KNOWLEDGE AND PRACTICE ON SELECTION ASPECTS ON POSTNATAL CARE

AMONG WOMEN REPRODUCTIVE AGE, WOMEN IN MCH SAYIDKA LAS- ANOD

GENERAL HOSPITAL,AL-HAYAT ANND MANHAL IN LAS-ANOD, SOMALIA

Submitted BY: ID:

1. Fatima Abdikadir Farah. NU-18-2543

2. Yasiin Abdikariin Ali. NU-18-2666
3. Mohamed Ibrahim Mohamed. NU-18-2534
4. Subayr Muse Farah. NU-18-2606
5. Sawda Abdurrahman Mohamed. NU-18-2720
6. Khadra Saleban Farah. NU-18-2223

Supervisor:

Mr. Osman Hajji {BSC, BS and MPH}

A RESEACH THESIS SUBMITTED TO NUGAAL UNIVERSITY STUDENTS OF

HEALTH SCIENCE, DEPARTMENT OF HEALTH OFFICER (HO) IN PARIAL FULFILLMENT OF

BACHELOR DEGREE IN HEALTH OFFICER.

MARCH,2022

LAS-ANOD, SOMALIA
 DECLARATION

We hereby declare that this Research Proposal entitled knowledge, practice on selection

aspects on postnatal care among postnatal women reproductive age admitted to maternal units

in Las-anod district health facilities, Sool Region, Somalia is original work, and it has not

been presented for the award of any degree Nugaal university.

Name Signature Date

Fatima Abdikadir farah ………_\……\………

Subayr muse farah ...\………...\...........

Mohamed Ibrahim Mohamed ...\………...\...........

Yasiin Abdikariin ALI ____________ …/ …….…\…

Khadra Saleban Farah ____________ ...\…...\..........

Sawda Abdurrahman Mohamed ____________ ...\…...\..........

 DEDICATION

We dedicated to our beloved fathers who taught us that the best kind of knowledge to have

and which have been learned for own sake and mothers who taught us that even the largest

task could be accomplished if it’s done one step at time. As well as all members of our family

who have extremely been supportive in terms of financial, spiritual and moral edifications

throughout the time we have engaged for writing this proposal.

 APPROVAL

This is certify that this research report entitled knowledge and practice on the select aspects
on postnatal care among women reproductive age among women in admitted maternal units
in Las-anod district health facilities, Sool region and submitted by Fatima Abdikadir Farah,
Sawda Abdurrahman Mohamed, Subayr Muse Farah, Mohamed Ibrahim Mohamed, Yasiin
Abdikariin Ali, Khadra Saleban Farah in partial fulfillment of the requirement for the degree
of health science department of Clinical health officer.

Supervisor: Mr. Osman Hajji

Signature: ___________

Date: --------/--------/------
 ACKNOWLEDGEMENT

We place our deep sense and gratitude to Almighty ALLAH who has showered his boundless

blessings on us enabling successful completion of this project work.

We express our deepest thanks and respectful regard to our guide Mr. Osman Hajji,

Lecturer at faculty of medicine & Health Sciences, who is always there to listen, comment

and give advice. He shows us different ways to approach research problems.We would like to

take this opportunity to express sincere thanks to Dr. Abdi Majid Hussein Sugule, Dean,

Faculty of Medicine & health Sciences.

We extend our thanks to Dr. Abdulrazak Mohamed Adan (Lafoole), president at Nugaal

University Las-anod-Somalia, for giving us the opportunity to conduct the study in this

university.

Words seems inadequate to express thanks to our teachers and all other non- teaching staff,

friends and Classmates for helping us and encouraging and also for being the source of

motivation to finish our tasks.

Most importantly, We would like to express our heartiest gratitude and thanks to our parents
for their endurance, sacrifice, moral support and encouragement, understanding and patience
without them this achievement would have not been possible and our brothers, sisters and
friends. They are always the source of our strength, happiness and permanent inspirations.
Special thanks go to all our family for their great concern and encouragements.
 ABREVIATIONS

ANC: Antenatal care

APH: Antepartum Hemorrhage

DVT: Deep Vein Thrombosis

ENBC: Essential new born care.

HIV: Human immunodeficiency.

MNCH: Maternal neonate child care.

MCH: Mother health care

PPH: Post-Partum Hemorrhage.

SPSS: Statistical package care of social science.

SRS: Simple Random Sampling

UNICEF: United Nation International Children`s Emergency Fund.

WHO: World health organization?

 ABSTRACT
Background: Globally Postnatal care (PNC) is the care given to the mother and her newborn
baby immediately after the birth and for the first six weeks of life. Maternal mortality is
higher in women living in poor communities. Young adolescents face a higher risk of
complications and death .Only a small proportion of women in developing countries- less
than 30% receive adequate postpartum care. In very poor countries like Somalia and regions
as few 5% of who receive such postpartum care might help to prevent many of these deaths,
in developed countries, 90% of new mothers receive postpartum care.
Objectives: the aim of this study is to assess knowledge and practice on selection aspects

postnatal care among women reproductive age in Las-Anod sool Religion, Somalia.

Methodology: This will a hospital based prospective cross-sectional study conduct at

selected Las-anod district health facilities in Sool region feb 2021 up to July 2021.
Participants will be Interviewed using structured questionnaire. Data will be collected and
entered into the computer by use of the Statistical Package for Social Scientists (SPSS)
version21.0.
Result: The study found out that of the 86 mother who were visited to Las-anod 5-sub-
selected hospitals .Knowledge and practice of mother in postnatl care is quite low ,and this
study showed more than half of the mothers 59.3% were not known postnatal care Another
study demonstrated that the knowledge and practice of postnatal care among Ethiopia
women of known postnatal care in Addis Ababa is 45 %. This study also shows that
postnatal care in women is neglected public health concern as we have seen in study findings.
This study found that 52.3% had their postnatal care visit only one time during their postnatal
period. Another study conducted on slum residents in Addis Ababa, Ethiopia mentioned that
81.6% of the PNC clients had four or more visits during their PNC period. (53)
Conclusion: Although the care given during the postpartum period is very important in
preventing maternal and neonatal morbidity and mortality, prenatal care service utilization is
very low in Somalia. Targeted interventions seeking to address this concern should be
multifaceted and include both improving awareness about the need for prenatal care service
and training of healthcare providers to provide respectful, quality care during pregnancy,
labor, birth and beyond so that women are not deterred from seeking care during the prenatal
period.
Contents
DECLARATION...........................................................................................................................
DEDICATION.............................................................................................................................
APPROVAL.................................................................................................................................
ACKNOWLEDGEMENT............................................................................................................
ABREVIATIONS........................................................................................................................
ABSTRACT................................................................................................................................VII

List of Tables: X
List of figures: XI
CHAPTER ONE:.......................................................................................................................
INTRODUCTION......................................................................................................................
1.1 Background............................................................................................................1
1.2. Statement of the problem.........................................................................................3
1.3. Purpose of the study..................................................................................................5
1.5. Research questions:...................................................................................................5
1.6. Hypothesis:.................................................................................................................5
1.7 Study scope.................................................................................................................6
1.7.2 Geographical scope.................................................................................................6
1.7.3 Time scope................................................................................................................6
1.8. SIGNIFICANCE OF THE STUDY..............................................................................................
1.9 OPERATIONAL DEFINITION OF KEY TERMS.........................................................................

CHAPTER TWO: LITERATURE REVIEW8

2.1. THEORETICAL REVIEW.......................................................................................................
2.2 CONCEPTUAL FRAMEWORK...............................................................................................

2.3 :Related Study 15

2.3.1.1 Importance and when to go for postpartum care...................................................15
2.3.1.2 Complications during postpartum period.............................................................16
2.3.2 Maternal risk factor:.....................................................................................................16
2.3.3 Socio demographic and environmental factor:..........................................................17
2.3.4 Cost of accessing post-natal care services:..................................................................18
2.4 GABS OF RESEARCH................................................................................................................
CHAPTER THREE METHODOLOGY.............................................................................
 3.0 INTRODUCTION..............................................................................................................
3.1 STUDY AREA....................................................................................................................
3.2 RESEARCH DESIGN.......................................................................................................
3.3 RESEARCH POPULATION............................................................................................
3.3.2. EXCLUSION CRITERIA.....................................................................................................
3.4 SAMPLE SIZE...................................................................................................................
3.5 SAMPLE PROCEDURE...................................................................................................
3.6 RESEARCH INSTRUMENT...........................................................................................
3.6.1. DATA COLLECTORS........................................................................................................
3.7 DATA COLLECTION PROCESS..............................................................................................
3.7.1 DATA GATHERING PROCEDURES....................................................................................
3.7.2 DATA QUALITY MANAGEMENT........................................................................................
3.8 DATA PROCESSING AND ANALYSIS.....................................................................................
3.9. RELIABILITY AND VALIDITY.........................................................................................
3.10 ETHICAL CONSIDERATIONS..............................................................................................
3.11. DISSEMINATION OF THE RESEARCH................................................................................
3.12. LIMITATION OF THE STUDY.............................................................................................

CHAPTER FOUR :DATA PRESENTATION, ANALYSIS AND DISCUSSION OF

FINDING 27
4.1. INTRODUCTION...................................................................................................................
4.2 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS...................................
4.1.1: KNOWLEDGE AND PRACTICE OF MOTHER PNC:..........................................................
4.1.3 MATERNAL RISK FACTOR...............................................................................................
4.2. INDEPENDENT VARIABLES.................................................................................................
4.3. DEPENDENT VARIABLES.....................................................................................................
4.4 RELATIONSHIP BETWEEN IV AND DV...............................................................................
4.5 SUMMARY OF FINDINGS......................................................................................................

CHAPTER FIVE :DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS.......

5.1 INTRODUCTION...............................................................................................................
5.2 DISSCUSSION..............................................................................................................
5.3 5.2 CONCLUTIONS.....................................................................................................
5.4 RECOMMENDATIONS..............................................................................................

REFERENCES 47
APPENDICES 50
APPENDIX 1: TRANSMITTAL LATTER...........................................................................................
APPENDIX 2: INFORMED CONSENT..............................................................................................
APPENDEX-3: ENGLISH VERSION QUESTIONAIRE.....................................................
APPENDEX-4 SOOMALI VERSION QUESTIONAIRE.......................................................
APPENDIX 5: WORK PLAN....................................................................................................
APPENDIX 6: BUDGET............................................................................................................

