Discharge time from healthcare facilities after birth in Tanzania: a secondary analysis of demographic and health surveys from 2015 to 16 and 2022

Background
Care during the immediate postpartum period is critical for women and newborn’s health. Following facility-based birth, it is recommended to monitor the health of women and newborns in the facility. In Tanzania, a third of women who give birth in a health facility report not receiving a health check during their stay. Duration of stay and factors influencing them are not well documented in Tanzania. We describe postpartum length-of-stay at two time-points, 2015/2016 and 2022 in Tanzania, and explore factors associated with early discharge.

Methods
We analysed secondary data from two Demographic and Health Surveys: n = 3,582 women from 2015 to 16 and n = 4,618 from 2022 who had a livebirth in a health facility during the three years preceding the survey. Early discharge was defined as discharge < 24 h after vaginal birth and < 72 h after a caesarean birth. We describe the percentage of early discharge at both DHS time-points and explore factors associated with it using 2022 data with multivariable logistic regression, separately by mode of birth.

Results
Almost half of women who had a vaginal birth were discharged early in 2015-16, compared to 30.3% in 2022. Early discharge increased among women who had a caesarean section from 17.2% in 2015-16 to 25.2% in 2022. The odds of early discharge were higher in Zanzibar compared to Eastern zone, and factors associated with early discharge included level of facility, frequency of antenatal care visits, maternal education and newborn underweight status.

Conclusions
Despite progress in reducing early postpartum discharge after vaginal births, it continued to affect a third of women giving birth in Tanzania in 2022. Disparities between regions and facility levels suggest potential inconsistencies in the application of postpartum guidelines, warranting the need to determine and address the underlying causes, standardise practice and ensure equitable access to quality postpartum care.