Postnatal care: increasing coverage, equity, and quality

Sacks, Emma; Langlois, Étienne V

doi:10.1016/s2214-109x(16)30092-4

Cited by 60 publications

(71 citation statements)

References 11 publications

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“…While maternal health and newborn health are inextricably linked and there is co‐occurring urgency to improve postnatal maternal health (Lawn et al ), studies that report on both maternal and newborn outcomes seem to place less emphasis on newborn health. Improving the quality of the formal healthcare system through HCP education may improve newborn health, women’s engagement with formal health care and lower costs throughout the maternal‐child care continuum (Sacks & Langlois ). Researchers should assess HCPs’ knowledge, use of guidelines, training and length of time engaged with caregivers providing newborn health recommendations.…”

Section: Discussionmentioning

confidence: 99%

Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

Reid

García

2019

International Nursing Review

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Aims To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations. Background In sub‐Saharan Africa, many newborn deaths occur in the community between days two to 42 of life. Introduction Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations. Methods Integrative review of studies conducted 2000–2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized. Findings Twelve qualitative, quantitative, or mixed‐methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow‐up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training. Discussion Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality. Conclusion Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality. Implications for nursing The unique role of nurses to promote newborn health appears under‐researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations. Implications for health policy As countries adopt universal health care, policies that enable formal providers to encourage maternal‐newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.

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Section: Discussionmentioning

confidence: 99%

Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

Reid

García

2019

International Nursing Review

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“…To achieve the aim of both thriving and flourishing, as well as surviving, it is important that mothers and families are supported and enabled to experience the optimal start in life with their newborn [1]. However, the postnatal period is a neglected phase of maternity care with more emphasis and resources placed on antenatal and intrapartum care [10]. According to the recent 'Countdown to 2030' report postnatal services have the lowest median national coverage of interventions on the continuum of maternal and child healthcare [11].…”

Section: Introductionmentioning

confidence: 99%

What matters to women in the postnatal period: A meta-synthesis of qualitative studies

Finlayson¹,

Crossland²,

Bonet³

et al. 2020

PLoS ONE

146

161

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Introduction The postnatal period is an underserved aspect of maternity care. Guidelines for postnatal care are not usually informed by what matters to the women who use it. This qualitative systematic review was undertaken to identify what matters to women in the postnatal period, to inform the scope of a new World Health Organization (WHO) postnatal guideline. Methods We searched MEDLINE, CINAHL, PsycINFO, POPLINE, Global Index Medicus, EMBASE, LILACS, AJOL, and reference lists of eligible studies published January 2000-July 2019, reporting qualitative data on women's beliefs, expectations, and values relating to the postnatal period. Data collection and analysis Author findings were extracted, coded and synthesised using techniques derived from thematic synthesis. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting findings was assessed using GRADE-CERQual. Results We included 36 studies from 15 countries, representing the views of more than 800 women. Confidence in most results was moderate to high. What mattered to women was a positive postnatal experience where they were able to adapt to their new self-identity and develop a sense of confidence and competence as a mother; adjust to changes in their intimate and family relationships, including their relationship to their baby; navigate ordinary physical and emotional challenges; and experience the dynamic achievement of personal growth as they adjust to the 'new normal' of motherhood and parenting in their own cultural context.

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“… 1 Yet, postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. 2 3 The Missed Opportunities in Maternal and Infant Health (MOMI) project ran from February 2011 until January 2016 in four African countries: Burkina Faso, Kenya, Malawi and Mozambique. The primary objective of the study was to improve maternal and newborn health through a focus on the postpartum period, adopting context-specific strategies to strengthen healthcare delivery and services at both facility and community level.…”

Section: Introductionmentioning

confidence: 99%

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project

Djellouli¹,

Mann²,

Nambiar³

et al. 2017

BMJ Glob Health

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Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective.

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Postnatal care: increasing coverage, equity, and quality

Cited by 60 publications

References 11 publications

Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

What matters to women in the postnatal period: A meta-synthesis of qualitative studies

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project

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