Skip to main content

The role of community-based health services in influencing postnatal care visits in the Builsa and the West Mamprusi districts in rural Ghana



Globally, maternal mortality is still a challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Postnatal Care (PNC) is one of the key strategies for improving maternal health. This study examined determinants of at least three PNC visits in rural Ghana.


We conducted a cross-sectional study at the Community-Based Health Planning and Services (CHPS) Zones in the Builsa and West Mamprusi Districts between April and June 2016. We selected 650 women who delivered within 5 years preceding the survey (325 from each of the two sites) using the two-stage random sampling technique.


Of the 650 respondents, 62% reported attending postnatal care at least three times. In the Builsa district, the percentage of women who made at least three PNC visits were 90% compared with 35% in the West Mamprusi district. Older women and those who attended antenatal clinics at least four times (AOR: 5.23; 95% CI: 2.49–11.0) and women who had partners with some secondary education (AOR: 3.31; 95% CI: 1.17–9.39) were associated with at least three PNC visits.


Men engagement in maternal health services and the introduction of home-based PNC services in rural communities could help health workers reach out to many mothers and children promptly and improve PNC visits in those communities.

Peer Review reports


Despite the establishment of a number of global and national initiatives to improve maternal health, maternal mortality is still a major concern in sub-Saharan Africa [1]. Every year in Africa, at least 125,000 women and 870,000 newborns die in the first week after birth [2]. In 2015, global maternal mortality was 303,000 with sub-Saharan Africa accounting for the highest number of deaths (201,000) [1]. In 2015, Ghana recorded 2800 maternal deaths which is high when compared with other sub-Saharan Africa countries [1]. Ghana is one of the countries that failed to achieve the targets set for the fourth and fifth Millennium Development Goals [3].

Postnatal care (PNC) is the care given to the mother and her newborn baby immediately after the birth and for the first 6 weeks of life [2]. The PNC period is crucial for both the mother and the newborn [2, 4, 5]. The first 6 weeks after birth is known as the PNC period [2]. The first day after birth is associated with the highest risk for both mother and baby [2]. Most deaths occur during the first 24 h after childbirth and half of maternal and neonatal deaths occur during the first week after birth [4]. Postpartum haemorrhage is the main cause of maternal mortality [4, 5]. Other causes include complications from unsafe abortion, hypertensive disorders during pregnancy, postpartum infections, obstructed labor [6] puerperal sepsis [5] and HIV [4].

For babies, many of them die due to birth asphyxia during the first day after birth and a lot more because they are born preterm [2]. In the second week after birth, about 38% of them in sub-Saharan Africa die due to infections [2]. Long term disability and poor development of both the child and the mother is reported to be associated with the early postnatal period [2].

Recognizing the role of PNC during this critical period for mothers and babies, the WHO recommended at least three PNC visits for all nursing mothers to ensure their survival and that of their newborns [7]. PNC is important to identify and manage complications that arise as a result of child birth and to provide health information that is beneficial to both mother and baby [2, 4, 5]. It ensures monitoring of women and their newborns in the pueperium so as to reduce morbidity and mortality risks. PNC also ensures prompt access to family planning services to prevent poorly spaced pregnancies [2].

In the national safe motherhood service protocol of Ghana, it is specified that all pregnant women attend PNC at least three times for uncomplicated pregnancies with more visits recommended in case of complications [8]. The first PNC visit is within 48 h, the second by day 7 and the third, 6 weeks after birth [9]. PNC is high (78%) across the country but the proportion of women receiving a PNC check-up within 2 days of delivery is higher in urban than rural settings [10]. Also, the number of women receiving the three recommended PNC visits in rural Ghana is low [10], thus necessitating an enquiry into the factors that are associated with such low attendance.

