities of Kano using multistage systematic sampling. Materials and Methods: Data were collected from mothers who delivered a live baby within the preceding year using an interviewer administered semi-structured questionnaire. Statistical analysis used: Data collected was analysed using the SPSS Statistics for Windows, Version 21.0. Results: Findings show poor postnatal care practices like delay in initiation of breastfeeding (77.2% and 88.4%, respectively), poor cord care (97.6% and 100%, respectively) and ingestion of potash gruel (35.4% and 65.9%, respectively) were abundant. Postnatal care practice was significantly associated with respondents' education and husband's education in the urban area (and age of respondents in the rural community (P < 0.05). Marital setting was the only predictor of postnatal practice (odds ratio = 0.25, 95% confidence interval [0.09–0.69]), where mothers in a monogamous setting had a 75% likelihood of good practice as compared to their polygamous counterparts. Conclusion: The preponderance of bad postnatal practices found among mothers in both urban and rural settings indicates the level of danger that mothers and their newborns are exposed to in the studied communities.

Keywords: Kano, newborn, postnatal care, puerperal, rural, urban

How to cite this article:
Abdullahi HM, Usman NO, Jibo AM. A comparative study of postnatal care practices among mothers in rural and urban communities of Kano State, Nigeria. Niger J Basic Clin Sci 2021;18:68-77

How to cite this URL:
Abdullahi HM, Usman NO, Jibo AM. A comparative study of postnatal care practices among mothers in rural and urban communities of Kano State, Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Dec 9];18:68-77. Available from: https://www.njbcs.net/text.asp?2021/18/2/68/332173

  Introduction Top

The postnatal period (or called postpartum, if in reference to the mother only) is defined by the WHO as the period beginning 1 h after delivery of the placenta and continuing until 6 weeks after delivery.[1] Newborn survival is inextricably linked to the health of the mother.[2] For both newborns and mothers, the highest risk of death occurs at delivery, followed by the 1st h and days after childbirth.[3] The health of both mother and child is largely dependent on the nature of the postnatal care they receive. In every society, there exist various practices, customs, beliefs and values, which may be healthy or unhealthy. Postnatal care practices such as breast care, perineal care, postnatal diet, postnatal exercises and family planning will promote health and reduce mortality and morbidity among mothers and newborns.[1] The care provided by the mothers to their newborns depends on knowledge and practice of the mothers regarding newborn care and this ultimately determines the newborn's heath status.

Early postnatal care is critical to promoting healthy household practices such as exclusive breastfeeding which are key to child health and survival.[2] More than half of infants in low- and middle-income countries are not exclusively breastfed,[4] contributing to malnutrition and infections. Maternal knowledge has been shown to be a significant determinant of newborn care practices with mothers who are more knowledgeable having better practices in the postpartum period.[5] The World Health Organisation recommends a set of practices that reduces newborn morbidity and mortality which has been identified as essential and these include clean cord care, thermal care, and initiating breastfeeding within the 1st h of birth.[6] Bathing of the newborn immediately after birth, delayed breastfeeding, and throwing out colostrum are some of the common newborn care practices that need to be changed. To change such practices, understanding the factors that determine such behaviour is necessary.

The related indices are far worse in northern Nigeria where few studies have been done and hence the need for this study which aims to identify and compare traditional postnatal practices among mothers in urban and rural communities of Kano State. The specific objectives of the study was to identify and compare traditional postpartum and newborn care practices among mothers in urban and rural communities and to identify factors associated with postnatal practices among mothers in urban and rural communities.

  Materials and Methods Top

Study setting

The study was carried out in Kano Municipal and Rimin Gado Local Government areas (LGA) of Kano State. The Nigerian Demographic and Health Survey (NDHS)[7] showed that North-Western Nigeria where Kano is located has a neonatal mortality of 39/1000 live births. It also revealed that 60% of mothers did not have any postnatal check-up. In spatial terms, there is a very high concentration of health care infrastructure, services and personnel in Kano metropolis compared to the rest of the state. About 75% of people who live in Kano have access to health services. In Kano Municipal LGA, there is one secondary health facility, five primary health care (PHC) centres, six health clinics, one health post and numerous private clinics while in Rimin Gado LGA there is one comprehensive health centre, nineteen health posts and one health clinic.

Study design and population

It was a comparative cross-sectional descriptive survey used to compare puerperal and newborn practices among 130 mothers each in urban and rural communities of Kano State. The sample size was determined using the formula for calculating sample size when comparing two proportions. The respondents were mothers who delivered a live baby within the preceding year of the study. A total of 260 respondents were randomly selected. A multi-stage sampling technique was applied in this study.

Stage 1: From a list of urban and rural LGAs, one LGA in each group was picked by simple random sampling (balloting).

Stage 2: From the total number of wards in each LGA, four wards each were selected using simple random sampling (balloting).

