MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF NURSING BASIC NURSING RESEARCH 1

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

BASIC NURSING RESEARCH 1: 302
RESEARCH PROPOSAL
ASSESS KNOWLEDGE AND UTILIZATION OF POSTNATAL CARE SERVICES AMONG WOMEN ATTENDING POSTNATAL VISIT AT MBAGARA HOSPITAL.

NAME: MGEDZI SHUHUDIA SEBASTIAN
REG NO: 2015-04-08695
PROGRAM: BSc. MIDWIFERY 3
COURSE COORDINATOR: Dr. MSELLE
SIGNATURE:___________________
SUPERVISOR: AGNESS MASSAE
SIGNATURE: __________________
ABREVIATIONS AND ACRONYMS
ANC — Antenatal Care
MoHSW — Ministry of Health and Social welfare
PNC — Postnatal Care
TDHS — Tanzania Demographic and Health Survey
UNICEF — United Nation Children Fund
WHO — World Health Organization
FP — Family Planning
PMTCT — Prevention of Mother to Child Transmission
EBF — Exclusive Breastfeeding

OPERATIONAL DEFINITION
Maternal death: is the death of women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causesADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “4104301801406”, “author” : { “dropping-particle” : “”, “family” : “Angore”, “given” : “Banchalem Nega”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Tufa”, “given” : “Efrata Girma”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bisetegen”, “given” : “Fithamlak Solomon”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2018” }, “page” : “1-9”, “publisher” : “Journal of Health, Population and Nutrition”, “title” : “Determinants of postnatal care utilization in urban community among women in Debre Birhan Town , Northern Shewa , Ethiopia”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=dbeb37b5-a712-4d96-af45-6008f2e49a37” } , “mendeley” : { “formattedCitation” : “(Angore, Tufa and Bisetegen, 2018)”, “plainTextFormattedCitation” : “(Angore, Tufa and Bisetegen, 2018)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Angore, Tufa and Bisetegen, 2018).

Mother: refer to any woman within the reproductive age (15-49) years who attends maternal child health care.

Postnatal care services: are the care provided to women and newborn for the first few months following birthADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “WHO”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “March”, “issued” : { “date-parts” : “2015” }, “page” : “1-8”, “title” : “Postnatal Care for Mothers and Newborns Highlights from the World Health Organization 2013 Guidelines”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=195bbda9-077e-4b89-9b8c-9405b6636a95” } , “mendeley” : { “formattedCitation” : “(WHO, 2015)”, “plainTextFormattedCitation” : “(WHO, 2015)”, “previouslyFormattedCitation” : “(WHO, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(WHO, 2015).

Utilization of postnatal care: it is accessing the postnatal care more than once within 42 days after deliveryADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1007/s10995-014-1474-3”, “ISBN” : “1099501414743”, “author” : { “dropping-particle” : “”, “family” : “Tesfahun”, “given” : “Fikirte”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Worku”, “given” : “Walelegn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “196”, “issued” : { “date-parts” : “2014” }, “page” : “2341-2351”, “title” : “Knowledge , Perception and Utilization of Postnatal Care of Mothers in Gondar Zuria District , Ethiopia : A Cross-Sectional Study”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5315a309-ab53-4e44-a48b-8890ff6e160c” } , “mendeley” : { “formattedCitation” : “(Tesfahun and Worku, 2014)”, “plainTextFormattedCitation” : “(Tesfahun and Worku, 2014)”, “previouslyFormattedCitation” : “(Tesfahun and Worku, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Tesfahun and Worku, 2014).

Knowledge: this is awareness or familiarity of services available in the postnatal care, such as counseling, breastfeeding and nutrition, health check on mother and child.

TABLE OF CONTENTS
List of abbreviations……………………………………………………………………………………………………………………………
Definitions of Terms………………………………………………………………………………………………………………………….

1.0INTRODUCTION
1.1 Background…………………………………………………………………………………………………………………………………
1.2 Problem statement…………………………………………………………………………………………………………………….

1.3 conceptual frame works………………………………………………………………………………………………………………
1.4 research question……………………………………………………………………………………………………………………….

1.5 Objectives…………………………………………………………………………………………………………………………………..

1.5.1 Broad objectives………………………………………………………………………………………………………………………
1.5.2 Specific objectives…………………………………………………………………………………………………………………….

1.6 Hypothesis……………………………………………………………………………………………………………………………………
2.0 LITERATURE REVIEW
2.1 Overview of postnatal services…………………………………………………………………………………………………….