Appendix 7: area of finding 62

 List of Tables:
Table :shows the socio-demographic characteristics of the
respondent 28
Table 2: shows the Knowledge and practice of mother PNC the respondents. 31
Table 3: shows the maternal Risk factor of the respondents. 34

List of figures:
Figure 1: a conceptual framework of the studies 14
Figure 2: Proportion of mother among Postnatal care and
allocation of sample size from four selected hospitals
based on simple random sampling. 22
Figure 3: What is meaning of postnatal care? 35
Figure 4: What is your educational level? 36
Figure 5: Postnatal care 36
Figure 6: Information about Postnatal care 37
Figure: 7 Lack of postnatal care 37
Figure 8: Postnatal care after delivery 38
Figure 9: Postnatal care place availability 38
Figure 10: Postnatal Care problem 39
Figure 11: Last birth place? 39
figure 12 :finding area of the study the knowledge and
practice on selection aspect on postanatal care among
reproductive
 CHAPTER ONE: INTRODUCTION

1.1 Background

Postnatal care is the care given to the mother and her newborn baby immediately after the

birth of the placenta and for the first six weeks of life.

Maternal mortality or morbidity is higher in women living in urban areas and among poor

communities. (Erin sines, 2015) Young adolescents face a higher risk of complications and

death as a result of pregnancy than other women, skilled care before, during and after

childbirth can save the lives of women and newborn babies. Only a small proportion of

women in developing countries- less than 30% receive adequate postpartum care (WHO

2017). In very poor countries and regions as few 5% of who receive such care, a large

proportion of maternal deaths occur during the first 6 weeks after delivery, and postpartum

care might help to prevent many of these deaths, in developed countries, 90% of new mothers

receive postpartum care Early diagnosis and emergent surgical management of perforation

peritonitis remain the mainstay of treatment (report Harvard college 2020). Mothers and new

born are vulnerable to illness and deaths during the postnatal period. Postnatal period is the

important part of maternal health care as the serious and life-threatening complications can

occur in postnatal period. The health of the mother is regarded as the indicator of health of

the society so postnatal care is important for the health of mother and newborn as well.

globally in improving maternal health. Around the world, 72% of women give birth attended

by skilled personnel,5 and the maternal mortality ratio has decreased from 380 to 210 per

100,000 live births between 2000 and 2013. Yet, in South-East Asia and sub-Saharan Africa

only 67% and 48% of women give birth with the assistance of skilled personnel,

respectively.5 Postnatal care reaches even fewer women and newborns: less than half of

women receive a
postnatal care visit within 2 days of childbirth.4 An analysis of Demographic and Health

Survey data from 23 sub-Saharan African countries found that only 13% of

women who delivered at home received postnatal care within 2 days of birth. The World

Health Organization (2018), Postnatal care is regarded as one of the most important

maternal health care services for the prevention of impairment and disability resulting from

child birth. The postnatal care includes systematic examination of the mother and baby and

appropriate advice given to the mother during postpartum period The postnatal period is

defined as the first six weeks after birth which is critical to the health and survival of a

mother and her newborn.

The World Health Organization (WHO) describes the postnatal care as the most critical and

most neglected phase of the life of the mothers and babies as most of the death occur during

the postnatal period Maternal mortality is a tragedy for individual women, for family and for

their community. Worldwide nearly 600000 mothers between the age of 15-49 years die

every year due to complication arising from pregnancy and childbirth. This means almost

every minute of every year maternal death occurs, 99% of which occur in developing

countries. In developed the maternal mortality ratio is around 27%/100000 live birth and in

developing country the ratio is 20 times higher the postnatal care is especially critical for

mother and newborn. It is the time to deliver intervention to improve the health and survival

of both mother and newborn After delivery the women begins to experience physiological

and psychological change in her body. These changes usually occur without difficulty.

However, factors such as blood loss, trauma during delivery, fatigue or infection (WHO fact

sheet 2015) level of knowledge of mothers regarding personal hygienic measures. The result

shown that below 30yrs of mothers obtained higher mean (%) percentage scores are (56.4%)

than those of older age mothers (47.4%). The primipara scored higher mean % score (56.4%)
as compared to multipara (55.4%). Mothers with a high level of education obtained high

mean percentage score (66.0%) than those with a low level of educations good knowledge

was positively associated with mothers who had some formal education. Living far from the

health center, and receiving education about newborn care at ANC visit were also associated

with an increased chance of having good ENBC (WHO, UNICEF 2014) The educational

status of the mothers was found to be positively associated with knowledge and practice on

ENBC. In line with this finding, it has been identified that higher levels of parental education

have a significant impact on the level of knowledge about newborn care, danger signs and

their health seeking behavior. Easy access to the health facility is expected to improve

community awareness towards healthy behaviors. However, the current finding showed that

respondents who lived far from the health facility (more than 30 minutes to reach on foot)

had better knowledge compared to mothers who lived near a health facility. This might be

because women that live near health facility may not be keen to know about newborn care as

they can easily access the health facility at the time when they need help. Married women had

3.48 times higher odds of having a good practice than others (divorced/widowed) that is

consistent with the finding of a similar study in women Somalia Getting information in

during ANC visit was found to have a positive association with ENBC practice. Likewise,

health information about ENBC during delivery and postpartum had a positive association

with ENBC practice. The result of the current study was also similar to a study conducted in

women which showed postpartum women who were informed.

1.2. Statement of the problem

Effects on women Half of all postnatal maternal deaths occur during the first week after the

baby is born, and the majority of these occur during the first 24 hours after childbirth.1 The

leading cause of maternal mortality in Africa – accounting for 34% of deaths – is

hemorrhage, the majority of which occurs postnatal. Sepsis and infection claim another 10
percent of maternal deaths, virtually all during the postnatal period.2 HIV-positive mothers

are at greater risk of postnatal maternal death than HIV-negative women.3 Access to family

planning in the early postnatal period is also important, and lack of effective PNC contributes

to frequent, poorly spaced pregnancies (Section III chapter 1). Postnatal care is regarded as

one of the most important maternal health care services for the of impairment and disability

resulting from child birth. The postnatal care includes systematic prevention mentation of the

mother and baby and appropriate advice given to the mother during postpartum period (Dutta,

DC. (2016).

The postnatal period is defined as the first six weeks after birth which is critical to the health

and survival of a mother and her newborn. The World Health Organization (WHO) describes

the postnatal care as the most critical and most neglected phase of the life of the mothers and

babies as most of the death occur during the postnatal period.

The aim of study was to find the effect of early surgery on postoperative outcome in patients

with perforation peritonitis. Each year nearly 7.7 million children under five years die around

the world; out of which approximately 3.1 million of the newborns die during the neonatal

period and almost all these (99%) deaths occur in the developing countries According to the

World Health Organization estimation, neonatal deaths account for 45% of the under-five

deaths More than one-third of these deaths take place in the first 24 h of birth, whereas three-

quarter of the neonatal deaths takes place in the first seven days of birth Effects on women

Half of all postnatal maternal deaths occur during the first week after the baby is born, and

the majority of these occur during the first 24 hours after childbirth.

1: The leading cause of maternal mortality in Africa- accounting for 34 percent of deaths –

is hemorrhage, the majority of which occurs postnatal Sepsis and infection claim another 10

percent of maternal deaths, virtually all during the postnatal period.

2: HIV-positive mothers are at greater risk of postnatal maternal death than HIV-negative

women.

3: Access to family planning in the early postnatal period is also important, and lack of

effective PNC contributes to frequent, poorly spaced pregnancies (DUTTA, 2016). Thus, the

researcher decided to find out knowledge and practice on selection aspects in postnatal care

among women reproductive age.

1.3. Purpose of the study

The purpose of this study will investigate about knowledge and practice on selection

Aspects on postnatal care among women reproductive age among mother postnatal care

admitted to maternal units in Las-anod district health facilities, Sool region in 2022.

1.4. General Objectives

To assess knowledge and practice on selection aspects of postnatal care among women

reproductive age in Las-anod district health facilities.

1.4.1. Specific Objectives

1. To determine knowledge on selection of mother postnatal care in Las-anod district

health facilities?

2. To identify the extent of selection of postnatal care among women reproductive age in

Las-anod district health facilities?

3. To explore the practice of mother does postnatal care in Las-anod district health

facilities.

1.5. Research questions:

1. What is the level of knowledge regarding about mother postnatal care at Las-anod

district health facilities?

2. What is the level of selection regarding about postnatal care at Las-anod district

health facilities?
 3. How to explore of practice regarding about mother postnatal care at Las-anod district

health facilities?

1.6. Hypothesis:

Null hypothesis Ho:

o There is no association between postnatal care and knowledge of the women among

reproductive age.

o There is no association between women postnatal care and knowledge of the women among

reproductive age

Alternative hypothesis Hi:

o There is association between postnatal care and knowledge of the women among

reproductive age.

o There is association between women postnatal care and knowledge of the women among

reproductive age

1.7 Study scope

1.7.1 Subject scope

The study will focus on the knowledge and practice on selection aspects of postnatal care

among women reproductive age in Las-Anod District, at Sool Region.

1.7.2 Geographical scope.

The study will be carried out in Las-anod district health facilities, Located in Las-anod, Sool

region.

1.7.3 Time scope

The study will focus on the in the period between to February to July 2022. . The proposal

will develop May, data will be collected, and the Thesis will present in July 2022.
 1.8. Significance of the study

The study is measure to be of great important to the government and its various agencies as it

were providing use full knowledge and information with regard to the knowledge, practice on

selection aspect of mother postnatal care Among women reproductive age. (Warren et al ",

2005) The study were significant researchers and follow students as it were not only fill the

knowledge and provide insightful information of knowledge and practice on selection aspects

of postnatal care among women reproductive age finding from this study were providing

policy makes with information for future planning and interventions of appropriate strategies

to promote and maintain health mother. Also, the finding of this study can also help as a

baseline data.