A number of studies have examined factors that influence utilization of PNC services by mothers [11,12,13,14,15,16,17,18,19,20]. Some have highlighted important linkages between demographic factors such as parity, birth rank, number of pregnancies, religion, mother’s education and utilization of PNC services [14,15,16,17, 20]. Studies in developing countries such as Ethiopia and Nepal show that access to economic resources ensures that women are able to finance their deliveries in health facilities and are able to obtain subsequent services such as PNC [15, 17]. Besides, women with better financial resources have a better chance of benefiting from health education campaigns through media outlets like television, and newspapers because they are able to afford them [17]. Also, physical access as well as the geographical location of the mother have been shown to influence the use of PNC services [15, 19]. At the individual and social levels, factors like ANC attendance, skilled attendant during child birth, place of delivery, previous use of PNC services, and experience of medical complications have had significant influence on utilization of PNC services as observed by several studies [13, 15, 16, 19].

UNICEF together with the Ghana Health Service pilot-tested a package of interventions that focused on maternal, neonatal and child health (MNCH) within the framework of the life cycle approach in the Builsa Districts from 2012 to 2017 aimed at reducing maternal, newborn and child health mortality in the Builsa Districts [21]. As part of the intervention strategies UNICEF/Ghana Health Service implemented home-based postnatal care in the Community-based Health Planning and Services (CHPS) zones. The health providers visited women, who resided far away or were unable to come to the health facilities for care to provide postnatal services at their doorsteps [21]. This study evaluates the effectiveness of the intervention program comparing PNC service access in CHPS zones in two rural communities, one with home-based postnatal care (Builsa) and one without this service (West Mamprusi).

Primary health care

Primary health care in Ghana is delivered through the CHPS Program and the health centres. After many years of investigation into appropriate strategies for service delivery in rural settings, the CHPS Initiative has adapted strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care [22]. In 2000 the Ghana Health Service began training Community Health Officers (CHOs) to provide basic services in rural areas through the CHPS program [22]. The CHPS initiative is a community-based health program aimed at increasing availability and access to basic health services including maternal and child health services to rural communities in Ghana [22]. It is a government initiative that brings together CHOs and community members to deliver health services to rural communities [22, 23]. The overall strategic goal of CHPS is to improve the health status of the population by strengthening the health system and empowering communities and households for service delivery and utilization [24]. This study was conducted in CHPS zones to ascertain the percentage of women who have had at least three PNC visits and determine factors associated with at least three PNC visits.


Study setting

The study was carried out in the Builsa and the West Mamprusi Districts of the Upper East and Northern Regions of Ghana. The population estimate for the 2010 census for the Upper East region was 1,046,545 with 79% being rural while that of the Northern region was 2,479,461 with 70% rural dwellers [25].

The Builsa district which is located in the Upper East Region of Ghana, has a population of 92,991 [25]. In 2012, the district was divided into two-Builsa North and South Districts -but for the purposes of this study, the old demarcation and name of the district would be maintained. The Builsas constitute about 83% of the entire population and the remaining 17% is made up of minor ethnic groups [25]. The district is served by a district hospital located at Sandema, the district capital, four health centres, two private clinics and twenty functional CHPS zones with resident CHOs [26].

The West Mamprusi District was carved out of the Gambaga District in 1988 under the Government of Ghana’s decentralization and local government reform policy. The district’s administrative capital is Walewale, which lies on the Tamale-Bolgatanga trunk road, approximately 68 miles away from Tamale. The West Mamprusi District has a population of 117,821 made up of mostly Mamprusis who constitute about 75% of the total population [25]. There are three main ethnic groups (Mamprusis, Kantosis and Comas) mixed with settlers such as Frafras, Kassenas, Bulisas, Zambarmas and Hausas. The most widely spoken language is Mampruli [26]. The districts’ health infrastructure is made up of one hospital in Walewale, one polyclinic, one health centre, two clinics and six functional CHPS zones with resident CHOs [26].

The study was conducted in the two districts because of the vast differences in health infrastructure, particularly the number of CHPS compounds and human resources.

Study design

This was a cross-sectional household survey with women who had ever given birth in the 5 years prior to the study in the Builsa and the West Mamprusi Districts.