2.2 Utilization and practice of PNC services……………………………………………………………………………………….

1.0 INTRODUCTION
1.1Background
Post natal period is defined by World Health Organization, as the period one hour after the delivery of the placenta and includes the six weeks that followADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “WHO”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “March”, “issued” : { “date-parts” : “2015” }, “page” : “1-8”, “title” : “Postnatal Care for Mothers and Newborns Highlights from the World Health Organization 2013 Guidelines”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=195bbda9-077e-4b89-9b8c-9405b6636a95” } , “mendeley” : { “formattedCitation” : “(WHO, 2015)”, “plainTextFormattedCitation” : “(WHO, 2015)”, “previouslyFormattedCitation” : “(WHO, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(WHO, 2015). It is called postpartum period when referring to the mother alone and post natal when referring to both the mother and babyADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1007/s10995-014-1474-3”, “ISBN” : “1099501414743”, “author” : { “dropping-particle” : “”, “family” : “Tesfahun”, “given” : “Fikirte”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Worku”, “given” : “Walelegn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “196”, “issued” : { “date-parts” : “2014” }, “page” : “2341-2351”, “title” : “Knowledge , Perception and Utilization of Postnatal Care of Mothers in Gondar Zuria District , Ethiopia : A Cross-Sectional Study”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5315a309-ab53-4e44-a48b-8890ff6e160c” } , “mendeley” : { “formattedCitation” : “(Tesfahun and Worku, 2014)”, “plainTextFormattedCitation” : “(Tesfahun and Worku, 2014)”, “previouslyFormattedCitation” : “(Tesfahun and Worku, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Tesfahun and Worku, 2014). All the services provided during this period are referred as post natal care (PNC) services. Postnatal period are critical phase in the life of mother and newborn babies. A large number of maternal and infant deaths occur in the first month since deliveryADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1007/s10995-014-1474-3”, “ISBN” : “1099501414743”, “author” : { “dropping-particle” : “”, “family” : “Tesfahun”, “given” : “Fikirte”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Worku”, “given” : “Walelegn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “196”, “issued” : { “date-parts” : “2014” }, “page” : “2341-2351”, “title” : “Knowledge , Perception and Utilization of Postnatal Care of Mothers in Gondar Zuria District , Ethiopia : A Cross-Sectional Study”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5315a309-ab53-4e44-a48b-8890ff6e160c” } , “mendeley” : { “formattedCitation” : “(Tesfahun and Worku, 2014)”, “plainTextFormattedCitation” : “(Tesfahun and Worku, 2014)”, “previouslyFormattedCitation” : “(Tesfahun and Worku, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Tesfahun and Worku, 2014). Half of postnatal maternal deaths occur within first 24 hours. In 2013, 2.8 million newborn died in their first month after delivery and 1 million of these died within the first 24 hours. Efforts have been taken globally to improve maternal and infant health. 72% of women give birth attended by skilled personnel which reduces maternal mortality rate from 380 to 210 per 100000 live births between 2000 and 2013. In sub-Saharan Africa 48% of women give birth under assistance of skilled personnel. Postnatal care; less than half of women receive a postnatal care visit within 2 days of childbirth. The analysis of 23 Sub African countries including Tanzania showed that 13% of women delivered at home receive postnatal care within 2 days of birth. The ministry of health and social welfare (MoHSW) guidelines call for at least 3 visits during the postnatal period (within one week, at 28 days and at 42 days) with the exception of immediate postnatal care around the time of deliveryADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “National”, “given” : “The”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Map”, “given” : “Road”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Plan”, “given” : “Strategic”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “April 2008”, “issued” : { “date-parts” : “2015” }, “title” : “United Republic of Tanzania Ministry of Health and Social Welfare The National Road Map Strategic Plan To Accelerate Reduction of Maternal , Newborn and Child Deaths in Tanzania”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=b2ebcc6c-4a2c-43df-90da-3051171e2be9” } , “mendeley” : { “formattedCitation” : “(National, Map and Plan, 2015)”, “plainTextFormattedCitation” : “(National, Map and Plan, 2015)”, “previouslyFormattedCitation” : “(National, Map and Plan, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(National, Map and Plan, 2015). Currently, there is very little evidence on the determinant of use of postnatal care from health facilities in Tanzania.

