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Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey

BMC Pregnancy and Childbirth volume 23, Article number: 575 (2023) Cite this article

Abstract

Background

A minimum length of stay following facility birth is a prerequisite for women and newborns to receive the recommended monitoring and package of postnatal care. The first postnatal care guidelines in Cameroon were issued in 1998 but adherence to minimum length of stay has not been assessed thus far. The objective of this study was to estimate the average length of stay and identify determinants of early discharge after facility birth.

Methods

We analyzed the Cameroon 2018 Demographic and Health Survey. We included 4,567 women who had a live birth in a heath facility between 2013 and 2018. We calculated their median length of stay in hours by mode of birth and the proportion discharged early (length of stay < 24 h after vaginal birth or < 5 days after caesarean section). We assessed the association between sociodemographic, context-related, facility-related, obstetric and need-related factors and early discharge using bivariate and multivariable logistic regression.

Results

The median length of stay (inter quartile range) was 36 (9–84) hours after vaginal birth (n = 4,290) and 252 (132–300) hours after caesarean section (n = 277). We found that 28.8% of all women who gave birth in health facilities were discharged too early (29.7% of women with vaginal birth and 15.1% after a caesarean section). Factors which significantly predicted early discharge in multivariable regression were: maternal age < 20 years (compared to 20–29 years, aOR: 1.44; 95%CI 1.13–1.82), unemployment (aOR: 0.78; 95%CI: 0.63–0.96), non-Christian religions (aOR: 1.65; 95CI: 1.21–2.24), and region of residence—Northern zone aOR:9.95 (95%CI:6.53–15.17) and Forest zone aOR:2.51 (95%CI:1.79–3.53) compared to the country’s capital cities (Douala or Yaounde). None of the obstetric characteristics was associated with early discharge.

Conclusions

More than 1 in 4 women who gave birth in facilities in Cameroon were discharged too early; this mostly affected women following vaginal birth. The reasons leading to lack of adherence to postnatal care guidelines should be better understood and addressed to reduce preventable complications and provide better support to women and newborns during this critical period.

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Background

Maternal mortality rate (MMR) in sub-Saharan Africa (SSA) is the highest worldwide despite substantial decline over the past three decades. Most countries in SSA are not on track to meet the Sustainable Development Goal (SDG) 3 target on MMR reduction [1, 2]. Historically, most programs to reduce MMR in SSA targeted antenatal and intrapartum periods, with positive results through increased antenatal care (ANC) coverage and proportion of facility-based childbirths [1, 3,4,5]. Nowadays, postpartum maternal deaths accounts for 55–65% of all maternal deaths partly because of the drop in antepartum and intrapartum mortality, and the risk of death remains high several months after childbirth [1, 6]. Therefore, inadequate maternal care during the postnatal period could undermine the hard-won gains in MMR from improved coverage and quality of ANC and skilled birth attendance.

The postnatal period is critical from the biological, health system and socio-cultural perspectives. Biologically, major recovery processes start immediately after childbirth and achieve restitution of the pre-pregnancy physiology by the end of the puerperium. Any deviation from the normal pathway to a healthy recovery can lead to serious complications and even mortality. Examples include uterine atony leading to postpartum hemorrhage or (de novo) postpartum pre-eclampsia or hypertension [7, 8]. In addition, some intrapartum complications can be missed during pregnancy and childbirth and diagnosed at advanced stages during early postnatal care (PNC) check-ups. Such complications are best illustrated by mental health challenges which can re-emerge up to one year following childbirth [9]. From a health system perspective, the postnatal period is the transition between pregnancy and the non-obstetric periods of women’s life in the continuum of care. It is recommended to counsel women on postpartum maternal and newborn care, and lifelong health topics like family planning, nutrition and prevention of communicable and non-communicable diseases [10, 11]. Moreover, focused care should start postnatally for pre-existing conditions and those that went undiagnosed during pregnancy, such as gestational diabetes. From a socio-cultural perspective, all communities have specific customs and norms to accommodate postpartum mothers and their newborns [12, 13].