1.9 Operational definition of key terms

o Postnatal car is care given mother and her baby immediately after the birth of the placenta

and for the six weeks of life.

o Mortality is the state of being mortal, or susceptible to death.

o Morbidity is a diseased state, disability or poor health due to any cause.

o Postoperative care given after surgery until patient discharged from hospital.

o Perforation peritonitis mostly result from the perforation of disease viscus [like abdominal

trauma].

o Multipara a woman who h had two or more pregnancies resulting in potentially viable

offspring.

o Primipara a woman who is pregnant for first time.

o Postpartum Hemorrhage is when a woman has heavy bleeding after giving birth

o Neonatal period is the first 4 weeks or 28 days of a child’s life after birth.

o Postpartum infection any bacterial infection of the female reproductive track following

childbirth or miscarriage
o Sepsis is the body extreme response to an infection
 CHAPTER TWO: LITERATURE REVIEW

2.1. Theoretical Review

The postnatal care defined as the time immediately after the birth of the baby and up to six

weeks (42 days) after birth is critical for the newborn and the mother immediately after birth

bleeding and infection pose the greatest risk to the mother’s life while preterm birth, asphyxia

and severe infections pose greatest risk to mother and newborn are vulnerable during

postnatal period especially during first 24 hours following delivery Approximately two third

of the maternal death occur in the developing countries during postnatal period More than

half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.

The maternal mortality ratio in developing countries in 2013 is 230 per 100 000 live births

versus 16 per 100 000 live births in developed countries. Developing countries account for 99

percent of maternal deaths annually. While increasing service availability and maintaining

acceptable quality standards, it is important to assess maternal satisfaction with care in order

to make it more responsive and culturally acceptable, ultimately leading to enhanced

utilization and improved outcomes. At time when global efforts to reduce maternal mortality

have been stepped up, maternal satisfaction and its determinants need to be addressed by

developing country governments. This review seeks to identify postnatal care among women

reproductive age maternity care in developing countries. Public health and medicine

databases were searched. English articles covering antenatal, intrapartum or postpartum care,

for either home or institutional deliveries, reporting maternal satisfaction from developing

countries (World Bank list). The postnatal period or puerperium is a period of adjustment

after pregnancy when the anatomic and physiological changes of pregnancy are reversed and

body returns to the normal state. (Rinda John 2005) This period starts as soon as the

placenta is expelled and extends up to the period of six weeks. During this time, the women

recover from the stresses of pregnancy and delivery. Hygiene, postnatal exercises, breast

feeding, family planning and immunization to the baby. Postnatal care is the care given to the
9
mother after delivery, up to 6 weeks’ period, during which reproductive organs return to

normal size, shape and optimum health is restored. The WHO estimates that 150 million

deliveries occur and nutrition education, postnatal vitamin A and iron supplementation for the

mother; immunization of newborns and postnatal family planning counseling and services

(UNFPA 2009). Postnatal care is the important part of maternal health care as it helps to

assess the health status of mother, institute an effective therapy to rectify the defect and to

note the progress the baby, and solve the problems and to formulate any preventive measure

to be taken. It also helps to provide necessary information. Women’s subjective experiences

are at the core of measuring disrespect and abuse in childbirth, as their perceptions would

have the most influence in their decisions to use health facilities in the future. Disrespectful

and abusive treatment covers a range of provider behaviors, such as shouting at or scolding

patients, requesting bribes, threatening to withhold health care, physical abuse, abandonment

in times of need, conducting procedures without consent and detaining mothers or babies at

the facility due to failure to pay. It may also include abuses stemming from lack of resources

within the health system, such as forcing women in labor to share a bed, Health care

providers need to foster a positive relationship with the clients to achieve the desired health

outcomes as women’s memories of their child bearing experiences stay with them for a life

time and are often shared with other women, contributing to a climate of confidence or doubt

around childbearing. These varied perspectives on quality alludes to offering a range of safe,

effective services that meet evidence-based standards while satisfying clients‟ needs and

desires, if an individual makes what is likely to be an arduous trip to a health facility only to

find staff that are indifferent and medicines out of stock, when this scenario becomes

common place, an entire community might become less likely to seek health services, even

when they are needed. Accessibility covers cost and the physical ease of reaching the facility.

Though all the maternal neonatal child care services (MNCH) in Kenya are theoretically free

of cost; there are some indirect and informal payments such as travel cost to and from the

10
facility, and paying for prescribed medicines that have been reported as considerable barriers

to accessing care and treatment The distance to a health facility is not only an actual obstacle

that prevents women from reaching health facilities but also a factor influencing the decision

to seek care, the unavailability of public transportation or prohibitive cost of transport means

that many women have to walk or improvise a way to reach health care, The remoteness

from health facilities also increases community members' out-of-pocket expenditure for

transportation costs.

Knowledge on selection aspects of postnatal care among women reproductive age.

Motherhood is a joy full stage as she is the only one capable to bring forth the new life.

Women the life given, is vulnerable to lose her life in the process of childbirth. Postnatal

period is the scientific term for the period following childbirth till 6 weeks during which the

body tissues particularly the genital and pelvic organs return back to pre-pregnant state. The

postpartum period or puerperium, begins as soon as placenta is expelled and last for

approximately 6 weeks when the uterus becomes regressed almost to the changes of

pregnancy, labor and delivery have resolved and the body has reverted to the non-pregnant

state. (Dutta, 2019 During) The present study highlights the knowledge on postnatal care

among postnatal mothers. It shows that participants had average knowledge on postnatal care.

The study shows that the most knowledgeable area was danger sign of mother and newborn

and the least knowledgeable area was family planning. (UNICEF 2018)

Awareness programmers are required to improve knowledge on the different aspects of

postnatal care. Further studies can be conducted to make more clear views, to plan for future

on reproductive rights, and to utilize the reproductive health services by people. Maternal and

child health is one of the basic needs of a society for it is the cornerstone on which a health

community and nation are built. Hence, the ministry of health of Eritrea has postnatal care

program with sequence of activities that begins with clean delivery practice, followed by

11
clean umbilical cord care, thermal care, special care of low birth weight or preterm birth,

early and exclusive breastfeeding, as well as immunization program.

The first component in the process of parenting which include care activities such as feeding,

clothing, holding, cleaning the infant, protecting it from harm and providing mobility for it.

The task-oriented activities or cognitive motor skills are not automatically supplied at the

birth of one’s child. The parent’s abilities in these respects have been influenced by cultural

and personal experiences (Mattson and Lee, 1992) several misconceptions, ignorance and

inadequacy of knowledge in relation to postnatal care is prevalent among postnatal mothers,

especially primigravida. The world health organization (WHO) estimates that 150 million

deliveries occur annually. Worldwide, every minute of every day, one woman dies off

pregnancy related complications, nearly women die each year, of these 99 percentages of

death occurs in developing countries. In India, every 5 minutes, one woman dies from

complications related to the pregnancy and childbirth. This adds up to 21,000 women per

year. (Betty. R. Sweet (2007)

Practice on selection aspects of postnatal care among women reproductive age.

Poor nutritional practices especially in pregnancy and early childhood can result in dire

consequences in the growth and development of a child. Key Methods This study using

purposive sampling enrolled 149 women who had carried at least one pregnancy term in

Enugu south east Nigeria. Logistic regression analysis was used to assess association between

avoidance of certain food in pregnancy and selected socio-demographic factors. Encourage

women to deliver with a skilled birth attendant at a health facility so they receive quality

intrapartum and postnatal care including administration of a u uterotonic during the third

stage of lab ours. Professional skilled care is important for all women and newborns during

lab our, childbirth and the first day after birth. Promote respectful and women centered

maternity care where women are treated with kindness, dignity and respect.

12
Respectful maternity care is an essential part of postnatal care particularly in health facilities.

It promotes best practices (such as rooming in, unless separation is medically necessary),

recognizes that women and their families should be fully informed on all aspects of care, and

values counselling as an opportunity to answer questions and address concerns.

Since older and younger women have different experience and influence, their behavior on

seeking postnatal care also vary, commonly younger women are more likely to utilize modern

health facilities than older women as they are likely to have greater exposure and knowledge

to modem health care and also access to education. On other hand older women are

likely to depend on past experience thus fail to utilize health care services. One study in

Nepal gave result that women under the age of 35 years utilized postnatal more than those

above 35 years, extent of movement, appears

to be a major determinant of postnatal care utilization among the poor to middle income

women. Both the mother and the baby are also at high risk of developing other complications

if the physiological adjustments that take place in their bodies after the birth do not occur

properly. This can result in loss of function or Interruption of essential supplies of oxygen

and nutrients needed to sustain life.

Knowledge & practice aspects of postnatal care among women reproductive age.

The postnatal period or puerperium is a period of adjustment after pregnancy when the

anatomic and physiological changes of pregnancy are reversed and body returns to the

normal state. This period starts as soon as the placenta is expelled and extends up to the

period of six weeks

(Nour N, 2008) this time, the women recover from the stresses of pregnancy and delivery.

The requirements during this period are nutritious diet, personal hygiene, postnatal exercises,

breast feeding, family 3 planning and immunization to the baby. Postnatal care is the care

given to the mother after delivery, up to 6 weeks’ period, during which reproductive organs

return to 4 normal size, shape and optimum health is restored. The WHO estimates that 150

13
million deliveries occur annually, Worldwide, every minute of every day, one woman dies of

pregnancy related complications. Nearly 6, 00,000 women die each year; of these 99% of

deaths occur in developing countries. Every single woman who dies, 30 women develop life

long illness and injuries related to pregnancy and childbirth. In India, every five minutes, one

woman dies from complications related to pregnancy and childbirth. This adds up to a total of

1, 21,000 women per years.15% of the women develop life threatening complications.65% of

deliveries are conducted at home.41% 5 of the women have skilled attendants to assist in

childbirth. (Et, 2014) (JE, 2014).

Lack of awareness is an important factor underlying maternal healthcare utilization. Lack of

information affects women's capabilities to make their own decisions about seeking help

found out that the most frequent reason for not obtaining PNC services was that women did

not feel sick and therefore did not require PNC services. Another obstacle is the failure by

Health provider to inform them about the PNC services and when and where to obtain care.

Low utilization of PNC services is, attributed to, women's lack of knowledge about its

importance, their lack of perceived need; especially if they are feeling well, in developing

countries, women spend more time on many multiple household chores than on their own

health as observed to give priority to the health needs of their infants rather than their own.

