An evidence-based policy brief: improving the quality of postnatal care in mothers 48 hours after childbirth

Sakala, Betty

doi:10.4314/mmj.v31i2.12

Cited by 12 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31 Furthermore, although WHO Postnatal care recommendations do exist, there is a paucity of literature providing guidance and frameworks to health workers at country or system level on how to provide high quality maternal care, particularly after facility birth. 32 As a result, the care provided is often incomplete and not universal to every women at birth. 17 Although not universal, women from Eastern Uganda were noted to receive the highest coverage of immediate postnatal care after facility birth.…”

Section: Discussionmentioning

confidence: 99%

Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

et al. 2021

View full text Add to dashboard Cite

IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.MethodsWe analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.ResultsData from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).ConclusionIn Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.

show abstract

Section: Discussionmentioning

confidence: 99%

Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Other barriers to PNC from our study have been previously reported and these include lack of resources [ 42 – 44 ], negative attitude of health care workers [ 22 , 45 ], cultural values [ 32 , 36 ] and cultural practices, restrictions, and confinement, and myths during the puerperium [ 41 ]. distance [ 23 , 24 , 32 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 91%

“…distance [ 23 , 24 , 32 , 46 , 47 ]. To overcome challenges associated with distance there is a need to incorporate PNC services into the village health clinics and outreach clinics like under-five clinics [ 42 ] because this will make them accessible to many within their communities. To realize that goal, health workers that run the community-based clinics will need to be trained for them to provide the required PNC services.…”

Section: Discussionmentioning

confidence: 99%

Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi

Nyondo-Mipando

Chirwa

Kumitawa

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Postnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 h of birth, 48–72 h, 7–14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies. Methods A concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study was conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 h of birth, at 48–72 h, 7–14 days, and six weeks after birth were conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach. Results The uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 h of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded the utilisation of PNC services. The enablers included the mother’s level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities. Conclusion Optimisation of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, time points, and services that need to be delivered to create demand for the services. There is a need to assess the contextual factors for a better response in improving the uptake of PNC services and in turn inform the development of strategies for optimizing the uptake of PNC services.

show abstract

“…While WHO recommends remaining in the facility for postnatal care for 24 hours following facility birth, when the most deaths occur [ 12 ], women and newborns in Malawi are often discharged earlier due to availability of space and funding. Additionally, facilities do not always prioritise allocating skilled providers for care following uncomplicated births [ 13 ]. These shortages of qualified staff as well as essential equipment represent contributors to delayed and incomplete care [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Distance to available services for newborns at facilities in Malawi: A secondary analysis of survey and health facility data

et al. 2021

View full text Add to dashboard Cite

Background Malawi has halved the neonatal mortality rate between 1990–2018, however, is not on track to achieve the Sustainable Development Goal 12 per 1,000 live births. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care. Methods Using data We used individual data from the 2015–16 Malawi Demographic and Health Survey and facility data from the 2013–14 Malawi Service Provision Assessment, linking households to all health facilities within specified distances and travel times. We calculated service readiness scores for facilities to measure their capacity to provide birth/newborn care services. We fitted multi-level regression models to evaluate the association between the service readiness and appropriate newborn care (receiving at least five of six interventions). Results Households with recent births (n = 6010) linked to a median of two birth facilities within 5–10 km and one facility within a two-hour walk. The maximum service environment scores for linked facilities median was 77.5 for facilities within 5–10 km and 75.5 for facilities within a two-hour walk. While linking to one or more facilities within 5-10km or a two-hour walk was not associated with appropriate newborn care, higher levels of service readiness in nearby facilities was associated with an increased risk of appropriate newborn care. Conclusions Women’s choice of nearby facilities and quality facilities is limited. High quality newborn care is sub-optimal despite high coverage of facility birth and some newborn care interventions. While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care.

show abstract

An evidence-based policy brief: improving the quality of postnatal care in mothers 48 hours after childbirth

Cited by 12 publications

References 15 publications

Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi

Distance to available services for newborns at facilities in Malawi: A secondary analysis of survey and health facility data

Contact Info

Product

Resources

About