Improving coverage and quality of PNC has become a global focus as a key lever to improve women’s and child’s health [10, 11]. The World Health Organization (WHO) issued recommendations for PNC in 1998, 2004, 2013, and 2022 [10, 11]. In the two latest editions, length of stay (LOS) of ≥ 24 h after uncomplicated facility-based vaginal birth was recommended and included among indicators of quality of maternal and newborn health services [10]. There is currently no WHO guidance on the minimum LOS following a caesarean section (CS). In high-income countries, women are typically discharged 2—4 days after uncomplicated CS and continuity of care is ensured through routine outpatient and/or home-based visits in the first days and weeks after discharge [14,15,16]. In SSA, while most women now give birth in health facilities (65%) coverage and quality of PNC remain suboptimal [17,18,19,20].

Cameroon, a lower-middle income country in SSA, has high maternal (427 maternal deaths per 100,000 live births) and morbidity rates [21,22,23]. Between 2004 and 2018, facility-based births rose from 59.0% to 67.0%, while population-level CS rate rose from 2.0% to 3.5% over the same period [23]. PNC for women has historically received less attention in health policies compared to other sexual, reproductive and maternal health topics, including family planning, comprehensive abortion care, ANC, emergency obstetric care, and prevention of mother-to-child transmission of the human immunodeficiency virus [21, 22]. The first national PNC guidelines were issued by the Ministry of Health in 2018 and remain in effect at the time of writing [17]. They recommend ≥ 24 h LOS after vaginal births but do not specify a minimum LOS following CS [17]. Cameroonian obstetricians agreed to not routinely discharge women before 5 days after uncomplicated CSs.

Early discharge from facilities following childbirth results from an interplay of individual, community and health system-related factors. Any intervention to improve the uptake of WHO and national recommendations on minimal LOS after childbirth should be informed by a thorough understanding of those factors. Little is known regarding the average LOS and determinants of early discharge in Cameroon [17,18,19,20]. The objectives of this study are to estimate the LOS following facility-based childbirth in Cameroon and to examine the determinants of early discharge.

Methods

Study design and data source

We conducted a cross-sectional study using Cameroon’s 2018 Demographic and Health Survey (DHS) data to examine the characteristics of live births during the 2013–2018 period. The 2018 DHS was a nationally representative population-based household survey. The sampling design followed a two-stage cluster strategy which we took into account in our statistical analysis. First, the country was divided into twelve survey domains: the ten administrative regions, the political capital (Yaounde) and the economic capital (Douala). Each survey domain except for Yaounde and Douala was subsequently divided into urban and rural strata. During the first sampling step, 470 clusters were systematically sampled in urban and rural strata using weighted probabilities proportionally to their number of households. In the second step, a simple random sampling of households in each selected cluster was undertaken. All consenting women of reproductive age (15—49 years) living in selected households or who spent the night preceding the survey in those households were interviewed.

Study population

We included all women aged 15–49 years who had a live birth in the survey’s five-year recall period (2013–2018). For each woman, we retained her most recent live birth if it occurred in a health facility. Respondents with missing, unknown or implausible LOS (> 8 weeks) were excluded from the analysis.

Conceptual framework

Building on results of a previous study, we hypothesized that LOS in health facility following childbirth is related to the interplay between several factors: contextual, socio-demographic, health facility, and obstetric and need-related [20]. Figure 1 illustrates the conceptual framework of determinants of LOS used in this study and shows the factors about which variables were available on the Cameroon 2018 DHS.

Fig. 1
figure 1

Conceptual framework of determinants of length of facility stay following facility childbirth

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Definitions

Outcome variables

During the DHS interview, LOS was captured by asking women: “How long after (name of the index child) was delivered did you stay in there (health facility)?”. Four possible answers were valid: “number of hours” (if less than one day), “number of days” (if at least one day and less than one week), “number of weeks” and “don’t know”. We used values expressed in hours as reported by women and transformed values in days and weeks into hours using the method described by Campbell et al. [20]. For example, LOS of one day was converted to 36 h (24 + 12), a stay of two days was converted to 60 h (48 + 12), and a stay of 3 days to 84 h (72 + 12). Similarly, LOS of one week was converted to 10.5 days (7 days + 3.5 days, which is 252 h). This transformation was done to account for the approximation based on the assumption that answers in days and weeks were, on average, longer in hours. We defined early discharge as a LOS < 24 h after vaginal birth and < 120 h (5 days) after CS.