Sample size and sampling

The sample size was calculated based on the average proportion of skilled delivery (50%) in the Upper East and Northern Regions with 5 year annual average of skilled delivery (2005–2009) of 1250 in the two districts (Builsa and West Mamprusi Districts) and 95% confidence interval as well as a corresponding p <  0.05 for significance. We used the formula for sample size n = {DEFF*Np (1-p)}/ {(d2/Z21-α/2*(N-1) + p*(1-p)} [27] and this gave a sample size of 295 women. We assumed a refusal rate of 10%, which brought the total sample size for each district to 325 women.

A two-stage sampling method was used and the primary sampling unit was the enumeration area (EA), defined as the geographic area canvassed by one census representative. Sampling EAs and households was based on the assumptions that: [1] CHOs were working in these EAs in the two districts and [2] there is homogeneity in the provision of CHO services across the EAs.

The first stage involved selecting geographical clusters or EAs, from an updated master sampling frame constructed from the 2000 Ghana Population and Housing Census. A total of 50 clusters were selected from the master sampling frame of 323 (West Mamprusi-197 and Builsa Districts-144). The clusters were randomly selected from the list of EAs in each district. The selection was based on a simple random technique. In the second stage of selection, we listed all households in the selected enumeration areas (clusters) and used the simple random sampling method to sample 50 of them from each selected cluster. We compiled the list of women with children less than 5 years in each household and randomly selected one of them for the interview. For the random selection process, each eligible member of the household was assigned a unique number, then each number was placed in a bowl and mixed thoroughly. The fieldworker then randomly picked numbered tags from the bowl and interviewed the selected women. A total of 1623 eligible women were on the household list compiled for the study.

Data collection

Data was collected using a structured questionnaire, which included items concerning social and demographic characteristics, such as age, religion, marital status, education and partner’s education, the wealth of the woman, ethnicity, religion, ANC attendance during previous pregnancy, skilled attendant at birth and PNC visits. Age represented the woman’s age at the time of interview, marital status reflected the type of union the respondents were involved in. Woman and partner’s education reflected the educational levels of respondents and their partners, respectively. Wealth index reflected their financial status, which was based on household assets. The questionnaire was developed in the English language, but the research team translated it into Buli and Mampruli-the major languages of the study areas. The questionnaire was pretested in communities outside the study sites. We trained six senior high school graduates as fieldworkers and two university graduates as supervisors for the data collection. The fieldworkers had a two-week training prior to the survey and visited households to interview eligible women. We started fieldwork on the 14th of April and ended on the 13th of June, 2016.

Data analysis

We performed descriptive statistics, bivariate and multivariable analysis. All p-values were two-tailed, and a value of p <  0.05 was considered significant. The outcome variable for the analysis was at least three PNC visits (Yes or No). This was ascertained by the question: How many times did you receive PNC after your last child birth? We included explanatory variables such as age of the woman, marital status, geographical location, women’s education, husband’s education, wealth index, religion, ANC attendance and type of delivery. The wealth index consisted of 23 household-related items. These independent variables were selected based on previous studies [28,29,30,31]. We generated quintile ranks for wealth status using principal component analysis.

All statistical analyses were performed using Stata Version 12 (Stata Corp., TX).


Respondents’ socio-demographic characteristics

Table 1 shows the characteristics of 650 women from the Builsa and the West Mamprusi districts that participated in the study. The number of respondents from these districts were 325 and 325 respectively. Of all the respondents, 50% were Builsa, 29% were Mamprusi, and 21% were other tribes living in the West Mamprusi district. Half of the respondents were Christians, 37% practiced Islam and 28% worshipped ancestral religion (Table 1). Slightly over half of the women and nearly three quarters of their husbands had no education. However, more of the men attained secondary or higher education than the women.

Table 1 Socio-demographic characteristics of respondents

About 87% of the women reported having had at least four ANC attendance, and 66% of them were supervised by a skilled attendant during child birth and 62% had attended PNC at least three times.

