Immediate postpartum care in low- and middle-income countries: A gap in healthcare quality research and practice

Clarke-Deelder, Emma; Opondo, Kennedy; Oguttu, Monica; Burke, Thomas F.; Cohen, Jessica; McConnell, Margaret

doi:10.1016/j.ajogmf.2022.100764

Cited by 6 publications

(8 citation statements)

References 46 publications

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“…In addition, despite the importance of postnatal care and contraceptive use in reducing maternal mortality [18], few studies have evaluated indicators in these areas and the quality of studies examining contraceptive use was moderate to low. The finding regarding the scarcity of evidence on postnatal care in LMICs is not unique to this study, as it has been reported in recent research as well [61]. Further research is needed to better understand the impact of health insurance on postnatal care and contraceptive utilisation.…”

Section: Inconclusive Results On Contraception and Postnatal Care Uti...mentioning

confidence: 64%

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

Kazibwe,

Tran,

Kaiser

et al. 2024

BMC Health Serv Res

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Background Low- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries. Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies. Results A total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment. Conclusion The introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries’ progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status. Trial registration This study was registered with Prospero (CRD42021285776).

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Section: Inconclusive Results On Contraception and Postnatal Care Uti...mentioning

confidence: 64%

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

Kazibwe,

Tran,

Kaiser

et al. 2024

BMC Health Serv Res

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“…Approximately, 60% of maternal deaths happen during the postpartum period, with 45% of these occurring within the initial 24 h following delivery. Therefore, it is crucial to conduct postpartum monitoring, including monitoring blood loss and assessing vital signs, to promptly detect and address any complications [ 54 ]. Practices related to the immediate care of women after birth were not satisfactorily frequent in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, in a review conducted in Kenya, inadequate monitoring was identified as a contributing factor in 27% of the examined mortality cases, while prolonged abnormal observation without intervention was found to have played a role in 24%. Multiple studies across maternity care and various clinical fields have demonstrated the importance of vital sign measurements in predicting adverse clinical outcomes and making better and timelier care decisions, which contributes to improved patient outcomes [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…These guidelines encourage continuous monitoring in the crucial first 24 h after childbirth, ensuring a positive postnatal experience for both women and their newborns. With the release of these guidelines, there's an opportune time to address deficits in the quality of immediate postpartum care in low- and middle-income countries (LMICs) [ 54 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

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Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka

Weerasingha,

Ratnayake,

Abeyrathne

et al. 2024

Heliyon

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“…For example, a 2015 study in six sub-Saharan African countries found that uterotonics were administered within 1 minute of delivery in 52% of observed deliveries [6]. While there has been less research on later postpartum monitoring, the existing evidence points to low rates of vital sign monitoring and blood less assessment [37]. Maternal death reviews from a variety of settings have identified insufficient monitoring as an important factor driving mortality [38].…”

Section: Discussionmentioning

confidence: 99%

Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya

Clarke-Deelder

Opondo

Achieng

et al. 2023

PLOS Glob Public Health

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Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of “suspected PPH”, defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response.

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Immediate postpartum care in low- and middle-income countries: A gap in healthcare quality research and practice

Cited by 6 publications

References 46 publications

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka

Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya

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