Determinants

Socio-demographic factors

Age of the woman in years at the time of the index childbirth was computed and categorized in four groups (< 20, 20-29, 30-39, 40-49). The woman’s highest completed educational level was categorized as: no education, primary education, secondary education and higher education. Two categories were created to capture employment status of women at the time of the survey: employed (paid work) and unemployed. Marital status at time of survey was defined as married/cohabiting or not. The wealth quintile of the woman’s household was used as provided by the DHS dataset. Religion was categorized as Christianity (Catholic, Protestant or other Christian) or Islam/others (Animist, other and no religion).

Health facility-related factors

We re-coded facilities of childbirth into: 1. public hospitals (secondary and tertiary care health facilities), 2. public dispensaries (including integrated health centers and sub-divisional medical centers that are both primary care health facilities in Cameroon), 3. private health facilities (faith-based or for-profit facilities of any level of care), and 4. unknown (when the health facility type could not be ascertained by the respondent or survey enumerator). We did not include the qualification of the birth attendant for several reasons: anticipated collinearity with the type of health facility and mode of birth, poor criterion validity of recall, and the fact the birth attendant is not necessarily the provider involved in discharge [24].

Obstetric & need-related factors

Parity at the time of discharge was categorized as 1, 2–4, or 5 + . The number of ANC visits during the index pregnancy was categorized as 0 (no ANC), 1–4, and 4 + , according to national guidelines for focused ANC. Mode of birth was reported by the woman as either vaginal or CS. Newborn birthweight was assessed by the following questions: “Was (name of child) weighed at birth?” if yes, “How much did (name) weigh at birth?”. The answer was recorded in grams, either from memory alone or checked in the ANC booklet and categorized as < 2500 g, 2500–3999 g, or ≥ 4000 g. The sex of the newborn was male or female. Wantedness of the index pregnancy was captured by the question: “When you got pregnant, did you want to get pregnant at that time?”. We categorized the woman’s response as yes (wanted) or no (unwanted or mistimed).

Context-related factors

Regions provided in the DHS dataset were grouped into five larger socio-ecological zones: Northern (Adamawa, North and Far North), Forest (Centre, South and East), English-speaking (North-West and South-West), Capital cities (Yaounde and Douala), and West-littoral (West and Littoral regions). Type of residence was provided in the dataset (urban or rural).

Statistical analyses

We performed statistical analyses using R version 4.2.0 (GNU's not Unix Generalized Public License version 2). The DHS design is a non-probability two-level stratified sampling. To ensure representativeness and accurate confidence intervals, the dataset provided a weight for each woman, which was used in analyses. We also adjusted for clustering and stratification. We described the characteristics of the study population; categorical variables were summarized using frequencies and percentages with 95% confidence intervals (95%CI). The number of observations with missing data was reported for each variable. We calculated the median LOS (and interquartile range) in hours and the percentage of women who were discharged early, stratified by mode of childbirth.

To evaluate the association between determinants and early discharge, we conducted bivariate and multivariate logistic regressions. We examined vaginal births and CS in the same model because of the small number of CS births. Variables associated with early discharge in binary analysis at p < 0.05 were included in the multivariable model. We obtained crude and adjusted odds ratios (OR) with 95%CI and accounted for the survey design.

Results

Characteristics of the study sample

Of the 14,677 women interviewed during the Cameroon 2018 DHS, 13,527 were aged 15–49 years and 6,463 had their latest live birth during the five years preceding the interview (Fig. 2). Home-based births accounted for 28.7% of the most recent live births (n = 1,857). Among the 4,606 facility-based births, LOS was missing for 12 women (four in public hospitals, three public dispensaries, and five in private health facilities) and was unknown by 21 women (four in public hospitals, fourteen in public dispensaries, and three in private health facilities). In addition, six participants (three in public hospitals, one in a public dispensary, and two in private health facilities) reported implausibly long LOS (> 8 weeks). These 39 women were excluded from the final analysis sample of 4,567 woman-baby dyads (Fig. 2).

Fig. 2
figure 2

Study sample flow chart

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Table 1 summarizes the characteristics of the study sample. Data were missing for two variables—number of antenatal consultations (n = 60, 1.3%) and birthweight (n = 300, 6.6%). Women in the study sample were predominantly aged between 15–30 years (67.9%), had some level of formal education (88.6%), were employed (72.3%), married/cohabiting (76.2%) and Christian (77.1%). Most were primiparous (60.8%) and reported receiving 4 + ANC consultations during the index pregnancy (80.0%). CS accounted for 6.1% of all births in this sample of women who gave birth in health facilities.