There a report also indicated overall poor attendance to postnatal check-up in the country of less than 30%.mid-term review of health sector strategies plan, shows an increase from 13.4% to 30.8% respectively, where the major increase was in urban areas at the rate of 37% and 22% among rural women. This has been due to several challenges facing postnatal services in Tanzania, including poor referral system of maternal and newborn health care services, low number of skilled personnel and poor adherence to postnatal services; inadequate infrastructure e.g PNC registers poor supply essential drugs and equipment like oxytocin and BP machineADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Physiotherapy”, “given” : “Science”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cape”, “given” : “Western”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “November”, “issued” : { “date-parts” : “2004” }, “title” : “FACTORS INFLUENCING UTILISATION OF POSTNATAL SERVICES IN MULAGO AND MENGO HOSPITALS Supervisors : Julie Phillips Professor Kristofer J . Hagglund”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=50972840-1ba9-470c-82dd-5020364da6b4” } , “mendeley” : { “formattedCitation” : “(Physiotherapy and Cape, 2004)”, “plainTextFormattedCitation” : “(Physiotherapy and Cape, 2004)”, “previouslyFormattedCitation” : “(Physiotherapy and Cape, 2004)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Physiotherapy and Cape, 2004).
1.2 Problem Statement
The postnatal period it covers a critical time for women, her newborn on her family on a physiological, emotion and social level as reported by WHO in 2013ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1007/s10995-014-1474-3”, “ISBN” : “1099501414743”, “author” : { “dropping-particle” : “”, “family” : “Tesfahun”, “given” : “Fikirte”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Worku”, “given” : “Walelegn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “196”, “issued” : { “date-parts” : “2014” }, “page” : “2341-2351”, “title” : “Knowledge , Perception and Utilization of Postnatal Care of Mothers in Gondar Zuria District , Ethiopia : A Cross-Sectional Study”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5315a309-ab53-4e44-a48b-8890ff6e160c” } , “mendeley” : { “formattedCitation” : “(Tesfahun and Worku, 2014)”, “plainTextFormattedCitation” : “(Tesfahun and Worku, 2014)”, “previouslyFormattedCitation” : “(Tesfahun and Worku, 2014)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Tesfahun and Worku, 2014). It provides both preventive and curative measures. The most important issues in postnatal period is an early identification of postnatal complications for both mother and baby aiming to reduce maternal and newborn morbidity and mortality. The mother is also provided with the important PNC services information on how to care herself and her child. Apart from the advantage of PNC, but still this area has remained less emphasized to both maternal and child health care services in developing countries. Few studies have been done in Tanzania, like which has done in Mbeya district; it shows several predisposing factors which hinder seeking behavior for PNC. Mothers who are expected to attend postnatal visits vary by age, social economic status and education level, therefore small number of women return for postnatal servicesADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “WHO”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “March”, “issued” : { “date-parts” : “2015” }, “page” : “1-8”, “title” : “Postnatal Care for Mothers and Newborns Highlights from the World Health Organization 2013 Guidelines”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=195bbda9-077e-4b89-9b8c-9405b6636a95” } , “mendeley” : { “formattedCitation” : “(WHO, 2015)”, “plainTextFormattedCitation” : “(WHO, 2015)”, “previouslyFormattedCitation” : “(WHO, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(WHO, 2015). To enhance maternal and child health, the knowledge on postnatal care services should be investigated as information seems to be a problem especially in rural areas Tanzania. This study will focus on assessment of knowledge on postnatal care and utilization of it in those women attending postnatal visit at Mbagara hospital, Dar-es-salaam.

1.3 Conceptual Framework
The behavioral model of health service use. The model provides the framework of understanding the potential influence on individual’s decision to make use of available services. The model is also meant to predict and explain use of health servicesADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Access”, “given” : “Open”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “page” : “1-15”, “title” : “Re-revisiting Andersen u2019 s Behavioral Model of Health Services Use : a systematic review of studies from”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=03d3eec8-835d-40cb-972a-3032ecec24f2” } , “mendeley” : { “formattedCitation” : “(Access, 2012)”, “plainTextFormattedCitation” : “(Access, 2012)”, “previouslyFormattedCitation” : “(Access, 2012)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Access, 2012). In this frame work illustrates the relationships between the dependent variable and independent variables.

Health system
Availability of services
Quality of services
Previous experience
e.g. place of last delivery
Social demographic factors
Age
Education
Cultural beliefs
Wealth status
Parity