Stage 3: Household listing was done and the households to be part of the study were selected using systematic sampling.

Stage 4: From each selected household, one eligible respondent was selected with a single one-time ballot.

Data collection

Data were collected from a total of 260 women who had a live birth within the preceding year using a pretested structured questionnaire translated to Hausa, the local language. The questionnaire was pretested in Gwale and Dambatta LGAs in Kano State to test their content validity. There were two Hausa speaking research assistants who collected data using paper-based questionnaires. The tool had two sections: Section I sought information on respondent's socio-demographic and obstetric characteristics, section II elicited respondent's postnatal and newborn care practices. Two independent professional Hausa scholars translated the questionnaire into local (Hausa) vernacular as it was administered in that language.

Data processing and analysis

Data collected were entered, validated and analysed using the IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Qualitative variables were summarised in percentages and frequencies, while quantitative variables were summarised with mean/standard deviation (SD) and median (interquartile range). The practice of postnatal care was assessed using a 52-point practice scale which was derived from the total number of postnatal practice questions asked in the questionnaire. Women were categorised as having poor practice if they scored between 0 and 16, fair if they score between 17 and 34 and good practice if they score 35 and 52. At bivariate level, (P < 0.05), confidence interval of proportions or Fisher's exact test was used where appropriate to assess factors associated with practice of puerperal and newborn care. Binary logistic regression model was used to control for confounders.

Ethical consideration

Approval to carry out this study was obtained from the Research Ethics Committee of Aminu Kano Teaching Hospital. Permission to conduct the study was also sought from the Kano State Hospital Management Board, Ministry of Health and local government for Kano state and the PHC Departments of Kano Municipal and Rimin Gado LGAs. A written informed consent was obtained from all respondents and permission obtained from their husbands for participation in this study. Ethical principles were strictly adhered to.

  Results Top

One hundred and thirty questionnaires were administered each in the urban and rural communities. The response rate was 97.7% in the urban and 99.2% in the rural communities. The mean ages (±SD) of respondents in the urban and rural communities were 29.5 ± 7.2 and 27.9 ± 6.5 years, respectively. Most women from both communities (95.4% urban and 93.8% rural) are Hausa and of the Islamic faith (97.7% and 100%), respectively. Nearly a quarter (23.7%) of the respondents in the urban community had tertiary education as against just 1.6% of their rural contemporaries. Almost half (47.2%) of the women in the rural setting had no formal education [Table 1].
Table 1: Summary of sociodemographic characteristics of respondents

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Mothers in the urban and rural communities had statistically significant differences (P < 0.05) in their place of delivery, skilled birth attendance, cutting of umbilical cord, initiation of breastfeeding, timing of first bath, use of spirit to clean the cord and method of keeping baby warm [Table 2] Mothers in the urban and rural communities had statistically significant differences (P < 0.05) in practice of uvulectomy, hair shaving, traditional scarification, female genital cutting, confinement duration, cultural hot bath, nursing in heated room, ingestion of potash gruel, intake of spicy meal, use of herbs and resumption of coitus [Table 3].
Table 2: Comparison of early postnatal practices between women in rural and urban local government areas (n=256)

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Table 3: Comparison of later postnatal practices between women in rural and urban local government areas (n=256)

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Postnatal care practice was significantly (P < 0.05) associated with tribe, education and husband's education in the urban community while age was the only significant factor associated with postnatal practice in the rural community [Table 4].{Table4}

After adjusting for covariates, marital setting was found to be a positive predictor of good postnatal practices in the urban area (P < 0.05) while none of the variables were significant predictors in the rural community [Table 5].
Table 5: Predictors of good postnatal care among respondents (n=256)

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  Discussion Top

There are various postnatal practices worldwide. In this study, more than half (60.8%) of the urban mothers had their last child delivered in a hospital as opposed to a mere tenth (12.3%) of their rural counterparts. This is similar to the findings of the NDHS 2018[7] These findings are likely due to the fact that even though some women prefer to deliver in health facilities, they are unable to do so because they cannot afford the cost of drugs and supplies, which are demanded in a situation of poverty and limited male support.[8] Other reasons provided include the fact that mothers reported that the child was born suddenly and there was no time to reach the facility, or they felt it was not necessary.[7] Home deliveries, especially in resource poor settings are riddled with risks for poor pregnancy outcomes[9] due to absence of skilled attendant at birth and lack of facilities to adequately manage obstetric emergencies.[10]

