Length-of-stay and factors associated with early discharge after birth in health facilities in Guinea by mode of birth: Secondary analysis of Demographic and Health Survey 2018

The immediate postpartum period (first 24 hours after birth) represents a critical time for women and newborns. Postnatal length-of-stay varies globally; in Guinea, a 24-hour facility stay following childbirth is recommended, with an emphasis on providing frequent monitoring of mother and newborn for the first 6 hours. This study describes postpartum length-of-stay following facility-based births in Guinea, and investigates factors associated with early discharge. This cross-sectional study analysed secondary Demographic and Health Survey data covering the most recent livebirths during 2013-2018. We included 2,763 women who gave birth vaginally or by caesarean section in healthcare facilities. Early discharge following vaginal birth was defined according to two cut-offs (<24 hours and <6 hours); early discharge following caesarean section was defined as <72 hours. We assessed socio-demographic, obstetric and health-system factors associated with early discharge using binary and multi-variable logistic regression. Among women with a vaginal birth, 81.5% were discharged <6 hours, with a median length-of-stay of 3 hours. 28% of women who had caesarean section were discharged <72 hours. Odds of discharge <6 hours among women who gave birth vaginally were lower for births in non-government hospital(aOR = 0.55[95%CI = 0.35;0.85]), and multiple births(aOR = 0.54[95%CI = 0.31;0.94]); while the odds were higher in five of the 8 regions compared to Boké. Among women who gave birth by caesarean section, odds of discharge <72 hours were lower for births in government hospitals(aOR = 0.09[95%CI = 0.03;0.3]), and girl newborns(aOR = 0.15[95%CI = 0.05;0.48]).This study showed that postpartum length-of-stays in Guinea is on average shorter than the local recommendations, with the majority of postpartum women with vaginal births spending less than 6-hours in health facilities after birth. Early discharge was associated with type of facility of birth and region. This warrants an in-depth exploration of reasons related to women's and families' preferences, health workers' practices, resource availability, and whether/how early discharge affects postpartum quality-of-care and health outcomes.