Multilevel Analysis of Individual and Contextual Determinants of Compliance with Complete Postnatal Care Visits in Sragen Regency, Indonesia

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Background: Compliance with complete postnatal care (PNC) visits is essential for the early detection of postpartum complications and the prevention of maternal morbidity and mortality. However, the coverage of complete postnatal care visits in several areas of Sragen Regency remains below the national target. This study aimed to examine the individual- and contextual-level determinants of compliance with complete PNC visits in Sragen Regency, Indonesia. Subjects and Method: This analytic observational study employed a cross-sectional design and was conducted in six primary healthcare centers in Sragen Regency, comprising three urban and three rural facilities. A total of 162 postpartum women were selected using purposive sampling. The dependent variable was compliance with complete postnatal care (PNC) visits. Individual-level independent variables included maternal age, educational level, employment status, parity, pregnancy risk status, mode of delivery, and knowledge of postnatal care, while the contextual-level variable was the category of the primary healthcare centers (urban or rural). Data were collected using a structured questionnaire and the Maternal and Child Health (MCH) handbook and were analyzed using multilevel logistic regression in STATA version 17. Results: Compliance with complete PNC visits was significantly higher among women of optimal reproductive age (aOR=6.75; p=0.027), those with higher education (aOR=5.20; p=0.015), unemployed women (aOR=3.06; p=0.026), primiparous women (aOR=4.41; p=0.002), women with high-risk pregnancies (aOR=4.34; p=0.004), women who had operative deliveries (aOR= 6.76; p=0.002), and women with good knowledge of postnatal care (aOR=16.98; p<0.001). There was a contextual effect of the primary healthcare service, with ICC= 9.70%. Conclusion: Compliance with complete postnatal care visits was influenced by both individual characteristics and the contextual characteristics of primary healthcare centers. Strengthening maternal knowledge and implementing context-specific postnatal care strategies are needed to improve the coverage of complete postnatal care visits.