الفهرس 
INTRODUCTION& AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Postnatal care is a care provided to women and their babies within42 days after delivery. A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery, and these first two days following delivery are critical for monitoring complications arising from the delivery.
The aims of care in the postpartum period also are: support of the mother and her family in the transition to a new family constellation, and response to their needs, early diagnosis and treatment of complications of mother and infant, including the prevention of vertical transmission of diseases from mother to infant, referral of mother and infant for specialist care when necessary, counselling on baby care support of breastfeeding, counselling on maternal nutrition, and supplementation if necessary, counselling and service provision for contraception and the resumption of sexual activity and immunization of the infant.
where a healthy, term baby has been born in an uncomplicated delivery, most guidelines call for the dyad to stay under observation by a skilled attendant for 24 to 48 hours. If mother and baby are discharged from the facility sooner than 48 hours, a qualified professional or skilled attendant should assess them within 24 to 48 hours after discharge. The first 24 to 48 hours are the most critical time for the woman and the baby, and thus it is a life-saving policy to provide individualized care during the immediate postnatal period under the direct or indirect supervision of a skilled attendant.
Women giving birth in a health institution reported very high levels of care after delivery. In marked contrast, only a small fraction of women delivering outside a health institution received post-partum care. Overall, post-partum care increased nearly 16% between 2005 and 2008 and was provided to two-thirds of the women surveyed. These figures hide big differentials; however, e.g. post-partum care in 2008 was 81% among urban women vs. under 60% among rural women, and in Upper Egypt only 42% of rural women. Similarly, 91% of the richest women received this care but only 43% of the poorest .
Over the past 25 years, Egypt has recorded important achievements in improving child and maternal survival and health. Between 1988 and 2014, the under-5 mortality rate declined from 108 to 27 child deaths per 1,000 live births; slightly more than half of these deaths occurred in the first month of the child life . Progress in coverage of prenatal care in Egypt has also been noteworthy in the last decade. In 2014, around 90 percent of mothers underwent antenatal care checks during pregnancy, 83 percent of them having had antenatal care on a regular basis. Among all births, 92 percent were attended by a skilled birth attendant and 87 percent took place in a health facility. As for the immunization rate, 92 per cent of children aged 18-29 months were fully immunized in 2014; the children had received complete vaccination against tuberculosis, measles, diphtheria, pertussis, tetanus and polio.
Components of Postpartum Care :-
In the postpartum period, women need:
• Information/counseling
- Care of the baby and breast feeding
- What happens to their bodies, including signs of possible problems - Self care - hygiene and healing - Sexual life - Contraception – Nutrition
• Support:
- from health care providers
- from husband and family: emotional and psychological Health
• care for suspected or manifested complications.
• Time to care for the baby.
• Help with domestic tasks.
• Maternity leave.
• Social reintegration into her family and community.
• Protection from abuse/violence.
• Constant responsibility of caring for the baby and others
In the postnatal period, newborn infants need:
• Easy access to the mother.
• Appropriate feeding.
• Adequate environmental temperature.
• A safe environment.
• Parental care.
• Cleanliness.
• Observation of body signs .
• Access to health care for suspected or manifested complications.
• Nurturing, cuddling, stimulation.
• Protection from (Disease - Harmful practices - Abuse/violence)
• Acceptance by family and society.
• Recognition (vital registration system).
Aim of this work is to determine women’s experience (K, A and P ) about post natal care services in the family health units of the city and some rural areas in El baliana district ; Sohag governorate.
• The level of knowledge, attitude and practice of mothers about postnatal care was evaluated with correct responses to total 20 questions given to each of them. The median knowledge, attitude and practice score was used for discrimination of each of them respectively. Scores over the median score were defined to be good and the scores below the median score were defined to be poor.
• Data entry and analysis were done using SPSS version 16.0. The calculation of frequency and percent¬ages for the classified data, mean, and standard deviations were obtained. While statistical differences between the classes were done with chi-square test and fisher exact test and final binary logistic regression model was done to show the final factors affecting poor knowledge. P-value at or below 0.05 was considered significant.
Our results were presented in groups of tables; generally as regard patients’ socio-demographic criteria :The mean age of the participants is 29.2 ± 6.44 years. More than half of them get married before age of 20 y and more than one quarter of them hadn’t received any kind of formal education.
The majority of the studied women answered positively about they stay at hospital post-partum, their attitude and practice corresponds with their knowledge (94.6%, 99.4% and 98% respectively).
Near fifth of the studied women don’t have information about items of physical check that should be done to the baby but more than two thirds know that the baby’s cord should be clamped, he should be dried and his breath and weight should be assessed.
While more than 70% have better perception about the duty of medical staff to teach parents skills to deal with the baby, only 38.6% of them reported that medical staff taught them such skills.
Out of the asked 60 questions to detect experience of the studied women about post-partum care, the mean of correct answers of the total knowledge, attitude and practice questions is 11.98 ± 4.38, 14.04 ± 3.36 and 11.41 ± 2.82 respectively.
The older the age of the women, the older her age at 1st marriage, the higher her education level, the more liability to have good knowledge about post-partum care.