Knowledge and values

Practice/utilization of PNC services

Figure 1.1 Conceptual Frame work
Source; behavioral model of health services use
In this programmed study the dependent variable is the utilization of PNC services and the independent variable is the knowledge woman has towards PNC, also health system and attitude. The model suggests that the utilization of health services is the function of predisposition to use the service, factors that impede or enable utilization of the services. Generally knowledge and values that people have towards health care services influences the need and desire to use and utilize this services. The purpose of the model is to discover the conditions that might facilitate or impede utilization of health servicesADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Access”, “given” : “Open”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “page” : “1-15”, “title” : “Re-revisiting Andersen u2019 s Behavioral Model of Health Services Use : a systematic review of studies from”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=03d3eec8-835d-40cb-972a-3032ecec24f2” } , “mendeley” : { “formattedCitation” : “(Access, 2012)”, “plainTextFormattedCitation” : “(Access, 2012)”, “previouslyFormattedCitation” : “(Access, 2012)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Access, 2012).
1.4 Research questions
1) What is the level of knowledge on postnatal care?
2) What is the level of utilization of postnatal care?
1.5 Objectives
1.5.1 Broad objectives
To determine knowledge and utilization of postnatal care services among women in Mbagara hospital, Dar-es-salaam
1.5.2 Specific objectives
1. Identify level of knowledge on postnatal care
2. Determine level of utilization of postnatal care
1.6 Hypothesis
There is association between knowledge and utilization of postnatal care services among woman in Mbagara hospital, Dar-es-salaam.

2.0 Literature Review
This literature review is discussed in two sections in accordance with the objectives of the study. The first section gives the general overview of PNC services. The second section explains the utilization of PNC, globally, Africa level and then finally in Tanzania.

2.1 Overview of Postnatal Services
Postnatal care services, care provided to women and her newborn for the first few months following birth. This care is very important for the survival of both mother and newborn and for the future stable health. Social and cultural issues can affect health during this period and the new mother should be kept into needs in promotion of those two aspects. This period being very crucial,, the mother and new born should be kept at center for regularity of care. Post natal visit depend much with the attendance in Ante Natal Care (ANC) and the quality of care delivered at ANC. In Tanzania postnatal care services is provided (7 days, at 28 days and at 42 days) with exceptional to services provided soon before dischargeADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “National”, “given” : “The”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Map”, “given” : “Road”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Plan”, “given” : “Strategic”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “April 2008”, “issued” : { “date-parts” : “2015” }, “title” : “United Republic of Tanzania Ministry of Health and Social Welfare The National Road Map Strategic Plan To Accelerate Reduction of Maternal , Newborn and Child Deaths in Tanzania”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=b2ebcc6c-4a2c-43df-90da-3051171e2be9” } , “mendeley” : { “formattedCitation” : “(National, Map and Plan, 2015)”, “plainTextFormattedCitation” : “(National, Map and Plan, 2015)”, “previouslyFormattedCitation” : “(National, Map and Plan, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(National, Map and Plan, 2015).
According to WHO (2013) guidelines; the first consultation within 48 hours, aim at evaluation to the mother and newborn on the progress after delivery. Counseling, cord care, information on breastfeeding, nutrition advice, Prevention of Mother to Child Transmission (PMTCT), FP methods and information on danger signs are given within this 48 hours. The guideline explains on best practices which will influence the good health for both mother and child. Timing of discharge after delivery, number and timing of postnatal contact, home visit for PNC, assessment of baby, exclusive breastfeeding (EBF) and cord care are the practice guided in WHO recommendation 2013.

Tesfahan and Work (2014); were the authors done a study in Ethiopia, assessing knowledge, perception on the utilization of postnatal care. 84.39% 0f women were aware that they should receive PNC and 16% of women stated that they always seek for PNC if they are sick. These results were different to those which were done to other part of Ethiopia where most of women were unaware about PNC. According to the results, those women who were aware, reported that they attended PNC for the purpose of 97.69% for vaccination, 42.49% for family planning, 22.98% for nutrition advice, 7.08% discussing for breastfeeding, and 1.16% receiving advice for danger signs. With this results I found its more important to assess knowledge on utilization of PNC in Tanzania.

2.2 Utilization and practice of postnatal services
The utilization of PNC services varies between developed countries and developing countries. Women and newborn in developed countries receive quality PNC services in comparison to developing countriesADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/s12884-015-0717-7”, “ISBN” : “1288401507”, “ISSN” : “1471-2393”, “author” : { “dropping-particle” : “”, “family” : “Mohan”, “given” : “Diwakar”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gupta”, “given” : “Shivam”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Lefevre”, “given” : “Amnesty”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bazant”, “given” : “Eva”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Killewo”, “given” : “Japhet”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Baqui”, “given” : “Abdullah H”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC Pregnancy and Childbirth”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “page” : “1-10”, “publisher” : “BMC Pregnancy and Childbirth”, “title” : “Determinants of postnatal care use at health facilities in rural Tanzania : multilevel analysis of a household survey”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=751f0254-991e-4926-8a91-1f0e23020f71” } , “mendeley” : { “formattedCitation” : “(Mohan <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Mohan et al., 2015)”, “previouslyFormattedCitation” : “(Mohan <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Mohan et al., 2015).
Mohan et al (pregnancy and childbirth)2015; study done in rural-Morogoro-Tanzania on the determinant of PNC use. In the study education which account for PNC knowledge was among of the factors which increases awareness on maternal health services. A number of women were not educated and hence poor attendance for PNC and the most who attended had experience in complication on birth.

