BackgroundIn low resource countries suboptimal clinical care has been identified a contributor to maternal and infant mortality. This study aimed to test the impact of a community intervention promoting client demand on provision of care during ANC, labour and the first postnatal contact (PNC).Methods This was implementation science research in Kasungu district of Malawi using a quasi-experimental design with an intervention site where mothers were exposed to a package of interventions aiming to improve knowledge and demand. The results were compared with a site where there was no intervention in the same district. The intervention included checklists for mothers, posters and a Radio Distance Learning (RDL) program.The study used mixed methods (qualitative and quantitative). A total of 1040 mothers participated in individual interviews. Sixteen Focus Group Discussions (FGDs) were conducted with 128 mothers and 8 Key Informant Interviews were conducted with health workers. Health passports were used to check service provision at both comparison and intervention sites. In addition, mothers’ checklists were used at the intervention site to verify service provision.Quantitative data were processed in Stata 16.0 using binomial regression and two-sample proportion tests. NVivo 12 was used to process qualitative data for thematic analysis through coding and merging or creation of new codes.ResultsAt the intervention site there a 21.9% mean increase in knowledge of demandable services in ANC (43.3% to 56.1%, p<0.001,), intrapartum services for the mother (20.6%, 41.8% to 62.6%, p=0.003,) and the neonatal services before discharge (17.5%, 47% to 64.5%, p=0.0039). For PNC, changes were non-significant. Overall, women at the intervention site were 50% more likely than women at the comparison site to demand a service in the continuum of care (RR = 1.5). Actual service provision was increased at the intervention sites across all elements of the continuum, including laboratory testing, clinical examination of mothers and newborns and provision of essential interventions such as oxytocin for prevention of postpartum haemorrhage, chlorhexidine for umbilical cord care and vitamin K.ConclusionThe intervention positively contributed to increased knowledge on care practices, attitudes towards demand, actual demand for care practices, services provision and service satisfaction.
BackgroundIn low resource countries suboptimal clinical care has been identi ed a contributor to maternal and infant mortality. This study aimed to test the impact of a community intervention promoting client demand on provision of care during ANC, labour and the rst postnatal contact (PNC). MethodsThis was implementation science research in Kasungu district of Malawi using a quasi-experimental design with an intervention site where mothers were exposed to a package of interventions aiming to improve knowledge and demand. The results were compared with a site where there was no intervention in the same district. The intervention included checklists for mothers, posters and a Radio Distance Learning (RDL) program.The study used mixed methods (qualitative and quantitative). A total of 1040 mothers participated in individual interviews. Sixteen Focus Group Discussions (FGDs) were conducted with 128 mothers and 8 Key Informant Interviews were conducted with health workers. Health passports were used to check service provision at both comparison and intervention sites. In addition, mothers' checklists were used at the intervention site to verify service provision.Quantitative data were processed in Stata 16.0 using binomial regression and two-sample proportion tests. NVivo 12 was used to process qualitative data for thematic analysis through coding and merging or creation of new codes. ResultsAt the intervention site there a 21.9% mean increase in knowledge of demandable services in ANC (43.3% to 56.1%, p<0.001,), intrapartum services for the mother (20.6%, 41.8% to 62.6%, p=0.003,) and the neonatal services before discharge (17.5%, 47% to 64.5%, p=0.0039). For PNC, changes were nonsigni cant. Overall, women at the intervention site were 50% more likely than women at the comparison site to demand a service in the continuum of care (RR = 1.5). Actual service provision was increased at the intervention sites across all elements of the continuum, including laboratory testing, clinical examination of mothers and newborns and provision of essential interventions such as oxytocin for prevention of postpartum haemorrhage, chlorhexidine for umbilical cord care and vitamin K. ConclusionThe intervention positively contributed to increased knowledge on care practices, attitudes towards demand, actual demand for care practices, services provision and service satisfaction.
Background: One of the factors affecting quality of care is that clients do not demand care practises during antenatal, intrapartum and postnatal care. This study aimed to identify care practices that can be demanded by the mother in the continuum of care from antenatal to postnatal.Methods: The study respondents included 122 mothers, 31 health workers and 4 psychologists. The researchers conducted 9 Key Informant Interviews with service providers and psychologists, 8 Focus Group Discussions with 8 mothers per group, and 26 vignettes with mothers and service providers. Data was analysed using Interpretative Phenomenological Analysis (IPA) where identified themes were identified and categorised. Results: During ANC and PNC mothers demanded all recommended services presented to them. Some services that were seen as demandable during labour and delivery included 4-hourly assessments of vital signs and blood pressure, emptying of the bladder, swabbing, delivery counselling, administration of oxytocin, post-delivery palpation, and vaginal examination. For the child mothers demanded head to assessments, assessment of vital signs, weighing, cord stamp and eye antiseptics, and vaccines. Women observed that they could demand birth registration even though it was not among the recommended services.Respondents proposed empowerment of mothers with cognitive, behavioural and interpersonal skills to demand services e.g. knowledge of service standards and health benefits and improved self-confidence and assertiveness. In addition, efforts have to be made to address perceived or real health worker attitudes, mental health for the client and the service provider, service provider workload, and availability of supplies.Conclusion: The study found that if a mother is informed in simple language about a service she is supposed to receive, she can demand numerous services in the continuum of care from ANC to PNC. However, demand cannot be a standalone solution for improving quality of care. What the mother can ask for is a step in the guidelines, but she cannot probe deeper to influence quality of the procedure. In addition, empowerment of mothers needs to be coupled with services and systems strengthening in support of health workers.
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