Table 1 Characteristics of study sample (n = 4,567)
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Length of stay following facility-based childbirth

Table 2 shows the median LOS in hours and the percentage of women discharged early. Among women who gave birth vaginally (n = 4,290), the median LOS was 36 h, while among those with a CS (n = 277), the median was 252 h (equivalent of 10.5 days). We estimated that 29.7% of women with vaginal births were discharged too early (< 24 h), as were 15.1% of women with a CS (< 120 h). Overall, we found that 28.8% of women who gave birth in health facilities were discharged early.

Table 2 Median length of stay and percentages of early discharge after facility-based childbirth in Cameroon, overall and by mode of birth (n = 4,567)
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The cumulative distribution of LOS is shown in Table 3, disaggregated by mode of birth. Among women who had a vaginal birth, very early facility discharge (< 2 h) was reported by 9.7% of women, while 21.6% reported being discharged within 6 h. LOS of four or more days was reported by 7.5% of women. Among women who had a CS, 2.7% reported having been discharged on the day of childbirth. Those discharged within 3 days accounted for 7.2% and 26.2% were discharged longer than 7 days after birth.

Table 3 Distribution of length of stay after facility-based childbirth in Cameroon by mode of childbirth (n = 4,567)
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Determinants of early discharge

Table 4 shows the crude and adjusted associations between determinants and early discharge for all births combined.

Table 4 Determinants of early discharge after facility-based childbirth in Cameroon, all modes of delivery included (n = 4,567)
Full size table

Bivariate analysis

Women who had their first child, gave birth by CS, were ≥ 20 years old and reported ≥ 4 ANC visits were significantly less likely to be discharged early. Compared to women who gave birth in public dispensaries, those who gave birth in private health facilities (OR:0.41; 95%CI: 0.32–0.53) and public hospitals (OR:0.35; 95%CI: 0.28–0.45) were less likely to be discharged early. Unemployed and unmarried women were less likely to be discharged early compared to employed and married women, respectively. Living in a rural area doubled the odds of early discharge compared to urban areas. Compared to the two capital cities, living in the Northern zone and in the Forest zone increased the risk of early discharge, while living in the English speaking zone reduced it. Wantedness of pregnancy, newborn’s sex and birthweight were not significantly associated with early discharge.

Multivariable analysis

In multivariable analysis, the following factors were no longer significantly associated with early discharge: marital status, household wealth quintile, parity, mode of birth, number of ANC visits, and residence. On the other hand, predictors which remained significantly associated with early discharge were age < 20 years (compared to 20–29 years: aOR: 1.44; 95%CI: 1.13–1.82), unemployment (aOR:0.78; 95%CI: 0.63 – 0.96), religion other than Christianity (aOR: 1.65; 95CI: 1.21–2.24), and geographic zone. Public hospitals remained protective against early discharge while private health facilities were no longer different from public dispensaries following adjustment. Primary education remained marginally associated with 20% higher odds of early discharge compared to secondary education.

Discussion

We found that too many women left health facilities too early after childbirth in Cameroon. Nearly one in three women who gave birth in a health facility was discharged too early to benefit from evidence-based PNC and observation. This percentage was double among women with vaginal births compared to CS. Socio-demographic characteristics (adolescence, unemployment and non-Christian religions) and the type of health facility (public dispensary) were associated with higher odds of early discharge, while none of the obstetric characteristics was associated with early discharge. The zone of residence was also associated with early discharge.

Length of stay following childbirth

The median LOS for vaginal births and for all women in our study were similar to findings by Campbell et al. in the following SSA countries: Benin, Ghana, Kenya, Liberia, Madagascar, Namibia, Nigeria, Sierra Leone, Uganda and Zambia [19]. Outside SSA, Kumar et al. reported similar LOS following both vaginal and caesarean births in India [25]. LOS following CS in Cameroon was much longer than in Europe and North America [14, 15, 26]; this is likely due to higher severity of complications among women who give birth by a CS, necessitating a longer period of in-patient care and observation [27]. There are several pathways for women to leave health facilities following childbirth: discharge by care providers (based on maternal and/or newborn clinical need and other factors, including payment of fees), referral to another facility (for maternal and/or newborn indication), and self-discharge. The prevalence of early discharge following vaginal births in our study was twice higher than following CS and the difference was significant in bivariate analysis. This can be explained by the difference in risks (perception by women and care providers) associated with CS births. On the users’ side, after uncomplicated vaginal births, women might be more prone to self-discharge against providers’ advice than those who had CS. On the supply side, providers may tend to delay discharge after CS to ensure that the least of medical criteria for safe discharge are met because of the absence of routine home-based PNC and low uptake of early outpatient PNC in Cameroon. In case of facility overcrowding, providers tend to prioritise discharge of women who had vaginal births.