This is in is in contrast to the fact that many women appreciate the need of monitoring child’s

health but do not see the need for post-natal checkups themselves especially if delivery was

an eventful Many women also report that PNC services are for the child to receive

vaccinations as reported by who Maternal lack of knowledge of obstetric complications and

lack of exposure to mass media has been associated with low utilization of health services as

reported by Even for women who delivered at health facility they reported that they did not

receive appointments for the services on discharge and were therefore not aware of them .

14
 2.2 Conceptual Framework

Knowledge and practice of mother PNC

o Awareness of PNC.
o Complications during postpartum period.
o Importance and when to go for PNC.
o Known PNC
o Breastfeeding
o Known starts and end of PNC

DEPENDENT VARIABLE

INDEPENDENT VARIABLE

Maternal risk factor SOCIODEMOGRAPHICAND

o Children stress ENVIRNMENTAL FACTORS
o Postpartum depression o Gender
o PPH o Maternal age
Postnatal
o Postpartum Infection o Children
Care
o 2.3Incontinence
Related studies o Occupation
o Nutrion o Marital status
o DVT o Income
o Postpartum psychosis o Educational status of the
o Life style mother
o Multiple pregnancy o Live

Figure 1: a conceptual framework of the studies

15
 2.3 :Related Study
2.3.1 Knowledge and practice mother of PNC
2.3.1.1 Importance and when to go for postpartum care

On continuum of care post-delivery, comprehensive postnatal care package was essential and

was put in place. It included routine visits in the immediate days following childbirth. This is

when risks were high for the mother. It was complemented by promotion of healthy

behaviors like exclusive breast feeding, identifying of complications and facilitating referrals

where applicable. This was to ensure a healthy mother (Kerber et al., 2007). On need for PPC

services, it was reported that half of the women who had at least one new health problem

arising in the first three months, retained it over time as they had not gone for the crucial ones

early in this period. When these services were not offered, the cost effectiveness of major

interventions was particularly high in terms of the low cost covered and the high number of

lives saved if they would have done so early (Adam et al., 2005).

Majority of mothers perceived that PPC was helpful to self, and children‟s health, but on

actual use slightly more than half of mothers utilized the services in Gondar Zuria, Ethiopia.

(Tesfahun et al., 2014). In another study on reasons for attendance, the two primary reasons

for women‟s attendance for postnatal/partum services were to receive own care and

immunizations for their babies (Warren et al., 2015).The majority of the mothers had

awareness on maternal care services inclusive but they did not know when they should seek

PPC services and concluded that mothers‟ awareness about PPC service is more focused on

the immunization of their babies than other services for self (Tesfahun et al., 2014).

Almost two-thirds of the women considered postnatal care as important and essential in a

study on factors associated with lack of postpartum care among Palestinian women. The most

frequent reason for not obtaining PPC care was that women did not feel sick and therefore

felt that they did not need the care, followed by not having been told by the doctor to come

back. On the barriers to go for services fewer women were not aware of the service

16
availability, some had no one to take care of the children, still others stated having experience

with previous deliveries and therefore not needing additional information among the reasons

This limited to some extend the care they were to receive during this period (Dhaher et al.,

2008).

2.3.1.2 Complications during postpartum period

Awareness on complications is important to women, in a study on postpartum utilization of

services and factors affecting it in North West Ethiopia, those mothers who were aware of

maternal complications that can occur during postpartum period were more likely to use than

mothers who were not aware. This was due to the fact that majority of them delivered in a

health facility and had been informed of the immediate and subsequent care they are

supposed to receive (Limenih et al., 2016). Majority of the respondents in a study done in

Nepal knew complications during this period. They mentioned postpartum hemorrhage,

genital infection, mastitis, painful breast engorgement, vaginal bleeding among others which

are the most common complications (Shah and Pariyar, 2016}

2.3.2 Maternal risk factor:

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to

fear and anxiety. But it can also result in something you might not expect — depression.

Most new moms experience postpartum "baby blues" after childbirth, which commonly

include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically

begin within the first two to three days after delivery, and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as

postpartum depression. Rarely, an extreme mood disorder called postpartum psychosis also

may develop after childbirth.

17
Postpartum depression isn't a character flaw or a weakness. Sometimes it's simply a

complication of giving birth. If you have postpartum depression, prompt treatment can help

you manage your symptoms and help you bond with your baby

2.3.3 Socio demographic and environmental factor:

Studies by Rutaremwa et al (2015) on determinants of maternal health services in Uganda has

shown that, the utilization of maternal health service package is closely related to income

levels of mothers. Rutaremwa et al (2015) further reiterated that, the low levels of PNC

services are related to a woman’s or husband’s occupation, education status and the level of

income. Mothers with higher income levels are more likely to make better use of basic

maternal health care services probably because they could afford the services as compared to

their counter parts with lower household income status.

Women who engaged in farming or commercial activities make better use of maternal health

services compared to those who are housewives (Ayele et al, 2014). In Tanzania, better

socioeconomic status of women was found to be associated with better use of maternal health

services (Exavery et al, 2014). Consequently, women whose partners are involved in income

generating activities, access to PNC should not be a big problem unless they are not well

informed about the importance of these health promotive and preventive services provided

during the PNC period. By engaging in business activities, mothers can be in better position

to pay for their health care needs than when they do not have any source of income.

In India, however, studies by Kalpalata and Gautam (2014) revealed that, socioeconomic

class of mothers affect their utilization of PNC services with only (21%) of women utilizing

PNC services coming from the lower socioeconomic class compared to only 3.7% from the

middle

class unlike the study finding by Ayele et al (2014); Exavery et al (2014) and Rutaremwa et

al (2015). The above differences in the determinants of postnatal service utilization by

different scholars is evidence that, the factors contributing to the use of postnatal care
18
services differs by geographical location and the different methodologies employed in

conducting such studies. Hence, more needs to be done to uncover some of the factors

determining the utilization of PNC services in the Maridi County where such services seem to

be underutilized by many mothers.

2.3.4 Cost of accessing post-natal care services:

Although a lot of opportunities such as focused ANC, using of peer counsellors and

reminders exists for scheduled targeted PNC visits recommended for all mothers, studies in

the USA have pointed lower utilization (40%) rates for PNC services provided by skilled

health care personnel among mothers with limited resources (MoPHS, 2011; ACOG, 2016).

This contributes to health disparities among population even though such cost-effective

strategies for improvement of postpartum care do exist at the primary health care facilities.

Availability of financial resources at the household levels can enable individuals to pay for

their health care related needs. On the other hand, limitation of household financial

resources to pay for essential drugs and supplies in the public health facilities in addition to

costs of transportation to access care could be one of the deterring factors for PNC services

utilization among mothers in the county.

Social support from the spouse or partner and other family members cannot be

underestimated because given the financial limitations; most mothers depend on their

husbands and family

member for economic support. Nakajubi (2016) pointed out that, many Ugandan women

received little or no support from their spouse/partners during the critical times of the

postnatal period. In South Sudan where the health system is still recovering following

decades of conflict, such situations expose most mothers to psychologically and physically

exhaustion explaining the underutilization of PNC services because of lack of needed support

from their family members. The engagement of male partners in planning and decision-

19
making right from the pre-natal, ANC and delivery period can improve PNC service

utilization by mothers following childbirth.

2.4 Gabs of research

Skilled care before, during and after childbirth can save the lives of women and newborn

babies. Only a small proportion of women in developing countries- less than 30% receive

adequate postpartum care (WHO 2017). In very poor countries and regions as few as 5% of

who receive such care, A large proportion of maternal deaths occur during the first 6 weeks

after delivery, and postpartum care might help to prevent many of these deaths, In developed

countries, 90% of new mothers receive postpartum care Early diagnosis and emergent

surgical management of perforation peritonitis remain the mainstay of treatment (report

Harvard college 2020) the WHO Recommended for prevention and treatment any condition

of knowledge and practice on postnatal care in Among women Reproductive Age Africa

and Somalia the Research Gap of knowledge and practice on selection aspects of mother

postnatal care Among women Reproductive Age Effects on women Half of all postnatal

maternal deaths occur during the first week after the baby is born, and the majority of these

occur during the first 24 hours after childbirth.1 The leading care (WHO 2017).

20
 CHAPTER THREE :METHODOLOGY

3.0 INTRODUCTION

This chapter was cover researcher design, research population, sample size sampling, data

collection and technique, data collection instrument, data presentation and analysis ethical

consideration, limitation of the study is to explain, justify and account for the research

Methodology that was selected in this study. In conducting the investigation, the researcher

intended to proceed from a quantitative descriptive design. A number of issues related to the

research methodology were extensively discussed below

3.1 STUDY AREA AND PERIOD

This study was carried out in las-anod maternal health facilities in February 2022 to July

2022 to knowledge and practice on selection aspect on postanatal care among reproductive

age in las-anod sool region. In this study was only carry out the maternal health facility.

Las-anod has been the capital of Sool Region since 1984, as well as capital of Las-anod

District. Sool Region has other three districts, Ainabo, Taleh and Hudun as shown on the

Map. Geographically, Las-anod is located at the center of a prime grazing area known as

the Nugaal Valley. Las anod population estimated 156,438 according to UNFP projections

(UNFPA, 2014).

3.2 RESEARCH DESIGN

The research design adopted for this study were descriptive cross-sectional study to analyze

knowledge and practice on selection aspect on postanatal care among reproductive age at

maternal health facilities in Las anod that are providing delivery and women related services

. It involved the Collection of quantitative date to enables the identification of many Inter

relationships in a pregnant woman. situation over a short Period.

In the point that this research emphasis the knowledge and practice on selection aspects of

postnatal care among women reproductive Age in Las-anod Sool Somalia.

21
 3.3 RESEARCH POPULATION

The subjects of interest of this study will be mother who in postnatal care period of Las-

Anod located in Sool Somalia. The study focused Inclusion criteria and Exclusion criteria

3.3.1. Inclusion criteria

 The research will focus on all postnatal Mather of the reproductive age who will be
admitted to maternal units in Las-anod district health facilities in between 15-49 years.
Mother who are in postnatal care period
 The lactating maternal health care selected in health facility las-anod ,sool ,somalia .