The significant difference in the PNC attendance rate between the two districts indicates the need for a stratified analysis and presentation of the data.

Factors associated with PNC visits by Study District

Table 2 presents the results of a regression analysis for at least three PNC visits according to selected characteristics, in the West Mamprusi district. The results revealed that, women who attended ANC four times (AOR: 8.88; 95% CI: 2.94–26.8), aged 36–49 (AOR: 12.33; 95% CI: 2.94–51.9), and whose partners had some secondary education (AOR: 3.66; 95% CI: 1.57–8.51) were more likely to attend PNC at least three times relative to those who attended ANC three or less times and whose partners had no education respectively.

Table 2 Regression Analysis Results for Postnatal Care Attendance in the West Mamprusi District

Table 3 presents regression analysis for at least three PNC visits by selected characteristics in the Builsa district. Adjusted odd ratios revealed that ANC attendance, age, women’s education, religion, marital status, partner’s education, parity, and distance to health facility, wealth and type of delivery were not associated with PNC visits.

Table 3 Regression Analysis Results for Postnatal Care Attendance in the Builsa District


The study revealed that 62% of women made at least three PNC visits, despite the wide difference between the two sites. Women attendance of four or more ANCs, age and partner’s education were associated with at least three PNC visits in the West Mamprusi district.

In the Builsa district, the percentage of women who made at least four ANC attendance, skilled delivery and at least three PNC visits were 90, 75 and 90% respectively. On the other hand, in the West Mamprusi district, the percentage of women having four ANC attendances, skilled delivery and at least three PNC visits were 81, 57 and 35% respectively. However, our results showed that the differences in use of ANC and skilled delivery in the West Mamprusi District compared to that of Builsa are not as low as that for PNC. The community engagement component of the CHPS program ensures that community health volunteers are able to identify all pregnant women and nursing mothers within their locations and monitor their use of health services [23]. This could have contributed to improved utilization of PNC services in the Builsa district. In addition, the introduction of home-based postnatal care in the Builsa district helped health workers to reach out to many mothers and children promptly and that improved PNC visits in those communities [21]. Home-based care is an integral part of health service delivery, particularly in the Builsa district. The relevance of this approach to health care delivery lies in the wide coverage of services to both mothers and children in the comfort of their homes. The approach brings health services to the doorsteps of the people and might have impacted positively on maternal health outcomes in the Builsa district (32). Thus, the home-based postnatal care strategy could have contributed to the difference in the PNC uptake between the two districts. This observation suggests that where health services are brought closer to the people, it could improve the uptake of the services including PNC as reported in other studies in Ethiopia and Tanzania [15, 32, 33].

Women who attended ANC at least four times were more likely to make three or more PNC visits. ANC offers women the opportunity to access health information and to appreciate the importance of PNC. In addition, women who make at least four ANC attendances are more likely to be those who adhere to health recommendations and therefore would make the required number of PNC visits. Evidence from other studies show that ANC attendance strongly predicts utilization of PNC services [17, 32,33,34,35].

Older women were associated with at least three PNC visits in the West Mamprusi district. These findings contradict those of Workineh and Hailu (2014), Neupane and Doku (2012) and Rwabufigiri et al. (2016) who said that women with multiple pregnancies usually perceive themselves as having acquired enough experience to handle subsequent pregnancies, hence they fail to use PNC services [20, 36, 37]. The long interaction between women and CHOs through the CHPS program and other community engagement strategies [23, 38] could have contributed to the older women knowing the importance of PNC and therefore utilizing the services. The findings suggest that, previous reproductive health activities such as ANC, skilled delivery, PNC and family planning services offered an important avenue for older women to establish contact with health services and develop a good relationship with health care providers which ultimately leads to an increase in utilization. Also, past experience of medical complications could have influenced the use of PNC services by older women as observed in other studies [15, 16, 19].

