Reaching Mothers and Babies with Early Postnatal Home Visits: The Implementation Realities of Achieving High Coverage in Large-Scale Programs

Abstract

BackgroundNearly half of births in low-income countries occur without a skilled attendant, and even fewer mothers and babies have postnatal contact with providers who can deliver preventive or curative services that save lives. Community-based maternal and newborn care programs with postnatal home visits have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits.MethodsUsing data from cross-sectional surveys of women with live births (Bangladesh 398, Malawi: 900, Nepal: 615), generalized linear models were used to assess the strength of association between three factors - receipt of home visits during pregnancy, birth place, birth notification - and receipt of home visits within three days after birth. Meta-analytic techniques were used to generate pooled relative risks for each factor adjusting for other independent variables, maternal age, and education.FindingsThe proportion of mothers and newborns receiving home visits within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. Mothers and newborns were more likely to receive a postnatal home visit within three days if the mother received at least one home visit during pregnancy (OR2.18, CI1.46–3.25), the birth occurred outside a facility (OR1.48, CI1.28–1.73), and the mother reported a CHW was notified of the birth (OR2.66, CI1.40–5.08). Checking the cord was the most frequently reported action; most mothers reported at least one action for newborns.ConclusionsReaching mothers and babies with home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision. In all settings, programs must evaluate what community delivery systems can handle and how to best utilize them to improve postnatal care access.

Cuidados prestados à mulher na visita domiciliar da “Primeira Semana de Saúde Integral”

“…When compared to a multicentre study, the proportion of home visits the first week after discharge in this study was lower than the proportion found in Bangladesh (57%) and Nepal (50%), and notably higher than the proportion found in Malawi (11%) in relation to home visits three days postpartum (11) . Unlike the pact, the information system for the prenatal and birth humanisation programme ("SISPRENATAL") does not include the percentage of women who received home visits in the puerperium in its process indicators (9) .…”

Utilization of post natal care in tribal area of Madhya Pradesh, India: A community based cross-sectional study

“…[19] Sitrin Deborah et al reported that, the proportion of mothers and new-borns who received a home visit within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. [20] In the present study, 28.1% mothers didn't receive post natal check-up, and most common reason of not receiving post natal check-up was that mother was not aware about this and nobody visited in 57.6% cases. Achrya LB, Cleland J stated that the main reason for the non-use of postnatal health services is the lack of awareness, or not perceiving a need for it.…”

“…Sitrin Deborah et al reported in Malawi that, 39% women received just one home visit, 51% two to three visits, and 6% received four or more. [20] Shah H et al, in a Study of assessment of maternal health service utilization in rural area of Surat district Gujrat, reported that 50.7% PNC visits was at home -out of these, in 31.6%, only one visit was done, in 39.6% cases, two PNC visits were done, and three or more visits were made in only 6.5% of cases. [22] In this study, education of the mother and knowledge of mother about need of postnatal check-up were signifycantly related with PNC utilization.…”

Proportion and factors affecting for post-natal care utilization in developing countries: A systematic review

“…[5] Several factors such the availability, accessibility, socioeconomic status of the users, and women's autonomy in household decision-making and quality of services as well as the characteristics of the users and communities in which the users live is directly associated with utilization of PNC in developing countries. [6] Studies from rural Bangladesh found that some of these factors were positively associated with the utilization of health services. [7] The aim of this study is to characterize and to find out the proportion of postnatal care utilization in developing countries.…”