“If they were telling us to go, we will go”: factors associated with effective postnatal care coverage before and after discharge – a mixed-methods study in rural western Kenya

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INTRODUCTION: Few studies have explored the extent to which mother-newborn dyads have access to high-quality postnatal care (PNC) in low-income and middle-income countries. This study aims to measure effective (quality-adjusted) PNC coverage for newborns both before discharge and after discharge from the delivery facility, and for mothers before discharge, and to examine factors influencing access to high-quality PNC. METHODS: We conducted an explanatory sequential mixed-method study in Kakamega County (Kenya) between January 2022 and November 2023. We collected quantitative data immediately after birth up to 60 days post partum and conducted in-depth interviews with mothers within the 60 days post partum. We present descriptive statistics of the effective PNC coverage cascade before and after discharge, with data analysed using multivariable logistic regression. Qualitative evidence was synthesised using thematic analysis. RESULTS: Out of 611 births, 134 (22%) mothers and 468 (77%) newborns received effective PNC immediately after birth, respectively. By contrast, following discharge, only 171 (28%) newborns received effective PNC. Health systems factors, including antenatal care quality (OR 3.24, 95% CI 1.03 to 10.26), whether mothers received complete counselling (OR 2.20, 95% CI 1.29 to 3.76), and whether newborns received check-ups and immunisations before discharge (OR 2.21, 95% CI 1.01 to 4.79) were associated with effective PNC for newborns after discharge. Qualitative evidence from 36 interviews identified three main themes: quality of care for mother-newborn dyads before and after discharge; individual and interpersonal barriers and facilitators (including mothers' perceptions of PNC, poverty and financial constraints, and information from social networks); and health systems-level barriers and facilitators (including communication and information on PNC, community outreach after delivery, and experience with quality healthcare influencing PNC use). CONCLUSIONS: PNC remains a weak point in the maternal newborn continuum of care, with low uptake and suboptimal quality. Efforts to enhance effective PNC, such as providing comprehensive counselling before discharge, are required across all levels of care.

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