Higher educational level of partner was positively associated with at least three PNC visits in the West Mamprusi district. In northern Ghana, men as heads of their lineages have power and authority to make decisions pertaining to their families including maternal health care [39,40,41,42]. Although research has shown men’s involvement in maternal health services [43, 44], they could do more to improve the health seeking behaviour of their partners by reminding them about appointment days, encouraging them to seek skilled care and accompanying them to the health facility for maternal health services. Also, in patriarchal societies where women lack autonomy, their partners should be given information on the need for routine visits to health care providers during pregnancy as well as the postpartum period to improve maternal and newborn survival.

Study limitations

This study had some limitations. First, recall bias was a potential limitation because some participants could have forgotten about past events involving PNC services, but to minimize this bias, past events were limited to the 5 years preceding the interview. Using different local languages to collect the data could also have distorted the presentation of the questions to the respondents. However, the standard training for fieldworkers and supervisors and the in-depth translation and back translation of the questions minimized the language bias.


Women who have had four ANC visits and those whose partners received some secondary education are more likely to have at least 3 PNC visits. The availability and access to PNC services in rural communities, particularly at the home-based level and male involvement in maternal health care could improve the use of PNC services in rural settings.

These key recommendations could help improve the use of PNC services:

  • The Ghana Health Service needs to scale-up the CHPS program to give all community members, particularly pregnant women and nursing mothers in rural communities, the opportunity to access health services at their doorsteps.

  • The Ghana Health Service needs to roll out the home-based PNC services, beginning with rural communities where distance from care may be a challenge for women with newborn babies.

  • Health professionals could use more innovative approaches to reach out to women in the West Mamprusi district to increase the use of PNC services.

  • Health professionals need to educate and engage men in maternal health programs.



Antenatal Care


Adjusted Odd Ratio


Community Health Officers


Community-based Health Planning and Services


Confidence Interval


Enumeration Area


Human Immunodeficiency Virus


Millennium Development Goals


National Health Insurance Scheme


Primary Health Care


Postnatal Care


  1. WHO Trends in Maternal Mortality: 1990 to 2015. WHO. [cited 2016 May 13]. Available from:

  2. Warren C, Daly P, Toure L, Mongi P. Opportunities for Africa’s newborns. “Postnatal care.”. Geneva, Switzerland: WHO; 2006.

    Google Scholar 

  3. UNDP. Ghana Millennium Development Goals, 2015 Report [Internet]. Accra, Ghana; 2015 [cited 2016 Jul 14]. Available from:

  4. Ronsmans C, Graham WJ. Maternal survival series steering group., maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189–200.

    Article  PubMed  Google Scholar 

  5. Say L, ChouD Gemmill A, Tunçalp O, Moller A, Daniels J, Gülmezoglu MA, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.

    Article  PubMed  Google Scholar 

  6. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;358(9963):117–71.

    Google Scholar 

  7. WHO. WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva, Switzerland; 2013 [cited 2016 Aug 5]. Available

  8. Ghana Health Service. Ghana National Safe Motherhood Service Protocol [Internet]. Accra, Ghana Health Service; 2008 [cited 2016 Apr 7]. Available from:

  9. Ministry of Health. Ghana National Newborn Health Strategy and Action Plan 2014–2018. 2014. Available from:

  10. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. Ghana Demographic and Health Survey 2014 Key indicators. Accra, Ghana: GSS, GHS, and ICF Macro; 2015.

    Google Scholar 

  11. Chakraborty N, Islam MA, Chowdhury RS, Bari W. Utilization of postnatal care in Bangladesh: evidence from a longitudinal study. Health Soc Care Community. 2002;10(6):492–502.

    Article  PubMed  Google Scholar 

  12. Ciceklioglu M, Soyer MT, Öcek ZA. Factors associated with the utilization and content of prenatal care in a western urban district of Turkey. Int J Qual Health Care. 2005;17(6):533–9.

    Article  PubMed  Google Scholar 

  13. Dhaher E, Mikolajczyk RT, Maxwell AE, Krämer A. Factors associated with lack of postnatal care among Palestinian women: a cross-sectional study of three clinics in the West Bank. BMC Pregnancy Childbirth. 2008;8(1):1–9.

