Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling

INTRODUCTION: Unlike physiological recovery, return to full functional status following childbirth takes longer than 6 weeks (42 days) of the traditionally defined postnatal period, and women with maternal morbidity usually require a longer period to recover. However, the extent to which this morbidity collectively impacts on women’s functional status is not well investigated in Ethiopia. We aim to determine the distinct trajectories and predictors of functional status among postpartum women in Northwest Ethiopia. METHODS: Health facility linked community-based follow-up study was conducted in Northwest Ethiopia from October 2020–March 2021. A sample of 779 delivering women was recruited after childbirth and before discharge using the criteria published by the WHO Maternal Morbidity Working Group. Functional status was measured by the Amharic version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) instrument. The Stata Traj package was used to determine trajectories of functional status using group-based multi-trajectory modelling. The multinomial logistic regression model was used to identify predictors of trajectory group membership. RESULTS: A total of 775 women participated at the first, second and third follow-up of the study (6(th) week, 12(th) week and 18(th) week of postpartum period). Three distinct functional status trajectory groups with different longitudinal patterns were identified across the six domains of WHODAS 2.0. Direct and indirect maternal morbidities, lower educational status, poor social support, vaginal delivery, stress, anxiety, posttraumatic stress disorder and fear of childbirth were found to be predictors of poor functioning trajectories. CONCLUSION: Early diagnosis and treatment of maternal morbidities and mental health problems, developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to improve functioning trajectories of postpartum women.