 The mothers those willing to participate

3.3.2. Exclusion criteria

 Those mother who passed postnatal care will be mother who in postnatal care period
 Prenatal care period mother visited in Las-Anod health facility
 Those mothers who has pregnant
 The mother those willing Non-participate

3.4 SAMPLE SIZE

Population refers to the entire group of people that the researcher wished to investigate.

A sample size is the number of study participants in the study.

The sample size will be determined by Keisha and Leslie (1965) formula as below :

N= Z^2PQ/D^2

Where N= sample size required

Z = Standard normal deviate (1.96 for 95% confidence interval)

P = Proportion of mother of postnatal care 20%

Q = 1-P

D = the level of precision desired (0.05).

The prevalence in which is taken from the same study by Berkley et al at Kilifi district

hospital in Kenya. In which the knowledge and practice on selection aspect on postnatal care

22
among women reproductive age 6% to 20% [ 55]. Two percent is selected as the least

figure and used to calculate the sample size.

2
1.96 × 0.20(1−0.20)
N= =223
0.052

Part II

The source of population 120 of postnatal care mother visited in las anod health facilities

which is less than 10,000, population correction formula is used to determine adjusted

minimum sample size as flows

NF= n/ (1+n/N)

Description
Nf= is the desired sample size when the population studied is less than 10,000
n= the sample size required
N= the estimation population size
Therefore
NF= n/(1+n/N)
223/(1+223/120 )
223/2.85 =78
When added 10% of non-respondents the sample size become 85.8when rounded off it
become =86
3.5 SAMPLE PROCEDURE

The researcher would use Simple Random sampling to select the study Respondents those are

available and randomly selected to participate filling questionnaire.

Selecting simple random sampling (SRS) through the week for in-patients admitted maternal

unit for the different health facilities, in order to get proper data that covers different patient.

23
 Total health facilities in Las-anod

4 sub-selected hospital in Las-anod

General hospital Manhal hospital Al-Hayat MCH Sayidka

45 30 25 20

Proportion of postnatal women in Las-anod hospitals

35 15
20 16

86

Figure 2: Proportion of mother among Postnatal care and allocation of sample size from
four selected hospitals based on simple random sampling.

24
3.6 RESEARCH INSTRUMENT

Researchers will use three instruments to collect the data: questionnaire, checklist and key

informant interview. The sampling procedure, which will be using for this study is

probability sampling, especially simple random sampling will be selected to collect data

because it allows us to decide who to include in the sample and also to collect focused

information and the selection of typical and useful cases and saves time and cost.

3.6.1. Data Collectors

Data will be collected by four trained BSc Health Officer Students and they will be

supervised by one BSc Health Officer Student having previous experience in data collection.

Continuous follow up and supervision will be made by principal investigator throughout the

data collection period from May 2022- Jun 2022

3.7 Data collection process

3.7.1 Data Gathering Procedures

Using a checklist, the records department will approach and the files for postnatal care treated

for mother will be requested, sorted, organized and only those that meet the criteria will use

to obtain data. Then the designed questionnaires will change from English to Somali and

back to English to check the consistency of the questionnaire.

Data will collect through record review and face-to-face interview of the index mothers using

pretested structured and interviewer-administered questionnaires by trained experienced

health professionals. They will interview about their socio-demographic and environmental

characteristics, maternal risk factors, and knowledge and practice mother of PNC by trained

health personnel in Las-Anod district health facilities.

3.7.2 Data quality management

Data will collect using a checklist, tallied then using Microsoft Excel 2013 the data will

present using tables and graphs. A close supervision will carry out by the principal

25
investigator during data collection time. Data from each respondent will check for its

completeness, clarity, consistency and accuracy by the supervisor.

3.8 Data processing and analysis

We typically use computers to arrange data in ways that make the information easier to

understand and analyze, the data may be arranged into a diagram such as a graph and tables

that shows how the dependent and the independent variables are in relation between them.

We also use mathematics to analyze the data and help them interpret their results. The types

of mathematics used include statistics, which is the analysis of numerical data, and

probability, which calculates the likelihood that any particular risk factor will occur.

Data will be analyzed and processed electronically using statistical package for social

scientists (SPSS) to analyze the study of postnatal mother in Las-anode district health

farcicalities, Sool region.

3.9. Reliability and Validity

According to Mugenda and Mugenda (2003), validity is the accuracy and meaningfulness of

inferences, which are based on the research results. In other words, validity is the degree to

which results obtained from the analysis of the data actually represent the phenomenon under

study. This study was used both construct validity and content validity.

For construct validity, the questionnaire was divided into several sections to ensure that each

section assesses information for a specific objective, and also ensures the same close ties to

the conceptual framework for the study. Validity of the questionnaire was initially tested

through Content Validity Index (CVI) by reviewing it with my lead supervisor.

After calculating CVI, the researcher was proceeded to collect data using the same

instruments if their CVI was reached 0.7 and above. If the CVI was below 0.70 then the

instruments were revised before proceeding to collect data.

26
Reliability refers to the repeatability, stability or internal consistency of a questionnaire (Jack

& Clarke, 1998). In order to measure the consistency of the information collected from the

questionnaire a test-re-test reliability was carried out. The structured questionnaire was first

distributed and after a two weeks interval, the same questionnaire was distributed to the same

group of people and it found out that information contained in the first set of questionnaires

did not vary considerably with the information contained in the second set of questionnaires.

3.10 Ethical Considerations

Medical research involving human subjects raises ethical concerns about the subject's right to

privacy; all study subjects will be asked to give informed consent and will be assured

regarding confidentiality and anonymity of data. The questionnaires and results of

investigation and interview are anonymous and data will be kept confidentially. The research

proposal will be submitting to Nugaal University research ethical committee for review and

approval.

3.11. Dissemination of the research

In addition to performing and supporting research, the dissemination of the study is vital to

for our study in order to reach the scholars who interest this topic.

We are going to distribute copies of the research to the university administration, its

professors, Lecturers of faculty of health science and the students of the university; we also

want to put a copy to the university library in order to become a base for the future

researchers.

3.12. Limitation of the study

This paper has so many limitations related data collect and were too difficult and

misconception of some of the respondents those believed that the questionnaire survey was

be targeting them or the research were used for financial purpose. Some of the most

challenged limitation is as follows:

27
Insufficient source: the most limited one of this research were not enough journals, articles

and books related directly to this study that can facilitate to conduct such kind of research.

Financial cost: Money is always problem when it comes a student or unemployed person,

also Time factor: The time were not enough to collect data, analysis, and submit the paper in

timely manner. Availability of respondents Most of the respondents were not easy to

respond quickly to the questionnaire because of poor communication due to covin19 as well

as they were mothers who care their daily house activities. especially the unit of analysis of

the study, so it became another limitation to cover the whole respondent ‘s and traveling

difficulty to reach the intension

28
 CHAPTER FOUR :DATA PRESENTATION, ANALYSIS AND DISCUSSION OF
FINDING

4.1. Introduction
This chapter is a presentaion of the findings, analysis and interpertation of the data gathered

by different instruments.the summary of the quantitative data was presented by the use of

tables that incorporates various statistical tools. Similarliy the qualitative data was organized

according to the themes, analyzed and used to strengthen the qauntitative one. Becouse the

research design is discriptive the qualitative data is used to support the result obtained from

the interpertation of the quantitative data. As mentioned earlier, among various data

collecting instruments, analysis of questionare and interview were used to collect necessary

information for this study. A total of 86 respondents participated in this study making the

research rate of 100%.

4.2 Socio-demographic characteristics of the respondents

The participants of this study were Eighty-six. Regarding the gender 86 (100.0 %) were

female while none of them were male 0 (0%). And when we look at the age of the

respondents 26 (30.2%) Ranged between 15-25 years and, while 28 (33%) ranged between

26-30 years, were 14(16%) of them were aged between 31-35 years, whereas, 13 (15%) were

aged between 36-40 years and, while 5 (5.8) aged between 41-49 part of the respondent.

Regarding the marital status 49 (57. %) of them were married, 23 (26.7%) were divorced,

whereas 14(16.3%) of them windowed. Authority of the live respondent, the majority of the

participant were urban 86(100%), and Rural 0 (0).

Concerning the level of education of the participants 31(36%) of the respondents haven’t had

any educational background, whereas 18(20.93%) were primary level, 21(24.4%) were

secondary level while 16 (18.6%) were university level graduates. as for the occupational

status of the respondents 19 (22.1%) were employed while 54 (62.8%) were unemployed and,

conforming 13 (15.1%) were business person. the largest income of the respondents was less

29
than 100$ and it was 30 (3a.9%), the second number of incomes were between 100-300 $ 26

(30.2%) and the third and the fourth were 17 (19.8%%) and 13 (15.1%) respectively.

Number of children of the majority 1-3 were 36(41.9%), while 4-5 and their 26(30.2%) are 6-

7 and 16(18.6%) their other 8 and above was 8 (9.3%).

The mean age of the respondents interviewed is 29.83(SD 7.138).

Table 1: shows the socio-demographic characteristics of the respondents.

