Background Maternal mortality remained a public health issue, especially in developing countries. Although the first two days after birth was a critical time in which the highest maternal death recorded, it was the most neglected period of maternal health services. Therefore, this study aims to determine the maternal and community-level factors of postnatal check-ups in Ethiopia Methods Demographic and Health Survey (DHS) in 2016 was utilized. A total of 3,948 women aged 15-49 giving birth in the two years before the survey were included. The response variables were post-natal check-ups in the first two days after birth, dichotomized into no check-ups in the first two days and check-ups within two days after giving birth. The explanatory variables were individual maternal characteristics such as education, household wealth, perceived distance to a health facility to get medical help, employment status, antenatal care (ANC), delivery by cesarean section, birth order and place of delivery, and selected community characteristics such as community literacy, community socioeconomic status, community ANC coverage, community perception of distance to a health facility, and regional states. A multi-level mixed-effects logistic regression model was employed. Result Only 17% of the women had a postnatal check-up within 2 days of giving birth in Ethiopia. Institutional delivery AOR 2.14 [95% C.I 1.70, 2.0] and giving birth by cesarean section AOR 1.66 [95% CI 1.10, 2.50] were found to be maternal factors, whereas administrative regions(Oromia 69%, Somali 56%, Benishangul 55%, SNNPR 43%, Gambela 66%, Afar 50% and Dire Dawa 55% which less likely to utilize postnatal care utilization as compared to Addis Ababa city administrative area), Higher community-level wealth AOR 1.44 [95% C.I 1.08, 1.2], ANC coverage AOR 1.52 [95% C.I 1.19, 1.96] and perceived distance of the health facility as a big problem AOR 0.78[95% C.I 0.60, 0.99] were the community factors associated with postnatal check-ups in Ethiopia. Conclusion Both maternal factors and community factors are found to be a significant association with postnatal care services utilization, however, based on the ICC maternal factors prevail the community-level factors. Increasing access to postnatal care services to the remote areas of Ethiopia was recommended.

Introduction: Early identification and management of postpartum complications through timely visit for postnatal care is one of the key interventions in reducing maternal mortality. A community-based national level representative dataset was necessary to inform decision makers in achieving the sustainable development goal (SDG) target of reducing maternal mortality by 70%. This study aims to determine the individual and community level predictors of timely utilization of maternal postnatal care service in Ethiopia. Methods: A community based nationally representative survey of Ethiopian Demographic and Health Survey (EDHS) in 2016 was utilized. A total of 3,948 women aged 15-49 giving birth in the two years before the survey were included. A two-level mixed-effects logistic regression analysis was employed. Result: Among women aged 15-49 years giving birth in the 2 years before the survey, 17% had a postnatal check during the first 2 days after birth in Ethiopia. Institutional delivery AOR 2.14 [95% C.I 1.70, 2.0] and giving birth by caesarean section AOR 1.66 [95% CI 1.10, 2.50] were found to be an individual level determinants, whereas administrative regions(Oromia 69%, Somali 56%, Benishangul 55%, SNNPR 43%, Gambela 66%, Afar 50% and Dire Dawa 55% which less likely to utilize postnatal care utilization as compared to Addis Ababa city administrative area), Higher community level wealth AOR 1.44 [95% C.I 1.08, 1.2], antenatal care coverage AOR 1.52 [95% C.I 1.19, 1.96] and perceived distance of the health facility as a big problem AOR 0.78[95% C.I 0.60, 0.99] were the community level predictors of timely utilization of post-natal care in Ethiopia. Conclusion: Less than one in five women utilized postnatal care in the first 2 days after birth in Ethiopia. Individual level factors (being gave birth at health facility and caesarean delivery) and community level factors (administrative regions, community level wealth, antenatal care and perception of distance to health facility as a big problem) were found to be significant predictors. Keywords: Postnatal care; multilevel; DHS; Ethiopia

BACKGROUND፡ Postnatal care is provided to women and their babies within 42 days after delivery. Although the first two days after birth was a critical time in maternal health, it was the most neglected period of maternal health services. Therefore, this study aims to determine the maternal and community-level factors of postnatal check-ups in EthiopiaMETHODS: Ethiopian Demographic and Health Survey (EDHS) in 2016 was utilized. A total of 3,948 women aged 15-49 giving birth in the two years before the survey were included. A multilevel mixed-effects logistic regression model was employed.RESULT: Only 17% [95% C.I; 16.46%-17.53%] of the women had a postnatal check-up (PNC) within 2 days of giving birth in Ethiopia. Institutional delivery AOR 2.14 [95% C.I 1.70, 2.0] and giving birth by cesarean section AOR 1.66 [95% CI 1.10, 2.50] were found to be maternal factors. Whereas, administrativeregions (Oromia 69%, Somali 56%, Benishangul 55%, SNNPR 43%, Gambela 66%, Afar 50% and Dire Dawa 55% which less likely to utilize PNC as compared to Addis Ababa), higher community-level wealth AOR 1.44 [95% C.I 1.08, 1.2], ANC coverage AOR 1.52 [95% C.I 1.19, 1.96] and perceived distance of the health facility as a big problem AOR 0.78 [95% C.I 0.60, 0.99] were the community level factors.CONCLUSION: Both maternal factors and community factors are found to be a significant association with PNC, however, based on the ICC maternal factors prevail the community-level factors. Therefore, public health interventions to increasing improve postnatal care services should focus on community level determinants.