Project – Evaluation of Postnatal Care Services and Maternal Outcomes at Primary Health Centre, Azare, Bauchi State, Nigeria

CHAPTER ONE

INTRODUCTION

Background of the Study

Postnatal care (PNC) refers to the healthcare services provided to a mother and her newborn immediately after childbirth up to six weeks postpartum. This period is one of the most critical phases in the continuum of maternal and newborn care because a large proportion of deaths and complications occur during the first days and weeks after delivery (World Health Organization [WHO], 2014). Globally, an estimated 287,000 women died from pregnancy-related causes in 2020, with almost all (over 99%) of these deaths occurring in low- and middle-income countries (LMICs) such as Nigeria; the postnatal period accounts for a significant share of this burden due to preventable complications like postpartum hemorrhage, sepsis, and hypertensive disorders (WHO, 2016).

In Nigeria, although efforts have been made to strengthen maternal health services, the uptake of PNC remains low. National survey evidence shows that a substantial proportion of women do not receive any postnatal care within the recommended period after delivery, and factors such as education level, distance to health facilities, socioeconomic status, and place of delivery are significantly associated with non-utilization of PNC services (National Population Commission [NPC] & ICF, 2019). Moreover, northern states such as Bauchi exhibit intra-regional variations, suggesting that some communities with high service availability still experience low uptake due to socio-cultural or systemic factors (Tobin et al., 2020).

The content and quality of PNC services are equally important. Effective PNC includes routine physical examinations, counseling on danger signs, breastfeeding and nutrition support, immunization for the newborn, screening for postpartum depression, and family planning services — all of which contribute to improved maternal outcomes and child survival (BMC Health Services Research, 2025). However, quality issues such as inadequate staffing, limited infrastructure, and poor client satisfaction can undermine utilization and outcomes (Okonofua et al., 2019).

At Primary Health Centre, Azare, Bauchi State, women continue to experience maternal morbidity and mortality that might relate to gaps in postnatal care delivery, despite the facility’s role as a key provider of primary maternal health services in the region. Understanding how PNC services are delivered and how they influence maternal outcomes in this setting is essential for targeted policy and program improvements, especially in achieving Sustainable Development Goal 3 (good health and well-being) (UNICEF, 2021).

Statement of the Problem

Despite recognition of its importance, postnatal care services in Nigeria are poorly utilized, and much of the existing research has focused on antenatal care and skilled delivery at birth, with less attention to the postnatal period (NPC & ICF, 2019). Yet, the postnatal period carries a high risk for both mothers and newborns, with complications like infection, postpartum hemorrhage, and neonatal conditions occurring most often within the first 48 hours after delivery (WHO, 2016). In some studies, up to 63% of mothers did not receive any postnatal care within the recommended period after birth, representing missed opportunities for life-saving interventions (PMCID: PMC4707769, 2015).

In Bauchi State, including Azare, there is limited evidence on how postnatal care services are delivered or how they impact maternal outcomes. Informal reports from health workers at the Primary Health Centre suggest challenges such as inadequate follow-up after delivery, inconsistent uptake of recommended PNC contacts, and poor documentation of maternal outcomes. Without systematic evaluation, policymakers and health managers lack the data necessary to address service delivery gaps, improve quality of care, and reduce maternal morbidity and mortality (Tobin et al., 2020). Therefore, an empirical assessment of postnatal care practices and their association with maternal outcomes in this setting is crucial to inform strategies to strengthen maternal health services and improve survival and wellbeing for mothers and newborns.

Research Questions

1. What are the demographic and obstetric characteristics of women receiving postnatal care at Primary Health Centre, Azare?

2. What is the level of utilization of recommended postnatal care services among these women?

3. What factors influence the utilization and quality of postnatal care services at Primary Health Centre, Azare?

4. What are the maternal outcomes associated with the use (or non-use) of postnatal care services at this facility?

Objectives of the Study

General Objective:
To evaluate postnatal care services and maternal outcomes at Primary Health Centre, Azare, Bauchi State, Nigeria.

Specific Objectives:

1. To describe the demographic and obstetric profiles of women attending postnatal care at the Primary Health Centre, Azare.

2. To assess the utilization level of recommended PNC services among these women.

3. To identify key determinants of PNC service utilization and quality at the health centre.

4. To determine associations between PNC utilization and maternal outcomes, including complications and recovery indicators.

Hypothesis

Null Hypothesis (H₀):
There is no significant relationship between the utilization of recommended postnatal care services and positive maternal health outcomes among women at Primary Health Centre, Azare, Bauchi State.

Significance of the Study

This study will provide evidence on how postnatal care services are being delivered at a primary healthcare facility in northern Nigeria and how these services relate to maternal outcomes. The findings will inform health policymakers, program implementers, and facility managers on service gaps and drivers of non-utilization, enabling better planning, resource allocation, and interventions to enhance postnatal care quality and uptake. It also contributes to the broader literature on maternal health service utilization in LMICs, particularly in under-researched northern regions of Nigeria.

Scope of the Study

The study will focus on women who delivered and accessed postnatal services at Primary Health Centre, Azare within the study period. It will examine service utilization patterns, determinants of care, and maternal outcomes up to six weeks postpartum. The study will include both quantitative service records and women’s self-reported experiences during the postnatal period.

Project – Evaluation of Postnatal Care Services and Maternal Outcomes at Primary Health Centre, Azare, Bauchi State, Nigeria