    Article  Google Scholar 

  14. Dhakal S, Chapman GN, Simkhada PP, van Teijlingen ER, Stephens J, Raja AE. Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth. 2007;7:19.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hordofa MA, Almaw SS, Berhanu MG, Lemiso HB. Postnatal care service utilization and associated factors among women in dembecha district, Northwest Ethiopia. Sci J Public Health. 2015;3(5):686–92.

    Article  Google Scholar 

  16. Hove I, Siziya S, Katito C, Tshimanga M. Prevalence and associated factors for non-utilisation of postnatal care services: population-based study in Kuwadzana Peri-urban area, Zvimba District of Mashonaland West Province. Zimbabwe Afr J Reprod Health. 1999;3(2):25–32.

    Article  Google Scholar 

  17. Khanal V, Adhikari M, Karkee R, Gavidia T. Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal demographic and health survey 2011. BMC Womens Health. 2014;14(1):1–13.

    Article  Google Scholar 

  18. Mrisho M, Obrist B, Schellenberg JA, Haws RA, Mushi AK, Mshinda H, Schellenberg D. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth. 2009;9(1):1–12.

    Article  Google Scholar 

  19. Titaley C, Dibley M, Roberts C. Factors associated with non-utilisation of postnatal care services in Indonesia. J Epidemiol Community Health. 2009;63(10):827–31.

    Article  PubMed  CAS  Google Scholar 

  20. Workineh G, Hailu DA. Factors affecting utilization of postnatal care service in Jabitena district, Amhara region, Ethiopia. Sci J Public Health. 2014;2(3):169–76.

    Article  Google Scholar 

  21. UNICEF. Project for Improving Access to Quality Health and Education Services in the Northern and Upper East Regions of Ghana-An Endline Evaluation. Ghana; 2017. Report No.: 9127709

  22. Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20(1):25–34.

    Article  PubMed  Google Scholar 

  23. Sakeah E, McCloskey L, Bernstein J, Yeboah-Antwi K, Mills S, Doctor HV. Is there any role for community involvement in the community-based health planning and services skilled delivery program in rural Ghana? BMC Health Serv Res. 2014;14(1):340.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ghana Health Service. Community-Based Health Planning and Services (CHPS)-Operational policy document. Policy Document No. 20 [Internet]. Ghana; 2005 [cited 2016 Sep 15]. Available from:

  25. Ghana Statistical Service. 2010 Population and Housing Census: Summary Report of Final Results. In Accra, Ghana: Ghana Statistical Service; 2012 [cited 2013 Dec 16]. Available:

  26. Ministry of Local Government. Ghana Districts - A repository of all Local Assemblies in Ghana. 2014. Available from:

  27. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health. 2011 [cited 2013 Dec 19]. Available from:

  28. Pell M, Meñaca A, Were F, Afrah AN, Chatio S, Manda-Taylor L, Hamel JM, Hodgson A, Tagbor H, Kalilani L, Ouma P, Pool R. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One. 2013;8(1):e53747.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Overboscha GB GB, NNN N-N, Van den Booma GJM GJM, Damnyag L. Determinants of antenatal care use in Ghana. Ournal Afr Econ. 2004;2(13):277–301.

    Article  Google Scholar 

  30. Browne JL, Kayode GA, Arhinful D, Fidder SAJ, Grobbee DE, Klipstein-Grobusch K. Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana demographic and health surveillance data. BMJ Open. 2016;6(3):e008175.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Abekah-Nkrumah G, Abor PA. Socioeconomic determinants of use of reproductive health services in Ghana. Health Econ Rev. 2016;6(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kanté AM, Chung CE, Larsen AM, Exavery A, Tani K, Phillips JF. Factors associated with compliance with the recommended frequency of postnatal care services in three rural districts of Tanzania. BMC Pregnancy Childbirth. 2015;15:341. Available from:

  33. Abor AP, Abekah-Nkrumah G, Sakyi K, Adjasi KC, Abor J. The socio-economic determinants of maternal health care utilization in Ghana. Int J Soc Econ. 2011;38(7):628–48.

