Factors associated with the length of stay at health facilities after childbirth among mothers and newborns in Dhading, Nepal: A cross-sectional study

Objective: To measure the length of stay at a health facility after childbirth, identify factors associated with the length of stay and measure the gap between the timings of the last check-up and discharge. Design: A cross-sectional study. Setting Five public health facilities in Dhading, Nepal. Participants 351 randomly selected mothers who gave birth at selected health facilities within 1 year of data collection between 10 and 31 August 2018. Outcome measure Length of stay (hours) at a health facility after childbirth. Adequate length was defined as 24 hours or longer based on the WHO guidelines. Results: Among 350 mothers (99.7%) out of 351 recruited, 61.7% were discharged within 24 hours after childbirth. Factors associated with shorter length of stay were as follows: travel time less than 30 min to a health facility (incidence rate ratio (IRR)=0.69, 95% CI 0.61 to 0.78); delivery attended by auxiliary staff (IRR=0.86, 95% CI 0.75 to 0.98); and delivery in a primary healthcare centre (IRR=0.67, 95% CI 0.58 to 0.79). Factors associated with longer length of stay were as follows: aged 22 years or above at the first pregnancy (IRR=1.25, 95% CI 1.13 to 1.40); having maternal complications (IRR=2.41, 95% CI 2.16 to 2.70); accompanied by her own family (IRR=1.17, 95% CI 1.03 to 1.34), accompanied by her husband (IRR=1.16, 95% CI 1.04 to 1.29); and delivered at a facility with a physical space where mother and newborn could stay overnight (IRR=1.20, 95% CI 1.07 to 1.34). Among mothers without complications, 32% received the last check-up 3 hours or less before discharge. Conclusions: Multiple factors, such as mothers' conditions, health facility characteristics and external support, were associated with the length of stay after childbirth. However, even if mothers stayed long, they might have not necessarily received timely and proper assessment before discharge.