In contrast to early discharge which was the main focus of this study, the case of women with LOS which seemed “too long” must be mentioned. In this study, 7.5% of women with a vaginal birth were discharged after five days or longer, and one in four women who had a CS left the hospital beyond the tenth postoperative day. Unnecessarily long LOS increases the risk of nosocomial infections, out-of-pocket costs (higher for CS), and disrupts early postnatal socio-cultural schemes at home, such as breastfeeding the newborn and care for other children [28]. Longer than expected LOS may be medically necessary in case of maternal or neonatal complications, but several non-medical factors might also be at play: detention for inability to pay fees, administrative red tape for discharge formalities, waiting time for the first newborn consultation by a pediatrician (for example, if not available during weekends), waiting time for newborn birth declaration, and waiting time for the first vaccine of the newborn which is often delayed by nationwide stock outs [25, 28, 29].

Determinants of early discharge

Our results show that adolescents (< 20 years old) were more likely to depart the facility of birth early compared to older women. Campbell et al. reported similar results in several SSA countries while Kumar et al. found no relationship between maternal age and LOS in India [20, 30]. On the contrary, Pereira et al. and McMahon et al. reported that adolescence was significantly associated with longer LOS following CS in Brazil and Tanzania, respectively [31, 32]. Our findings were unexpected because the higher prevalence of childbirth complications among adolescents should necessitate longer LOS than in adults [33,34,35]. We suggest possible reasons include adolescent mothers leaving early due to stigma or to avoid additional expenses. Further studies are needed to provide a better understanding of this finding; in the meantime, clinicians should pay a particular attention when discharging adolescent mothers to ensure that the recommended minimal LOS and high-quality care are met. Reasons why Christian women were discharged in due time and whether/how other socio-economic factors are causing residual confounding in this association should also be examined in further studies.

Concerning contextual factors, early discharge was significantly more likely in Northern and Forest zones which have the highest percentages of home-based childbirth (ranging from 20.2% – 63.0%) and the lowest coverage of maternal health services in the country [36, 37]. We hypothesize that in those zones, the few women who give birth in health facilities might be more likely to advocate for earlier (self-)discharge in line with regional cultural expectations. Self-discharge might be one of the drivers of the much higher odds of early discharge in the remote and rural Northern zone, where women might live far from health facilities and rely on infrequent transport. In these poorest zones of the country, the infrastructure (space, beds, privacy, water and sanitation) in health facilities might be suboptimal and could have motivated early self-discharge by women, as it was documented in rural Tanzania [32]. Health authorities should focus on those geographic zones when implementing the current national guidelines on LOS and PNC.

In bivariate analysis, living in a rural area increased by two folds the probability of early discharge; this is similar to results reported by McMahon et al. in a rural region of Tanzania where 90% of women with uncomplicated vaginal births were discharged within 24 h [32]. However, the association between rural residence and early discharge lost significance after multivariable analysis like in the sub-Saharan African multi-country study by Campbell et al. [20]. Women who had vaginal birth in public dispensaries where significantly more likely to be discharged early than those in public hospitals. McMahon et al. reported similar results in Tanzania [32]. This could be explained by higher proportions of complicated births in hospitals which serve as referral facilities, warranting longer stays for adequate management compared to dispensaries, where most women have few or no complications. Other possible reasons include the higher qualifications of health care providers in hospitals resulting in better compliance to national guidelines, and use of lengthy and rigorous procedures for discharge. Dispensaries and other primary care facilities should be the priority target of any strategy to increase the uptake of recommendations on LOS following facility-based birth.

The drivers and root causes of the high prevalence of early discharge following facility-based childbirths in Cameroon have not been explored to date. To that end, we suggest further qualitative research like that carried out by McMahon et al. in Tanzania, which resulted in identification of drivers pertaining both to the supply and demand sides: overcrowding of health facilities, women’s physical and mental discomfort, self-discharge, pressing household commitments and routine practices (closing time and group discharge of low-risk women to accommodate others) [32]. Such study would provide insights into the elements of PNC which are not properly delivered when women are discharged early and help advocate for improvements.