Variable Frequency (N) Percent (%)

Gender of
respondents
Female 86 100.0
Male 0 0

Age of
respondents
15-25 26 30.2
26-30 28 33
31-35 14 16.
36-40 13 15
41-49 5 5.8
Total 86 100.0
Marital status of the
respondents
Married 49 57.0
Divorced 23 26.7
Widowed 14 16.3
Total 86 100.0
Live of the respondents

Urban 86 100.0
Rural 0 0
Total 86 100.0
Level of education
Primary 18 20.93
Secondary 21 24.4
Universality 16 18.6
No Education 31 36.0
Total 86 100.0

30
 Occupation of the
respondents
Employed 19 22.1
Business person 13 15.1
Unemployed 54 62.8
Total 86 100.0
Family income
Less than $100 30 34.9
100-300$ 26 30.2
300-500$ 17 19.8
$500 and above 13 15.1
Total 86 100.0
Number Children of
respondents
1-3 36 41.9
4-5 26 30.2
6-7 16 18.6
Above 8 8 9.3
Total 86 100.0
Last child of age respondent
Below 12 months 41 47.7
1-2 years 32 37.2
2-3 years 13 15.1
Total 86 100.0

4.1.1: Knowledge and practice of mother PNC:

This table shows participant mother visit health centers during postnatal period the most

number of respondents were answered 46(53.5%) no and other side small number of them

their answered was 40(46.5%) yes while the mothers answered no for the no known

postnatal care 51(59.3%) and others said yes 35(40.7%) known postnatal care . Regarding

for meaning of postnatal care of the majority respondent no known meaning of PNC were

49 (57%), most participate PNC is the care given to the mother and her newborn baby

immediately after the birth and for first six weeks of life of respondent were 34 (39.5%),

while. PNC is the care given only newborn their 1 (1.2%) and other respondent PNC is the

care given only mother was 2 (2.33%). where do you get information of postnatal care of

31
respondents as an indicates of percentage and number radio, 0 within percentage 0 where TV

7 is within percentage of 8.1%, while health center 28 within percentage 32.6% within MCH

45 and percentage 52.3 %while community 6 and percentage 7%. As lack of postnatal care

can increase, maternal morbidity and mortality rate of respondent of the majority no were

48(55.8%) and another respondent no was 38(44.2%). ,While do you have postnatal care after

delivery of respondent of the majority yes were percentage 56( 65.11%) and another

respondent no was 30(34.88%.) When the asked postnatal period did starts and end the

majority from delivery to first 24 hours were 40(46.5%), while after one months and their

17(19.8%) of the respondents are delivery up to six weeks 7(8.1%) and the last respondent

was first two weeks 22(25.6%). Whereas following problem the majority from no

flowing any problem 44(51.2%), and their post- partum hemorrhage 20(23.3%), while

puerperal infection 7(8.1%) and the last respondent was post ecclesia 15(17.4%). Place

variability postnatal care the majority health center 32(37.2%), while home 26(30.2%) and

the last respondent was hospital 28(32.6%). When asked do you know any of postnatal

care the majority respondent no 47 (54.7%), while yes and their 39(45.5%). same to that,

balance diet and rest of respondents, majority of them were yes 54(62.2%), and their no

32(32.2%). The Counselling for family planning performance during postnatal care the

majority of yes participant 48(55.8%), while no 38(44.2%). Authority of the breast-feeding

respondent, the majority of the participant were yes 78(90.7%) while no 8(9.3%) the

participant mothers answered yes for the administer of oxytocin during postnatal care while

50(58.1%) of them have said No 36 (41.9%) .and additional to the last birth place, the most

responses health facility 50(58.1) of them had home 36(41.9).

32
Table 2: shows the Knowledge and practice of mother PNC the respondents.

Variable Frequance Percentage

Visit healt center

40 46.5%
Yes

No 46 53.5%

Total 86 100%

Do you known PNC

Yes 35 40.7

No 51 59.3

Total 86 100

PNC

PNC is the care given to the

mother and her newborn baby

34 39.5
immediately after the birth and for

first six wks of life

PNC is the care given only

1 1.2
mother

PNC is the care given only

2 2.3
newborn

No known meaning of pnc 49 57

Total 86 100

Informatio PNC

Radio 0 0

TV 7 8.1

Health center 28 32.6

33
 MCH 45 52.3

Community health 6 7

Total 86 100

Maternal mortality and morbidity

Yes 38 44.2

No 48 55.8

Total 86 100

do you have postnatal care

after delivery ?

Yes 56 65.11

No 30 34.88

Total 86 100

Start and end

From delivery to first 24hr 40 46.5

First 2 weeks 22 25.6

After one months 17 19.8

Delivery up to six weeks 7 8.1

Total 86 100.0

Flowing problem

Postaoartum hemorrhage 20 23.3

Puerperal infection 7 8.1

Posta eclapsia 15 17.4

No flowing any problem 44 51.2

Total 86 100.0

34
 Place valiabilty

Home 26 30.2

Health center 32 37.2

Hospital 28 32.6

Total 86 100.0

Known any PNC

Yes 39 45.3

No 47 54.7

Total 86 100.0

The PNC award afte delivery

Yes 41 47.6

No 45 52.3

Tatal 86 100

Balance deit and rest

Yes 54 62.8

No 32 32.2

Total 86 100

Councelling for family

planning

Yes 48 55.8

No 38 44.2

Total 86 100

Start breastfeeding

Yes 78 90.7

No 8 9.3

35
 Total 86 100

Oxytocin during postanal

care

Yes 50 58.1

No 36 41.9

Total 86 100

Last birth of place

Home 36 41.9

Health facility 50 58.1

Total 86 100

4.1.3 Maternal Risk Factor

Table 4.1.3 shows 34 (47.2%) of mothers that participated in the study had children stress
while 75(87.2%) of the mothers didn’t. and the mothers who had post-partum depression
were 14 (16.3%) whereas the mothers who didn’t were 72(83.7%).
When asked which treated was used the answer no used any things were 72(83.72) of the
mothers whereas the anti-depression was 7 (8.13%), while life style change was 3(3.5%),
while Concealing were 2(2.3%), last answer others 2(2.3%) of them. 27 (31.4%) had post-
partum hemorrhage, while 59 (68.6%) of the mothers didn’t.
, 63 (73.3%) of them had no have Post-partum hemorrhage , whereas 16 (18.6%) of them had
one time , while 5 (5.8%) had two times , and last but not least 2 (2.3%)of them had three
times . The mothers who had multi pregnancy were 62 (70.9%) and the ones who didn’t were
25 (29.1%).

Table 3: shows the maternal Risk factor of the respondents.

Variable Frequence Percentage

Children stress 11 12.8
Yes
No 75 87.2
Total 86 100.0

36
Posta-partum depression
Yes 14 16.3
No 72 83.7
Total 86 100.0
Used treated
Anti-depression 7 8.13
Concelling 2 2.3
Life style change 3 3.5
No used any drugs 72 83.7
Total 86 100
PPH
Yes 27 31.4
No 59 68.6
Total 86 100
Time PPH
1 Time 16 18.6
2 Time 5 5.8
3 Time 2 2.3
More 0 0
No have PPH 63 73.3
Total 86 100.0
Multi pregnancy
Yes 61 70.9
No 25 29.1
Total 86 100.0

37
 Figer 3:meaning of postanatal care

Figure 3: shows that most of the respondent no known meaning of PNC 49(56.98%).

Figure 4: What is your educational level?

Figure 4: Socio demographic characteristics of postnatal care for the study of determinants
the maternal unit of the hospitals in Las-anod district, Sool regional.

38
 Figure 5: Postnatal care

Figure 5: shows that most of the respondents had known postnatal care (40.70%), while had
not known PNC (59.30%).
Figure 6: Information about Postnatal care

This figure 6: showed where do you get information of postnatal care of respondents as an
indicates of percentage and number radio, 0 where TV is (8.14%) while health center was
(32.56 %), whereas MCH were (52.33%) while community (6.98%)

39
 Figure: 7 Lack of postnatal care

Figure 7: shows that the most increase maternal morbidity and mortality was answer No
(55.81%), while said yes (44.19%).

Figure 8: Postnatal care after delivery

40
Finger 8: shows the do you have postnatal care after delivery of respondent of the majority
yes were 52.33% and another respondent no was 47.67%.

Figure 9: Postnatal care place availability

Finger 9: shows that the most of respondents were home answer (30.23%), and 37.21%
respondents were health center, while respondents were (32.56%).

Figure 10: Postnatal Care problem

41
Finger 10: shows of the majority from no flowing any problem (51.16%), while puerperal
infection and their (8.14%), whereas postpartum hemorrhage were (23.26), and the last
respondent was post ecclesia (17.44%).

Figure 11: Last birth place?

Figure 11: shows that most of the respondents had last place of birth home (41.86%), whereas
the health facility (58.14%).

42
 4.2. Independent variables
These were the factors that contributed to the occurence of postnatal care to the mothers who

visited at the four health facilites that was selected for the study.including, socio-

demographic factors,that included (age, gender/sex, marital status, educational status,

occupational status), maternal risk factor and knowledge and practice of Postanatal care .

4.3. Dependent variables

In this study the depedent variables was knowledge and practice on selection aspect on
postanatal care among women reproductive age visited at maternal health facilities.
4.4 Relationship between IV and DV
There is a relationship between PNC and associated factors, This study examines the

existence of the relationship between knowledge and practice on selection aspects of

postnatal care among women reproductive age like the education level of

mathore ,knownledged and practice of postanatel care whether the mother had postanatal care

follow up or not ,if the there were any lack of the postanal care,, if there were the occurence

of following problem that could exacerbate and cause postpartum hemorrhage,post eclapsia .

The examined correlation of significance that shows the piavriate of two tailed significant

and showed the strong relationship between DV and IV, so there is strong relationship

between DV and IV and sagnificant was 0.05 that shows there is association between both of

them.

4.5 Summary of findings

100 percent of the participators of this study where female headed 57.0 percent of the female

were married, 26.7 percent were divorced, while 16.3 percent were widowed.

The mean age of the female interviewed was 29.83years (SD 7.19138)

Regarding the age of the respondents the largest percentage of the mothers 33 percent were

between 26-30 years, while 30.2percent of them were at age fifteenth and twenty five

Corelation testing showed a significant relation between postanatal care and

knowledged ,practice .

43
Parcipate mother 40.7 percentage known postanal care , the age of the mother, educational

background and family income had great significant effect while the occupation of the

respondents had little to no significant.

Regarding the postapartum hemorrhage respondent had the 31.1 percentage of, while

answered no 59 percentage.

Shows (47.2%) of mothers that participated in the study had children stress, while 87.2%
percentage of the mothers didn’t.
The mothers who had post-partum depression were 16.3% whereas the mothers who didn’t
were (83.7%).
When asked which treated was used the answer no used any things were 72(83.72) of the
mothers whereas the anti-depression was 7 (8.13%), while life style change was 3(3.5%),

44
 CHAPTER FIVE :DISCUSSIONS, CONCLUSIONS AND
RECOMMENDATIONS
5.1 :Introduction
This chapter is summary result of the study that was carried out at the four selected hospitals

which were general hospital, manhal hospital, alhayad hospital and the sayid MCH to

recognize the knowledge and practice on selection aspect on postanatal care among women

reproductive age visited at maternal health facilities in la-sanod, sool region. A summary of

the major findings of the study was made, conclusion and recommendations was presented

based on the findings.