WHO in 2010 reported that 40% of women with live birth in previous five years do not receive any postnatal check-up. In Tanzania as among of the developing countries, the system of PNC services is not much developed and less evidencedADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “National”, “given” : “The”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Map”, “given” : “Road”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Plan”, “given” : “Strategic”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “April 2008”, “issued” : { “date-parts” : “2015” }, “title” : “United Republic of Tanzania Ministry of Health and Social Welfare The National Road Map Strategic Plan To Accelerate Reduction of Maternal , Newborn and Child Deaths in Tanzania”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=b2ebcc6c-4a2c-43df-90da-3051171e2be9” } , “mendeley” : { “formattedCitation” : “(National, Map and Plan, 2015)”, “plainTextFormattedCitation” : “(National, Map and Plan, 2015)”, “previouslyFormattedCitation” : “(National, Map and Plan, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(National, Map and Plan, 2015). In practice, mothers and newborn are supposed to be discharged at least 24 hours after delivery if the delivery was uncomplicated. The study shows that there is a risk for compromise health to both mother and new born if discharged below 48 hours after delivery. In Tanzania the most of women are discharged as early as two to three hours after delivery. These prove the unclear utilization of PNC services. The PNC services are done within 24 hours and are considered as the first PNC visit, and this apply even to home delivery. There are addition three visits, at 7, 28, 42 days post delivery. In Tanzania most of women do attend PNC services at first contact for health facility delivery, and other visits they mainly focused in infant immunizationADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1186/s12884-015-0717-7”, “ISBN” : “1288401507”, “ISSN” : “1471-2393”, “author” : { “dropping-particle” : “”, “family” : “Mohan”, “given” : “Diwakar”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gupta”, “given” : “Shivam”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Lefevre”, “given” : “Amnesty”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bazant”, “given” : “Eva”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Killewo”, “given” : “Japhet”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Baqui”, “given” : “Abdullah H”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “BMC Pregnancy and Childbirth”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2015” }, “page” : “1-10”, “publisher” : “BMC Pregnancy and Childbirth”, “title” : “Determinants of postnatal care use at health facilities in rural Tanzania : multilevel analysis of a household survey”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=751f0254-991e-4926-8a91-1f0e23020f71” } , “mendeley” : { “formattedCitation” : “(Mohan <i>et al.</i>, 2015)”, “plainTextFormattedCitation” : “(Mohan et al., 2015)”, “previouslyFormattedCitation” : “(Mohan <i>et al.</i>, 2015)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(Mohan et al., 2015).

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Angore, B. N., Tufa, E. G. and Bisetegen, F. S. (2018) ‘Determinants of postnatal care utilization in urban community among women in Debre Birhan Town , Northern Shewa , Ethiopia’. Journal of Health, Population and Nutrition, pp. 1–9.

Mohan, D., Gupta, S., Lefevre, A., Bazant, E., Killewo, J. and Baqui, A. H. (2015) ‘Determinants of postnatal care use at health facilities in rural Tanzania?: multilevel analysis of a household survey’, BMC Pregnancy and Childbirth. BMC Pregnancy and Childbirth, pp. 1–10. doi: 10.1186/s12884-015-0717-7.

National, T., Map, R. and Plan, S. (2015) ‘United Republic of Tanzania Ministry of Health and Social Welfare The National Road Map Strategic Plan To Accelerate Reduction of Maternal , Newborn and Child Deaths in Tanzania’, (April 2008).

Physiotherapy, S. and Cape, W. (2004) ‘FACTORS INFLUENCING UTILISATION OF POSTNATAL SERVICES IN MULAGO AND MENGO HOSPITALS Supervisors?: Julie Phillips Professor Kristofer J . Hagglund’, (November).

Tesfahun, F. and Worku, W. (2014) ‘Knowledge , Perception and Utilization of Postnatal Care of Mothers in Gondar Zuria District , Ethiopia?: A Cross-Sectional Study’, (196), pp. 2341–2351. doi: 10.1007/s10995-014-1474-3.

WHO (2015) ‘Postnatal Care for Mothers and Newborns Highlights from the World Health Organization 2013 Guidelines’, (March), pp. 1–8.