Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia

Abstract

Study objectives-The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period. Design-A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42. Setting-The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia. Participants-A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42. Main results-At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p<0.01) as perceived by mothers. There were more mothers in Group B (p<0.01) perceiving insuYcient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems ( p<0.03). In both groups the mothers' perceived own health problems, were significantly higher (p<0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p< 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p<0.01). Conclusions-There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care. (J Epidemiol Community Health 1998;52:385-391) The concept of high risk pregnancy has been extensively discussed in recent years 1 and programmes have been suggested to improve the coverage, content and quality of health service and support for the childbearing women. 2-5Less attention has been paid to describing the health and social situation of women as well as their concerns during the postpartum period. Information is limited on mother's self perceived health problems and self care actions for herself and her newborn child and the cor...

Postpartum Health among Rural Zambian Women

“…The type of health problems the women reported in this study is comparable with those in other studies, [10][11][12][13]15 but there are large differences in frequency of occurrence. This can be ascribed to the differences in study populations and the methods used to elicit health problems.…”

Evidence-based training of frontline health workers for door-to-door health promotion: A pilot randomized controlled cluster trial with lady health workers in Sindh Province, Pakistan

“…The results are also in line with an extensive literature on home visiting programmes and face-to-face counselling aimed to improve maternal care and parenting, in both developed [16][17][18][19] and developing countries [20][21][22][23][24], including cultural minorities in the former [25,26]. Some authors have found that most of the positive effects were concentrated in higher risk subgroups [27].…”

Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review

“…Nevertheless, the conclusion regarding reduced mortality remained stable even after we included two such trials 32,33 from developing countries (Zambia 32 and the Syrian Arab Republic 33 ). Upon assuming that all deaths in these two trials occurred in the neonatal period, the pooled RR of We depicted both random-effects and fixed-effects model estimates for completeness; however, we preferred a random-effects model because substantial heterogeneity (I 2 > 50%) was observed for neonatal mortality.…”