The study provides detailed information about the knowledge and practice on selection aspect

on postanatal care among women reproductive age visited at maternal health facilities.

5.2 :DISSCUSSION

Knowledge and practice of mother in postnatal care is quite low ,and this study showed more
than half of the mothers 59.3% were not known postnatal care Another study demonstrated
that the knowledge and practice of postnatal care among Ethiopia women of known
postnatal care in Addis Ababa is 45 %.
This study also shows that postnatal care in women is neglected public health concern as we
have seen in study findings. This study found that 52.3% had their postantal care visit only
one time during their postnatal period. Another study conducted on slum residents in Addis
Ababa, Ethiopia mentioned that 81.6% of the PNC clients had four or more visits during their
PNC period. (53)
Out total 86 participate in this study 56(65.11%) were had good practical in
postnatal care and 30(34.88%) were had poor practical in postnatal care.
Another research made by heath center at Addis Ababa,
Ethiopia. May 14, 2017 states 84%|had good practical 16 had bad practical about postnatal
care.
The majority of our Maternal age was a significant factor specifically, women age between 15-

35 years were 28(33%) more likely to postnatal care compared to age between 15-25 years

26(30.2%), while age 31-35 were 14(16%) , where as 36-40 13(15%) and age a41-49 years

5.8 percentage The respondent married were percentage (57%), while 26.7% of the

respondents are divorced and the other respondent (16.3%) are windowed.

45
Families their income was less than 100$ (34.9%) dollar per month. also, majority of mother

occupation was unemployed (62.8%) percentage.

do you think lack of postnatal care can increase maternal morbidity and mortality rate?

Respondents in the field were asked do you think lack of postnatal care can

increase maternal morbidity and mortality rate. The result found were that

majority r of respondents 48(55.8%) of them revealed that lack postnatal care not

increase maternal morbidity and mortality rate, while minority 38(44,2%)

disagreed with the question. That means the majority of respondents they not

know lack of postnatal care can increase maternal morbidity and mortality rate

mother due to they haven’t educational background.

Do you know when baby start breastfeeding?

Majority of respondents 78(90.7%) them answered yes while 8(9.3%) answered no. that

mean of respondent they known benefits of breast feeding.

5.3 5.2 CONCLUTIONS

Finally, the study revealed that, number of respondents, did not receive any information

and awareness about PNC. Moreover, there were many reasons that could cause some

mothers’ low knowledge of PNC like some of the mothers did not contact to the health

centers as well as inadequate knowledge benefits of PNC.

Although the care given during the postpartum period is very important in preventing

maternal and neonatal morbidity and mortality, postnatal care service utilization is very low

in the Somalia. Targeted interventions seeking to address this concern should be multifaceted

and include both improving awareness about the need for postnatal care service and training

of healthcare providers to provide respectful, quality care during pregnancy, labor, birth and

46
beyond so that women are not deterred from seeking care during the postnatal period.

Endeavors to increase awareness of the importance of postnatal care should be targeted not

only to women, but also families and healthcare providers. Awareness should include

information and education provided during prenatal care and prior to discharge following

birth. More emphasis should be placed on the importance, as well as the components, of

postnatal care in pre-service healthcare educational programs and continuing education with

midwives, nurses and physicians.

From the data collected it was evident that the mothers do have basic knowledge about KMC,

that the attitude and practices could be improved. Knowledge could also be extended /

deepened through adequate information sessions during prenatal visits at the clinics and when

admitted to the ward.

According to the respondent of the study it was evident to the mother’s majority attend to the

governmental hospitals so the trained nursing staff should frequently provide training for

those not trained. During these training sessions the nursing staff must be trained to include

advantages of KAP during information session with the mother. More promotion methods

such as pamphlets and posters, especially in the clinic must be available and visible for the

mothers.

From the data collected it showed the source of postnatal care information majority of the

respondent are involved in relatives while the most important part health workers are still in a

gap to reach their community the advantages of postnatal care among mothers. To build that

space we have to empower the skills of the health workers and promote capacity building of

staff, monitor and evaluate quality of health staff.

47
Considerable gaps in knowledge regarding postnatal care among postpartum mothers were

evident. Special attention should be laid on rural residents, single/living together,

junior/below in educational level, prim-gravida/para, non-Tigrigna ethnicity, and 17 to

25 years old mothers

5.4 RECOMMENDATIONS

As the study indicated the knowledge of the respondents were low of practice, of the
postnatal care among women pregnancy.
So, in order to increase practice of the pregnancy women. Practice and knowledge of
postnatal care among women. Much attention should be given by all responsible bodies, after
analysis and evaluation the study finding, I suggest and recommend the following
recommendations:
 This study to introduce innovative and education programmers for all women

postnatal care, community members in generally (especially those responsible for family

decision-making, and at primary, secondary and university.

 The mother to visit health center when they get pregnancy in first their trimester up to

third, they need mothers to understand the benefit postnatal period starting early.

 To make internships university students who concern this topic to participate this

solution as a volunteer.

 All heath worker and programmed of health system to improve women they live Las-

anod, Sool, Somalia.

 To increase the awareness about postnatal care mothers

 To promote the capacity of midwives

 To encourage mothers to adopt postnatal care

 To be aware mothers during postnatal care

48
 REFERENCES
1.Barriers to utilization of postnatal care at village level in Klaten district, central Java

Province, Indonesia. BMC health services research. 2017 Dec;17.

2: Evidence-based inpatient postnatal care among women in a national hospital.

3: Fekadu, G. A., Getahun, F. A., & Kidanie, S. A. (2018). DHS WORKING PAPERS. 4:

Indu, P. (2016). A Study to assess the knowledge and practice on selected aspects of postnatal

care among primi mothers Coimbatore, PPG College of Nursing, (Coimbatore).

5: Kazakhstan: a best practice implementation project. JBI Evidence Implementation.

2020 Sep World Health Organization.

6: Munabi‐Babigumira, S., Glenton, C., Lewin, S., Fretheim, A., & Nabudere, H. (2017).

Factors that influence the provision of intrapartum and postnatal care by skilled birth

attendants in low and middle‐income countries: a qualitative evidence synthesis. Cochrane

Database of Systematic Reviews, (11).

7: Munabi‐Babigumira, S., Glenton, C., Lewin, S., Fretheim, A., & Nabudere, H. (2017).

Factors that influence the provision of intrapartum and postnatal care by skilled birth

attendants in low and middle-income countries: a qualitative evidence synthesis. Cochrane

Database of Systematic Reviews, (11).

8: Nimako, Kojo Twum. Feasibility of Service Delivery Redesign for Improved Maternal and

Newborn Survival in Kakamega County, Kenya. Diss. 2020.

9: postnatal care among postnatal mothers. Saudi J Med Pharm Pci (2015) 10:

Reproductive health, 11, 1-4. Langlois, Étienne V., et al. "Protocol for a systematic review on

inequalities in postnatal care services utilization in low-and middle-income countries."

Systematic reviews 2.1 (2013).

11: Report: enormous progress in child survival but greater focus on newborns urgently

needed.

49
12: Report: enormous progress in child survival but greater focus on newborns urgently

needed.

13: Sein, K. K. (2012). Maternal health care utilization among ever married youths in

Criminating Township, Myanmar. Maternal and child health journal.

14: Tesfahun, Fikirte, Walelegn Worku, Fekadu Mazengiya, and Manay Kifle.

"Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District,

Ethiopia: a cross-sectional study." Maternal and child health journal 18, no. 10 (2014

15: Vasudeva, S. A Quasi-Experimental Study to Assess the Effectiveness of Early

Suckling on Maternal and Neonatal Outcome during Third Stage of Labor at DMM Hospital,

Chennai. Diss. Mohamed Sathak AJ College of Nursing, Chennai, (2012).

16: WHO recommendations on intrapartum care for a positive childbirth experience.

17: World Health ---Organization; 2018 Jun 25. World Health Organization. 18: WHO

recommendations on postnatal care of the mother and newborn. World Health Organization;

2014.

19: Wardlaw, T., You, D., Hug, L., Amouzou, A., & Newby, H. (2014). UNICEF.

20: Rahman, K. M. M. (2010). The determinants of use of postnatal care services for

mothers: Does differential exists between urban and rural areas in Bangladesh? The Internet

Journal of Epidemiology, 8(1), 1055.

21: WHO, (2013). Recommendations of postnatal care to mother and newborn. Geneva:

World Health Organization.

22:WHO; 2011: Early initiation and exclusive breastfeeding.

23: WHO, 2003.: Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland:
A joint WHO/UNICEF statement. Geneva.
24:WHO; 2003: Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland:
A joint WHO/UNICEF statement. Geneva.
25: WHO; 2001: Report of the global consultation on Summary of guiding principles for
complementary feeding of the breastfed child. Geneva.

50
26:Woldie TG, Kassa AW, Edris. M. 2014; Assessment of Exclusive Breast-Feeding Practice
and Associated Factors in Mecha District, North West Ethiopia. Science Journal of Public
Health. 2(4):330-6.

51
APPENDICES
Appendix 1: transmittal latter
Salaam
Magacaygu waa ______________________________________________ Waxaanu nahay

ardayda Jaamacadda Nugaal, Kuliyadda Caafimaadka. Ujeedadda daraasadani u uruurineynaa

waa in aanu qiimeynayno baaxadda iyo sababaha la xidhiidha daryeelka lasiiyo hooyada

dhalmada kadib kuwaas oo sooxaadiray xarumaha caafimadka ee gobolka sool. Waxa laguu

doortay inaad ka qayb qaadato daraasadan, waxaadna qayb ka tahay dadka tijaabadan iyo

su’aalahan laga qaadi doono. Aadna noo buuxiso foomka su'aalaha ee aan ugu talagalnay

inaad noo buxisaan.

macluumaadka daraasaddan waxa kaliya oo loo isticmaali doonaa ujeeddooyin

Cilmi Baadhis si ay u ibo furto macluumaad muhiim ah oo ku saabsan, in la

ogaado baaxadda iyo sababaha la xidhiidha daryeelka lasiiyo hooyada dhalmada

kadib.