    Article  Google Scholar 

  34. Dahiru T, Oche MO. Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria. Pan Afr Med J. 2015;21:321.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tesfahun F, Worku W, Mazengiya F, Kifle M. Knowledge, perception and utilization of postnatal Care of Mothers in Gondar Zuria District, Ethiopia: a cross-sectional study. Matern Child Health J. 2014;18(10):2341–51.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Neupane S, Doku DT. Determinants of time of start of prenatal care and number of prenatal care visits during pregnancy among Nepalese women. J Community Health. 2012;37(4):865–73.

    Article  PubMed  Google Scholar 

  37. Rwabufigiri NB, Mukamurigo J, Thomson RD, Hedt-Gautier LB, Semasaka SJP. Factors associated with postnatal care utilisation in Rwanda: a secondary analysis of 2010 demographic and health survey data. BMC Pregnancy Childbirth. 2016;16:122.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sakeah E, McCloskey L, Bernstein J, Yeboah-Antwi K, Mills S, Doctor HV. Can community health officer-midwives effectively integrate skilled birth attendance in the community-based health planning and services program in rural Ghana? Reprod Health. 2014;11(1):90.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lloyd CB, Gage-Brandon AJ. Women’s role in maintaining households: family welfare and sexual inequality in Ghana. Popul Stud. 1993;47(1):115–31.

    Article  Google Scholar 

  40. Adongo PB, Phillips JF, Kajihara B, Fayorsey C, Debpuur C, Binka FN. Cultural factors constraining the introduction of family planning among the Kassena-Nankana of northern Ghana. Soc Sci med 1982. 1997;45(12):1789–804.

    CAS  Google Scholar 

  41. Ganle JK, Obeng B, Segbefia AY, Mwinyuri V, Yeboah JY, Baatiema L. How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study. BMC Pregnancy Childbirth. 2015;15:173.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Somé DT, Sombié I, Meda N. How decision for seeking maternal care is made—a qualitative study in two rural medical districts of Burkina Faso. Reprod Health. 2013;10:8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Furuta M, Salway S. Women’s position within the household as a determinant of maternal health care use in Nepal. Int Fam Plan Perspect. 2006;32:17–27.

    Article  PubMed  Google Scholar 

  44. Mullany BC, Becker S, Hindin MJ. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomised controlled trial. Health Educ Res. 2007;22:166–76.

    Article  PubMed  Google Scholar 

Download references


The authors are grateful to the Navrongo Health Research Centre, The World Health Organization-TDR, the Ministry of Health in Ghana and the Ghana Health Service. We also appreciate the District Health Management Teams of the Builsa North and South Districts and the West Mamprusi District for contributing to this study. We are also grateful to the data collectors and supervisors for collecting the data. The authors also thank the study communities for their cooperation during the data collection.

Author’ contributions

ES conceptualized the idea, designed the study, conducted the data collection, performed the data analysis, interpreted the results, and drafted the manuscript. RA, JKS, MD, EK and ARO contributed to the study design and interpretation and critical revision of the manuscript. DAz, DAn and SO contributed to the study design and interpretation and critical revision of the manuscript. All authors read and approved the final manuscript.


This work was funded by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (No.B40118).

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Author information

Authors and Affiliations


Corresponding author

Correspondence to Evelyn Sakeah.

Ethics declarations

Ethics approval and consent to participate

This study was approved by Navrongo Health Research Centre’s Institutional Review Board. The participants agreed to participate in this survey and signed an informed consent. If a participant was aged between 12 and 17 years, the consent of parent or legal guardian and the assent of the minor were obtained before the interview was conducted.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakeah, E., Aborigo, R., Sakeah, J.K. et al. The role of community-based health services in influencing postnatal care visits in the Builsa and the West Mamprusi districts in rural Ghana. BMC Pregnancy Childbirth 18, 295 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: