Maternal knowledge, attitude and practices with regard to postnatal care services in a Free State rural hospital
Mothers and newborn are vulnerable to illness during the postnatal period. In Africa, half of the mortalities during the postnatal period occur during the first week after delivery, and most of these deaths are preventable. To overcome this burden of disease South Africa implemented the guidelines for maternity care to encourage mothers and newborns to attend to their clinic within three to six days. Unfortunately, the utilisation of these services in South Africa, but more especially, Ladybrand is neglected and the maternal- and neonatal mortality and morbidity rate remains high. A study to assess the maternal knowledge, attitude and practices with regard to postnatal care services in a Free State rural hospital, was thought to be the best strategy to identify the barriers that ultimately prevent the mothers from utilising these services. The aim of the study were to describe the maternal knowledge, attitudes and practices (KAP) with regard to postnatal care services in a Free State rural hospital. Considering the nature of KAP studies, a quantitative, descriptive, cross-sectional design was used to address the domain investigated. The research question addressed was what are the maternal knowledge, attitude and practice with regard to postnatal care services in a Free State rural hospital? The theory of planned behaviour together with knowledge, attitude and practices were used as guidelines to design a structured questionnaire as data collection tool. Ethics approval was obtained from the Health Science Research Ethics Committee, University of the Free State, and the three principles of the Belmont report were continuously implemented throughout the course of the study. The questionnaire was piloted on a sample of four respondents who gave birth in Senorita Nhlabathi hospital. The pilot study was implemented before the actual data collection to identify any unforeseen problems that may affect the validity and reliability of the study. No problems were identified during the pilot study and the data was included in the main study. The data collection took place in the maternity ward at Senorita Nhlabathi hospital, and included a sample of 110 respondents who delivered babies during July to October 2017. One hundred and ten questionnaires were completed and almost all of the respondents were Sesotho speaking women with a mean education level of grade 11. The respondents had a mean age of 28 years, with the youngest participant 18 years and the oldest 47 years of age. The majority (79.1%) of the respondents were unemployed and living in an informal type of dwelling (76.4%). More than half of the respondents (57.7%) lived less than two kilometres from the nearest clinic and all of the respondents had access to primary healthcare services. With regard to the results pertaining the theory of planned behaviour and knowledge attitude and practice, the knowledge of the respondents were found inadequate with an average between 50-70% (behavioural beliefs, normative beliefs, subjective norms, control beliefs and perceived behaviour control). The attitude of mothers towards postnatal care services was found to be negative (44.6%, n=49). The worst performing statements with regard to attitude included long waiting times at the clinic (73.6%) and the respondents showed signs of postpartum depression during their previous pregnancies (74.6%). The practice (intention, 93.6%; actual behaviour control, 81.8%; and behaviour, 82.7%) performed overwhelmingly well, although the statement that underperformed in all three sections was related to the utilisation of postnatal care services. Poor maternal knowledge, attitude and practice were found with regard to postnatal care services in a Free State rural hospital. The awareness and attitude of the mothers towards postnatal care services should be addressed through health education throughout the antetnatal care period and before discharge from the hospital, and thereby decreasing the maternal and newborn morbidity and mortality.