Determinants of maternal length of stay following childbirth in a rural health facility in Eritrea

BACKGROUND: The days following childbirth are a critical phase in the lives of mothers and newborns. Postpartum length of stay is a critical indicator of the efficiency of health care delivery. This study aims to explore maternal length of hospital stay (LOS) following childbirth and associated factors in a rural health facility in Eritrea. METHODOLOGY: A retrospective study of all mothers who delivered at Nakfa Hospital between 2020 and 2022 was conducted. Sociodemographic, past obstetric, and neonatal factors associated with postpartum LOS were evaluated for both vaginal delivery (VD) and cesarean delivery (CD). The determinants of LOS following VD were explored using negative binomial regression. RESULTS: A total of 2025 mothers [1975 (97.5%) VD and 50 (2.5%) CD] were included in the study. The median LOS following childbirth was 1 (IQR: 0–1) day for VD and 6 (IQR: 4–8) days for CD. A substantial proportion of mothers were found to have inadequate stays following VD [29% (95% CI: 27–31)], whereas 68% (95% CI: 54-81%) stayed for > 4 days following CD. In this study, VD that were attended by physicians had no inadequate stay, whereas 27.4% of deliveries attended by midwives and 31.3% by associate nurses resulted in inadequate stay (P-value < 0.001). Determinants of LOS following VD were: the presence of maternal complications (IRR = 2.8, 95% CI: 1.6-5, p-value < 0.001), delivery years 2020 and 2021 (IRR = 1.5, 95% CI: 1.2–1.8, p-value < 0.001 and IRR = 1.4, 95% CI: 1.2–1.7, p-value < 0.001, respectively), and delivery hour interval 23:00–7:00 (IRR = 0.8, 95% CI: 0.7–0.9, p-value = 0.03). CONCLUSION: A substantial proportion of mothers stay too short post-VD to allow adequate postnatal care, which can have untoward consequences for maternal and child health. Going forward, improved coverage of antenatal care for early diagnosis of maternal complications in pregnancy as well as assessing the level of knowledge and provisions of training and refresher courses for birth attendants should be worked upon. In addition, efforts to conduct studies that explore maternal and health care provider perspectives on LOS should be emphasized.