Strengths and limitations

This study is the first to assess LOS following facility birth in Cameroon and determinants of early discharge. It used a large nationally representative sample with high completion rates, which makes the results generalizable. Nevertheless, it has some limitations. Firstly, there is a possible recall bias because information was self-reported and collected retrospectively about an event dating up to five years earlier. The extent of validity and reliability of the LOS question has not been tested prior to the survey, women might not remember their exact LOS, and there was substantial heaping in the responses. In addition, the formula we used to transform LOS from days and weeks to hours is an approximation which has not been validated against direct prospective measurements. Secondly, social desirability bias could have impeded some answers because the interviewers were publicly announced and endorsed by public authorities. Women with an early (self-)discharge might have reported a longer length of stay, thereby artificially reducing the prevalence of early discharge. Thirdly, reliance on secondary data made it impossible to explore a broader range of factors associated with early discharge; especially those related to facility, health providers, women’s health status and content of care received by women during their postnatal stay in health facilities. Finally, the wording of the survey question to capture the LOS did not specify whether women stayed in the health facility for their own care or for the sick newborns.

Conclusion

This first study to assess LOS in Cameroon found that more than a quarter of women who gave birth in health facilities were discharged too early as per the recommendations of the Ministry of Health, suggesting a misalignment between guidelines and practice. Several associated factors have been identified but root causes and drivers of early discharge and their concrete impact on completeness of recommended postnatal care content are still to be determined in view of informing response policies and strategies to improve the quality of postnatal care.

Availability of data and materials

The data that support the findings of this study are available from The Inner City Fund International Demographic and Health Survey Program (https://www.dhsprogram.com/data/dataset_admin/login_main.cfm) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of The Inner City Fund International Demographic and Health Survey Program.

Abbreviations

ANC:

Antenatal Care

aOR:

Adjusted Odds Ratio

CS:

Caesarean section

DHS:

Demographic and Health Survey

LOS:

Length of stay

MMR:

Maternal mortality rate

NA:

Not applicable

OR:

Odds Ratio

PNC:

Postnatal Care

SDG:

Sustainable Development Goal

SSA:

Sub-Saharan Africa

WHO:

World Health Organization

References

  1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980–1004.

    Article  PubMed  PubMed Central  Google Scholar 

  2. United Nations. The sustainable development goals report 2022. 2022. p. 64. Available from: https://unstats.un.org/sdgs/report/2022/The-Sustainable-Development-Goals-Report-2022.pdf. (Cited July 29).

    Google Scholar 

  3. Global Health Observatory | By category | Antenatal care coverage - Data by country. Available from: https://apps.who.int/gho/data/node.main.ANTENATALCARECOVERAGE4 . Accessed on 1 May 2022.

  4. Global Health Observatory | By category | Institutional births - Data by country. Available from: https://apps.who.int/gho/data/node.main.SRHIB?lang=en. Accessed on 1 May 2022.

  5. Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S, Freedman L, et al. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia. 1146 Heal Policy Plan. 2017;32:1146–52.

    Article  Google Scholar 

  6. Gazeley U, Reniers G, Eilerts-Spinelli H, Prieto JR, Jasseh M, Khagayi S, et al. Women’s risk of death beyond 42 days postpartum: a pooled analysis of longitudinal Health and Demographic Surveillance System data in sub-Saharan Africa. Lancet Glob Health. 2022;10(11):e1582–9.

    Article  CAS  PubMed  Google Scholar 

  7. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spog CY, editors. Williams Obstetrics. 23rd ed. New York: The McGraw-Hill Companies; 2006. p. 646–60.

  8. World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience. 2022. Available from: www.mcsprogram.org. Accessed on 4 June 2022.

    Google Scholar 

  9. Antenatal and postnatal mental health: clinical management and service guidance. London: National Institute for Health and Care Excellence (NICE); 2018. (NICE Clinical Guidelines, No. 192.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK553127/.

  10. Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol. 2012;206(6):470–5.

    Article  PubMed  Google Scholar 

  11. World Health Organization (WHO). Postnatal care of the mother and newborn 2013. World Health Organization; 2013. p. 1–72. Available from: http://apps.who.int/iris/bitstream/10665/97603/1/9789241506649_eng.pdf. Accessed on 11 June 2022.