Although the WHO recommends dry cord care as the best practice, cord care practices differ based on cultures. In this study, cord care practices were poor. Majority of the urban mothers (62.3%) said a surgical blade was used to cut the cord during their last delivery while very few of the rural (12.3%) had surgical blade being used to cut the cord. Care of the umbilical stump was with methylated spirit in over half (51.5%) of the urban respondents as opposed to very few (8.5%) of the rural respondents. More women in the rural than urban engaged in unhygienic cord practices in this study. This could be due to the preponderance of customs and influence of old wives as well as poor antenatal care attendance in rural communities. This is similar to studies found in India, Pakistan, Nepal, Kenya, Ghana and Nigeria (Edo, Bayelsa and Kano)[11],[12],[13],[14],[15],[16],[17],[18],[19] which all showed poor hygienic cord practices. Poor cord care is a major public health concern that could lead to neonatal sepsis which is responsible for about 15% of neonatal deaths globally. Countries in the sub-Saharan region contribute a large proportion to this global figure.[20]

Although the proportion of babies breastfed worldwide is high, sub-optimal breast-feeding practice is still the norm in most low-income countries.[7],[21],[22] In this study, less than a quarter of both urban and rural mothers initiated breastfeeding within 30 min of delivery (22.3% and 11.5%, respectively). This is lower than the urban-rural rates reported by the NDHS 2018 (49% and 38%, respectively) but is similar to studies done in Jordan, India and in different regions[14],[17],[23],[24],[25] of Nigeria which all show late initiation of breastfeeding. Contrastingly, a study in Vietnam showed over half (60.7%) of mothers initiated breast feeding early (30 min after birth) the reason being that most mothers in rural South Vietnam are homemakers and are also less exposed to formula advertisements than their urban counterparts.[26] The practice of giving prelacteal feeds was very common in this study with half of mothers giving prelacteal feeds in both urban and rural communities (54.6% and 48.5%) Prelacteal feeding could lead to neonatal morbidity and mortality as they are usually done in unhygienic conditions.[27]

Uvulectomy is an archaic practice still practiced in many parts of Africa. In this study, uvulectomy was quite common with slightly below half (46.9%) of the urban and majority (86.9%) of the rural respondents practicing it. This is further reiterated by a study which showed the practice is commonest among the Hausa ethnic group.[28] These findings are similar to those found in studies in Tanzania, Sudan and Nigeria.[29],[30],[31],[32] The major reasons given were tradition, fear of upper airway obstruction from an enlarged uvula as well as throat problems in child-hood which is similar to reasons given in a study done in Jigawa state.[33] The practice of uvulectomy is fraught with harmful consequences such as excessive bleeding, infections and death.[34]

In this study, Female Genital Cutting was practiced more in the rural (33.8%) than in the urban communities (13.1%), which is the reverse of the NDHS 2018 where the rate was higher in the urban community. The major reasons given for practicing FGC in this study were tradition and coital problems that prevent marital harmony. Type 1 (clitoridectomy) was the major FGC done in this study which is similar to studies done in Burkina Faso and Owerri, Nigeria.[35],[36] Contrastingly, a study done in the south west of the country showed that FGCs were mainly done at 7 years.[37] Female genital cutting is a human right violation and is associated with life threatening complications such as excessive bleeding, infection and shock.[38]

In this study, cultural hot bath was practiced by over half (53.8%) of urban respondents and more than three quarters (89.2%) of their rural counterparts. This is similar to other studies done in Kano,[14],[39] which all reported high rates of cultural hot baths with the explanation given as helping to maintain the hot-cold balance in the body after childbirth which is viewed as a cold state or tradition.

This practice is done along with sitz baths and nursing in heated rooms, which was also observed in the majority of respondents in this study though none of the mothers, lay on a heated bed. These practices could lead to cardiovascular problems like hypertensive heart disease which are major causes of maternal mortality. Surprisingly, a study done in Laos showed the both urban and rural women still lie on the 'hot bed', which is a bed with hot charcoal laid beneath for 3–4 weeks after delivery.[40]

In this study, more mothers in rural than in urban communities ingested potash gruel (65.4% and 34.6% respectively) and ate spicy meals (79.2% and 63.1%, respectively) which may be because of their lower educational status which translates to less awareness of its consequences or the more ingrained cultural habits found in the rural community. This is also a major cause of hypertensive heart disease postpartum. This is similar to findings in studies carried out in Taiwan and Bangladesh[41],[42] This is in contrast to a study done in an urban area in Laos, which showed postpartum women were restricted eating spicy meals during postpartum period.[40]

The use of contraceptives following postpartum was very low in this study though it was practiced more in urban than rural communities (16.9% and 0.8%, respectively). This is in keeping with data from the NDHS 2018, which showed very low contraceptive prevalence rate (1%) in the northwest region.

  Conclusion Top

In both urban and rural communities, there was a preponderance of bad traditional postnatal practices such as delay in initiation of breastfeeding, poor cord care, uvulectomy, Female Genital Cutting, cultural hot bath and ingestion of potash gruel. This indicates the level of danger mothers and their newborns are exposed to in the studied urban and rural communities and increasing community outreaches and enlightenment campaigns will go a long way in helping reduce the prevalence of harmful traditional practices. This study was carried out among two of the forty four LGA of Kano State, so further studies can look at more LGAs for a more generalisable result.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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