Although all women with 5 or more living males have more good practice about post-partum care, women with 3-4 living males show no difference in their practice level. There is slight increase in practice about post-partum care among women with 1-2 living males in favor of the good level.
In the final regression model, it is found that women younger than 20 years are nearly five times more liable to have poor knowledge regarding postnatal care than those older than 35 years.
And it is found that with no formal education are nearly twenty times more liable to have poor knowledge regarding postnatal care than those of collage or higher.
Al-Eslah village where women have more knowledge this is due to more number of nurses , education massages and highly home visits .while women of Abosteet village have poor knowledge nearly ten times Al-Eslah village according to poor health educations , very poor home visits and low level of education.
Also, house wife women have triple the risk of having poor knowledge compared to those who working.
Also, women with abortion history have triple the risk of having poor knowledge compared to those who don’t.
Plus women who have one child are nearly four times more liable to have poor knowledge compared to who have four or more. So more child the more knowledge.
Conclusion
The postnatal period is a critical phase in the lives of mothers and their newborn babies. Inability to promote adequate health behaviors for mothers and newborn children, illnesses, disabilities and even death occur due to lack of PNC. Yet, this is the most neglected period for the provision of quality care (WHO, 2013).
So, it was a must to study experiences of women about PNC services in our community and its associated factors.
In this paper, we found that the mean percentage level of knowledge of postnatal mothers on selected aspects of postnatal care was 59.9% and the mean level was 11.98 with standard deviation of 4.38. Fifty seven point seven of the studied women had a good knowledge regarding postnatal services and 42.3% had poor knowledge.
The cause of insufficient knowledge of mothers in the study may be due to the low educational level of mothers and decrease educational programs. About two-thirds of the studied population were from the rural areas, and only 11-20% of mothers had higher than primary level education.
Undoubtedly, providing postpartum homecare can improve access to the health services, reduce waiting lines and families’ costs, and can also provide a better opportunity for the family members to be educated and accompany the newly delivered mother. women who received regular midwifery services at home mentioned better quality and method of care compared to those who visited hospitals for receiving the same midwifery care (Fenwick, Butt et al., 2010)
Despite the above mentioned information, only 46.3% of the women in our study know that they have the rights of home visits postpartum and only 37.1% of the studied ladies had had a home visit postpartum.
In this study, 28.3% of studied mothers didn’t know any danger signs while 62.3% informed that bleeding, severe headache, fever and severe calf pain are danger signs which should be checked carefully in postpartum period.
In the current study we found that 84.3% of the studied women had a good knowledge on essential needs of the newborn baby.
The present study showed a significant association between women age, their age at 1st marriage and having knowledge about postnatal care. The higher the age and the higher the age of 1st marriage, the higher the knowledge about postnatal care. Seventy five point six percent of mothers above 35 years had good knowledge compared to 55.2% of those having 20-35 years compared to 29.4% of those below 20 years. All the studied women who get married after 30 years had good knowledge, while only 53% of those who get married before 20 years had good knowledge.
The current study revealed a significant relationship between knowledge of mothers about postnatal care and their education level. non-formally educated mothers had more poor than good knowledge regarding post natal care (57.3% vs. 42.7% respectively). but the percent reversed markedly with increased education to reach 79.2% vs. 20.8% of good and poor knowledge among mothers who finished their college or had received postgraduate education.
Regarding monthly income, the current study showed that only 53.1% of the studied women with monthly income below 3000 LE had good knowledge. The knowledge level increased with the increase in the monthly income to the degree that all the studied women with monthly income higher than 6000 LE had good knowledge.
Regarding parity, the present study showed that primipara mothers had the least percentage of good knowledge about postnatal care compared to para2 or more mothers. The majority (77.8%) of primipara ladies had poor knowledge about postnatal care while most (68.9%) of para 2 ladies had good knowledge about postnatal care.
The majority (90%) of the currently studied mothers made 5 or more ANC visits and 58.7% of them had good knowledge about postnatal care. The minority (2.3%) of the currently studied mothers made only 2 ANC visits and 12.5% of them had good knowledge about postnatal care. This indicate the importance of ANC visits and the advices given through them in increasing women awareness.
Maternal education has a positive impact on the utilization of health care services. This may be due to maternal education increases women’s perceived seriousness about maternal health issues. Or may be because The higher educated mothers are more conscious than illiterate mothers in utilizing the services.
Regarding number of children and its association with practicing of postnatal services, the current study documented that 61.7% of mothers with 5 or more child had a good practice to postnatal services versus 49.4% of those with 1-2 child. This can be explained by the fact that women with more kids seek family planning methods more than those with fewer kids.
Recommendation
• Attaining global agreement on timing, frequency, and content of care.
• Establishing or revitalise a national working group to develop and operationalise a national PNC package.
• Adapting programmatic protocols and key messages for use in PNC.
• Training/retraining health workers.
• Address supply and logistics issues Strengthen the programme.
• Bridge key gaps in implementation at the family/community, outreach and facility level between family planning, ANC, childbirth, and PNC Improve the information available to guide programmatic decision making.
• Improving and standardise monitoring indicators for PNC.
• Conducting relevant operations research.