Sociodemographic and Socioeconomic Determinants of Postnatal Health Check Providers in Sierra Leone: Evidence from the 2019 SLDHS

Maternal and neonatal outcomes are critically influenced by the quality of postnatal care. Despite efforts to improve maternal healthcare utilization in Sierra Leone, significant disparities persist in access to professional postnatal care. This study examines the factors associated with the type of healthcare provider performing postnatal checkups among mothers. This study used data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). Of 7,323 women who gave birth in the five years preceding the survey, 3,403 provided information on whether their postnatal check was conducted by a doctor, nurse/midwife, auxiliary midwife, traditional birth attendant, community/village health worker, or another provider. Analyses were conducted using SPSS version 29, and descriptive, Chi-square test, and multinomial logistic regression were used to analyse the data. Chi-square tests revealed that the following variables have an influence on postnatal health providers such as region (χ²=169.349, p=0.001); place of residence (χ²=90.723, p=0.001); level of education (χ²=29.253, p=0.0253); wealth index (χ²=107.884, p=0.001); working status (χ²=23.667, p=0.001); and birth order (χ²=19.022, p=0.04). Binary logistic regression analysis revealed that determinants significantly associated with receiving postnatal care from professional care included age (women aged 30–34, OR=1.491; 35–39, OR=1.566; 40–44, OR=1.585), region (Eastern, OR=2.833; Northern, OR=3.512; North-western, OR=2.269; Southern, OR=2.842), urban residence (OR=1.209), wealth index (Poorest, OR=1.466; Poorer, OR=1.527; Middle, OR=1.788), place of delivery (Government health centre, OR=1.371; Private hospital/clinic, OR=3.952), marital status (living with a partner, OR=1.991) and birth order (0–4, OR=0.687; 5–9, OR=0.547). Conversely, determinants for non-professional care showed inverse trends. These findings highlight significant socioeconomic and geographical inequities in postnatal care access, underscoring the need for targeted interventions to improve healthcare infrastructure, promote facility-based deliveries, and enhance maternal health education.