Magacaaga laguma qori doono su’aalahan. Dhamaan macluumaadka aad na siiso

waxa loo hayn doona si adag oo kalsooni leh waxaadna xaq u leedahay inaadan ka

jawaabin su’aal walba oo aadan rabin, sidoo kale, waxaad xaq u leedahay inaad ka

qayb qadato ama diido daraasaddan. Ka qayb qaadashadaadu waa doorashadaada,

sababtoo ah ka qayb qaadashadadu aad ayay muhiim u tahay si ay u timaado

najiito muhiim, si aan u ogaano heerka baaxadda iyo daryeelka lasiiyo hooyada

dhalmada kadib.

52
 Appendix 2: Informed consent
Our names are……………………………………………………………. we are students In

Nugaal university faculty of health science, department clinical health officers. We are here

to study about the knowledge and practice on selection aspect on postanatal care among

reproductive age visited in las anod healthy facilities and you are chosen to participate in this

study. You are selected and included in the study as part of the sample population to

complete the questionnaire designed by us.

The information obtained in this study will be used only for research purposes to generate

important information about knowledge and practice on selection aspect on postanatal care

among reproductive age visited in maternal health facilities in las-anod.

The study will involve various personal-issues. In order to attain this study objectives your

good will, kindly participation and genuine response is needed. Confidentiality is strictly

protected and none of your response will be reported separately. Therefore, there is no need

to write your names ID numbers on these questionnaires. It’s your right to participate or to

refuse in this study. And you can drop any individual questionnaire. But your participation

and contribution in the study is very important to come up with important findings which

help improve quality of health service. So please take few minutes to answer to the questions.

53
 APPENDEX-3: ENGLISH VERSION QUESTIONAIRE
Dear respondents

We are students at Nugaal university faculty healthy science, department of clinical healthy

officer. We conducted a study to assess the knowledge and practice on selection aspect on

postanatal care among reproductive age visited in maternal health facilities in las-anod sool

region

NO
Section 1. socio demographic factors Coding category
1 1. Male
Sex of the mother 2. Female
2 1. 15-25
Age of the mother 2. 26-30
3. 31-35
4. 36-40
5. 41-49
3 1. Single
Marital status 2. married
3. divorced
4. windowed
4 1. Primary
Educational status mother 2. Secondary
3. University
4. No educated
5 1. Employed
Occupation 2. unemployed
3. Business person
4. unemployed
6 1. less than 100$
Family income mother 2. 100-300$
3. 300-500$
4. 500$and above
7 Number of children 1. :1-3
2. 4-5
3. 6-7
4. above 8

8 Last child 1. Below 12 months { }

2. 1year-2 year { }
3. 2 year-3 year { }

54
No Section B: knowledge and practice of PNC Coding category

9 Do you visit health centers during postnatal 1. Yes

period? 2. no

10 1. Yes
DO you know postnatal care? 2. No
11 1. PNC is the care given to the
mother and her newborn baby
Meaning postnatal care immediately After the birth
and for first six weeks of life
2. PNC is the care given only
mother
3. PNC is the care given only
newborn
4. :NO known meaning of PNC
12 1. Radio
Information 2. TV
3. health Centre
4. MCH
5. community health

13 1. Yes
do you think lack of postnatal care can increase 2. No
maternal morbidity and mortality rat?

14 Do you have postnatal care after delivery? 1. Yes

2. No

16 1. from delivery to first

24 hours {}
End and start PNC
2. first 2 weeks {}
3. after one month {}
4. delivery up to six
weeks {}

55
15 Flowing problems postpartum hemorrhage
puerperal infection
post ecclapsia
no flowing any problem

17 Place availability Home

healthy center
hospital

18 do you know any of postnatal care Yes

No
19 Did you come back in the postnatal care award after Yes
delivery? No

20 well balance diet and rest making during postnatal Yes

period? No

21 Counseling for family planning performance during Yes

postnatal care? No

22 Do you know when baby start breastfeeding Yes

No
23 Do you administer of oxytocin during postnatal care? Yes
no
24 Last place birth Home
Health facility
25 do you have postnatal care after delivery ? 1. Yes
2. No

NO Section 4. Maternal Risk Factor Codding category

56
26 Yes
Have you Children stress? No

27 Have your Post-partum depression? Yes

No
28 what was used to treated? Antidepression
Cancelling
Life style change
Others
No used any things

29 Have you PPH? Yes

No
30 H How many times have PPH? 1 time
2 time
3 time
More
No have PPH

31 Have you multi pregnancy? Yes

No

57
 APPENDEX-4 SOOMALI VERSION QUESTIONAIRE
Waxaan nahay ardayda jaamacadda Nugaal University kulliyadda caafimaadka waxaan

uruurineynaa daraasad aan ku qiimeynayno baaxadda iyo sababaha kena daryeelka lasiiyo

hooyada dhalmada kadib kuwaas oo sooxaadiray xarumaha caafimadka ee gobolka sool.

NO Qaybta A:maclumaadka qofka Jawabo

1 Jinsigaaga 1. Lab
2. Dhedig
2 Da’da hooyada 1. 15-25
2. 26-30
3. 31-35
4. 36-40
5. 41 iyo wixii kasareeya

3 Xaalada guurka 1. Keli

2. Guursaday
3. Kala tagnay
4. Laga dhintay
4 Heerka waxbarashada 1. Dugsi hoose
2. Dugsi sare
3. Heerka koowad jamacada
4. Wax ma baran
5 Shaqada 1. Shaqaale
2. Ma shaqeeyo
3. Ganacsade
6 Dakhliga qoyska 1. Wax ka yar $100
2. $100-300
3. $300-500
4. $501- iyo ka badan
7 Tirade carruurta 1. 1-3
2. 4-5
3. 6-7
4. 8 iyo ka badan
8 ilmihii ugu dambeeyay da’diisa 1. Kayar 12 bilood
2. 1 ilaa 2 sano
3. 3 sano iyo ka wayn

NO Qaybta B: Aqoonta iyo kibradda hoyada Jawabaha

2 Ma booqata xarumaha cafimaadka ? 1:Haa
2:Maya

58
2 Magaran daryeelka hooyada dhalmada kadib? 1. Haa
2. maya
3 Waa maxay daryeelka lasiiyo hooyada 1. Waa daryelka
dhalmada kadib? lasiiyo hooyad iyo
ilmaha 6 isbuuc ee
hore
2. Daryeelka hooyada
bes lasiiyo
3. Daryeelka ilmaha
bes lasiiyo
4. Mabaa aqaan
macnihiisa
4 Xagee Xogta ka hesha? 1. Idacada
2. Dhalada TV
3. Xarunta cafimaadka
4. Xanada dhalanka
iyo hooyada
5. Bulsha
5 Xillimu bilowda ama dhamada daryelka 1. Marku dhasho ilaa
hooyada? 24saac
2. Labbada isbuuc
hore
3. Bil kadib
4. Marku dhasho ilaa
4bilood kadib
6 Wax dhibato ah ma la kulantay ? 1. Dhiig bax
dhalmada kadib
2. Caabuq
3. Dhiikar
4. Wax dhibato ah ma
arag
7 Xage ku heshay daryeelka ? 1. Guriga
2. Xanadada
3. Hospitalka
8 Wax ma ka garan daryeelka hooyada dhalmada 1. Haa
kadib ? 2. Maya
9 Ma ku labbatay qolalka bukaan jiif dhalmada 1. Haa
kadib? 2. Maya
10 Cunto dheeli tiran iyo nasasho ma heshay marka 1. Haa
dhashay kadib? 2. Maya
11 Ma lagala taliyey kala krinta ubadka inta ku 1. Haa
jirtay daryelka hooyad dhalmada kadib 2. Maya
12 Ma garan marka ilmaha naaska uu bilowday? 1:haa

59
 2:maya
13 Maa qadatay kululayso dhalmada kadib ? 1:haa
2:maya
14 Ilmihi uu dambeyey xage kudhashay ? 1. Guri
2. Xarun cafimad
15 Ma heshay daryeel dhalmada kadib? 1:Haa
2:Maya

No Qaybta C. khatarta hooyada Jawaaboh

1 Makuqabta carurta dhibaato 1:haa
2:maya
2 Ma yelatay dhalmad kadib niyad jab ? 1. Haa
2. Maya
3 Waa maxay dawadda aad isticmashay? 1:Kahortaganiyad jabka
2:Latalin
3:Isbadal nolasha ah
4:waxyaabo kale
5:wax dawo ah maba
isticmalin
4 Maledahay dhiig bax dhalmada kadib 1. Haa
2. Maya
5 Imisa jeer yelatay dhiig bax dhalmada kadib ? 1. hal mar
2. labbo mar
3. saddex mar
4. kabadan
5. mabaa yeelan

4 Mayeelatay uurar badan ? 1. haa

2. maya

60
 APPENDIX 5: WORK PLAN
WORK PLAN OF THE STUDY

Table 1.0: Tentative work plan of the study on knowledge and practice on selection aspect on

postanatal care among reproductive age visited at maternal health facility in las anod sool

region February 2022-jully 2022

ACTIVITY TIME FRAME

no Activities
Feb March April may 2022 Jun 2022 July
2022 2022 2022 2022
1 Proposal
development
2 Preparation and
submission of first
draft
3 Second draft
submission

4 Three topics
submission and
approval

5 Proposal
presentation and
defence
6 Preparation of the
data collection tools
& SPSS
7 Recruitment and
training of

61
 supervisors
8 Pretesting

9 Data collection

10 Data coding entering

and cleaning
11 Data analysis and
thesis writing
12 Approval of ethical
clearance

13 Preparation of final
report
14 Thesis defence

62
 APPENDIX 6: BUDGET
Table1.1: Personal budget break-down of the study from February 2022– July2022

description quantity Price total

N
O

1. photocopy 4 10$ 50$

2 Pen 10 0.2$ 2$

3 Paper questionnaire 420 3 35$

4 vehicle 1 90 90$

5 transportation 4 25 100$

6 Mobile cost prepares 4 7 28$

7 Supervisor 6 $50 $300

Total 585 USD

63
Appendix 7: area of finding

Figure 12:finding area of the study the knowledge and practice on selection aspect on
postanatal care among reproductive age

64