  12. Gjerdingen DK, Chaloner K. Mothers’ experience with household roles and social support during the first postpartum year. Women Health. 1994;21(4):57–74.

    Article  CAS  PubMed  Google Scholar 

  13. Eberhard-Gran M, Garthus-Niegel S, Garthus-Niegel K, Eskild A. Postnatal care: a cross-cultural and historical perspective. Arch Womens Ment Health. 2010;13(6):459–66.

    Article  PubMed  Google Scholar 

  14. Cegolon L, Mastrangelo G, Maso G, Pozzo GD, Heymann WC, Ronfani L, Barbone F. Determinants of length of stay after cesarean sections in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005–2015. Sci Rep. 2020;10(1):19238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kruse AR, Arendt LH, Jakobsen DH, Kehlet H, Lauszus FF, Forman A, Uldbjerg N, Sundtoft IB, Kesmodel US. Length of hospital stay after cesarean section in Denmark from 2004 to 2016: a national register-based study. Acta Obstet Gynecol Scand. 2021;100(2):244–51.

    Article  PubMed  Google Scholar 

  16. Wen SW, Liu S, Marcoux S, Fowler D. Trends and variations in length of hospital stay for childbirth in Canada. CMAJ. 1998;158(7):875–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Cameroon. Ministry of Public Health. Norms and standards for sexual and reproductive health and family planning. Yaounde: Ministry of Public Health; 2018. Available at https://www.minsante.cm/site/?q=fr/content/normes-et-standards-en-sant%C3%A9-de-reproduction-planification-familiale-au-cameroun. Accessed on June 15, 2022.

  18. Tessema ZT, Yazachew L, Tesema GA, Teshale AB. Determinants of postnatal care utilization in sub-Saharan Africa: a meta and multilevel analysis of data from 36 sub-Saharan countries. Ital J Pediatr. 2020;46(1):175.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Benova L, Owolabi O, Radovich E, Wong KLM, Macleod D, Langlois EV, et al. Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: a cross-sectional study using Demographic and Health Survey data from 33 countries. PLoS Med. 2019;16(10):e1002943.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Campbell OM, Cegolon L, Macleod D, Benova L. Length of stay after childbirth in 92 countries and associated factors in 30 low- and middle-income countries: compilation of reported data and a cross-sectional analysis from nationally representative surveys. PLoS Med. 2016;13(3):e1001972.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cameroon. Ministry of Public Health. 2016–2027 Health Sector Strategy. Yaounde: Ministry of Public Health; 2015. Available at. https://www.minsante.cm/site/sites/default/files/HSS_english_0.pdf. Accessed on 24 May 2022.

  22. Cameroon. Ministry of Public Health. Health analytical profile 2016. Yaounde: Ministry of Public Health; 2017. Available at https://www.afro.who.int/sites/default/files/2017-07/Health_Profile_Cameroon_2016_ENG.pdf. Accessed on 16 July 2022.

  23. Cameroon National Institute of Statistics & ICF. 2020. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé, Cameroun et Rockville, Maryland, USA. Available at: https://dhsprogram.com/publications/publication-fr360-dhs-final-reports.cfm. Accessed on 26 July 2022.

  24. Benova L, Moller A-B, Hill K, Vaz LME, Morgan A, Hanson C, et al. What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation. PLoS One. 2020;15(5):e0233969.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kumar P, Dhillon P. Length of stay after childbirth in India: a comparative study of public and private health institutions. BMC Pregnancy Childbirth. 2020;20(1):181.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ntembe A, Tawah R, Faux E. Redistributive effects of health care out-of-pocket payments in Cameroon. Int J Equity Health. 2021;20(1):227.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ngowa JD, Ngassam A, Fouogue JT, Metogo J, Medou A, Kasia JM. Early maternal complications of cesarean section: about 460 cases in two university hospitals in Yaounde. Cameroon Pan Afr Med J. 2015;21:265.

    PubMed  Google Scholar 

  28. Dey T, Ononge S, Weeks A, Benova L. Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of demographic and health surveys between 2001 and 2016. BMJ Glob Health. 2021;6(4):e004230.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Adegoke AA, van den Broek N. Skilled birth attendance-lessons learnt. BJOG. 2009;116(Suppl 1):33–40. https://doi.org/10.1111/j.1471-0528.2009.02336.x.

    Article  PubMed  Google Scholar 

  30. Tamang T, Wangchuk T, Zangmo C, Wangmo T, Tshomo K. The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay. BMC Pregnancy Childbirth. 2021;21(1):637.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Pereira SL, Silva TPR, Moreira AD, Novaes TG, Pessoa MC, Matozinhos IP, et al. Factors associated with the length of hospital stay of women undergoing cesarean section. Rev Saude Publica. 2019;53:65.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Njim T, Tanyitiku BS, Babila CS. Prevalence of adolescent deliveries and its complications in Cameroon: a systematic review and meta-analysis. Arch Public Health. 2020;78:24.

    Article  PubMed  PubMed Central  Google Scholar 

  33. McMahon SA, Mohan D, LeFevre AE, Mosha I, Mpembeni R, Chase RP, Baqui AH, Winch PJ. “You should go so that others can come”; the role of facilities in determining an early departure after childbirth in Morogoro Region Tanzania. BMC Pregnancy Childbirth. 2015;15:328.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Agbor VN, Mbanga CM, Njim T. Adolescent deliveries in rural Cameroon: an 8-year trend, prevalence and adverse maternofoetal outcomes. Reprod Health. 2017;14(1):122.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tamambang RF, Njim T, Njie AE, Mbuagbaw L, Mafuta A, Tchana M, Choukem SP. Adolescent deliveries in urban Cameroon: a retrospective analysis of the prevalence, 6-year trend and adverse outcomes. BMC Res Notes. 2018;11(1):469.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(Suppl 1):40–8.

    Article  PubMed  Google Scholar 

  37. Cameroon. Ministry of Public Health. Health analytical profile 2016. Yaounde: Ministry of Public Health; 2017. Available at https://www.afro.who.int/sites/default/files/2017-07/Health_Profile_Cameroon_2016_ENG.pdf. Accessed on 19 July 2022.

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Acknowledgements

Authors are thankful to the Inner City Fund International Demographic and Health Surveys program for granting them access to the 2018 Cameroon DHS database.

Funding

LB was funded in part by the Research Foundation – Flanders (Fonds Wetenschappelijk Onderzoek) as part of her Senior Postdoctoral Fellowship (award number 1234820N).

JTF was consecutively funded by the Belgian Directorate General for Development Co-operation (DGD) as part of his scholarship for a Master in Public Health and by the Japanese Ministry of Education, Culture, Sports, Science & Technology, through its WISE Programme Research Grant for his Joint PhD at the Nagasaki University and the London School of Hygiene and tropical Medicine.

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Authors and Affiliations

  1. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK

    Jovanny Tsuala Fouogue, Louise-Tina Day & Veronique Filippi

  2. Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon

    Jovanny Tsuala Fouogue, Bruno Kenfack & Jeanne Hortence Fouedjio

  3. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

    Jovanny Tsuala Fouogue, Aline Semaan, Tom Smekens, Thérèse Delvaux & Lenka Beňová

  4. School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

    Matsui Mitsuaki

  5. Department of Clinical Sciences, Higher Institute of Medical Technologies, Yaounde, Cameroon

    Florent Ymele Fouelifack

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  1. Jovanny Tsuala Fouogue
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Contributions

Conceptualization: JTF, LB. Formal analysis: JTF, AS, TS, TD, LB. Funding acquisition: LB. Methodology: JTF, AS, LB. Writing: JTF, LB. Review and editing: JTF, KB, TD, YFF, FJH, LTD, VF, MM. Supervision: LB. All authors reviewed and approved the manuscrit.

Corresponding author

Correspondence to Jovanny Tsuala Fouogue.

Ethics declarations

Ethics approval and consent to participate

The Inner City Fund International institutional review board approved the protocol, the procedures and questionnaires for the 2018 DHS survey and Cameroon’s National Ethics Committee granted a clearance. In addition, informed consent was obtained from all participants or/and from their legal guardians before each interview. Informed consent for participants below the age of 16 and for illiterate participants was obtained from their parents and/or their legal guardian(s). All methods were carried out in accordance with relevant guidelines and regulations. The DHS program granted us access to the dataset.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Fouogue, J.T., Semaan, A., Smekens, T. et al. Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey. BMC Pregnancy Childbirth 23, 575 (2023). https://doi.org/10.1186/s12884-023-05847-4

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Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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