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Mokhlesi SS, Vasilevski V, Sweet L. Breastfeeding and pre-pregnancy bariatric surgery: A scoping review. Women Birth 2024; 37:101600. [PMID: 38513305 DOI: 10.1016/j.wombi.2024.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Bariatric surgery is a procedure for people with class II and III obesity who are unable to lose weight using traditional methods. The incidence rate of bariatric surgery in reproductive-age women is increasing rapidly, so the number of women who become pregnant after bariatric surgery is rising. AIM To collate and synthesise available literature regarding breastfeeding following bariatric surgery. METHODS This review was reported by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-Scr). The review included peer-reviewed research studies and research-based conference abstracts on breastfeeding outcomes in mothers who have undergone bariatric surgery before pregnancy. Health databases were searched from 1990 to December 2023. Included studies were analysed using a narrative synthesis. FINDINGS From 1506 abstracts, 16 papers were identified. Three themes emerged from the analysis: challenges in exclusive breastfeeding, nutritional composition in breast milk, and breastfeeding experience. There was a tendency for lower breastfeeding rates and shorter durations in mothers who had bariatric surgery. Most studies focussed on the nutritional composition of breast milk however these results were mixed. Only three articles were qualitative, and their findings showed that women wanted more information and support about breastfeeding following bariatric surgery. DISCUSSION Our review indicates breastfeeding challenges in post-bariatric surgery mothers and reduced breastfeeding rates. It is unclear whether bariatric surgery impacts the nutritional quality of breast milk due to inconsistent study outcomes. CONCLUSION Future research is essential, specifically on understanding the breastfeeding concerns and experiences of women who have undergone bariatric surgery.
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Affiliation(s)
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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Lojander J, Axelin A, Niela-Vilén H. 'Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study'. Eur J Obstet Gynecol Reprod Biol 2024; 296:76-82. [PMID: 38412800 DOI: 10.1016/j.ejogrb.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. STUDY DESIGN A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. RESULTS The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7-156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2-9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03-0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. CONCLUSION Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed.
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Affiliation(s)
- Jaana Lojander
- Department of Nursing Science, 20014 University of Turku, Finland.
| | - Anna Axelin
- Department of Nursing Science, 20014 University of Turku, Finland
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Ghatak S, Dutta M. Utilizing maternal healthcare services: are female-headed households faring poorly? BMC Pregnancy Childbirth 2024; 24:299. [PMID: 38649989 PMCID: PMC11034127 DOI: 10.1186/s12884-024-06445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021). METHODS The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. RESULTS 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. CONCLUSION The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. TRIAL REGISTRATION Not Applicable. JEL CLASSIFICATION D10, I12, J16.
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Affiliation(s)
- Subhasree Ghatak
- Research Scholar, Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, India.
| | - Meghna Dutta
- Assistant Professor of Economics, Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, India
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Xu W, Liu J, Meng X, Zhang Y, Xu Y, Zhou L, Zhang F, Wang H. Status and predictors of readiness for hospital discharge in women with caesarean section: A latent profile analysis. Midwifery 2024; 133:103994. [PMID: 38608543 DOI: 10.1016/j.midw.2024.103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Women undergoing caesarean section (CS) experience difficulties when preparing for discharge, and readiness for hospital discharge (RHD) may depend on individual characteristics. OBJECTIVE To explore the status of RHD in women with CS, identify the latent classes of RHD, and analyse predictors from a bio-psycho-social perspective. METHODS A sample of 410 women with CS completed the following questionnaires on demographic and obstetric characteristics: Readiness for Hospital Discharge Study-New Mother Form (RHDS-NMF), Parents' Postnatal Sense of Security (PPSS), Quality of Discharge Teaching Scale (OB-QDTS), and Postpartum Support Questionnaire (PSQ). Latent profile analysis was used to identify the latent classes of RHD. Multiple logistic regression analysis was used to analyse the predictors. RESULTS In total, 96.6 % of women with CS reported discharge ready, and the score of RHDS-NMF was 136.09 ± 25.59. Three latent classes were identified as Low RHD (16.1 %), Moderate RHD (41.7 %), and High RHD (42.2 %). Primiparas (OR = 2.867 / 1.773; P = 0.012 / 0.033), emergency CS (OR = 3.134 / 2.470; P = 0.006 / 0.002), lower levels of PPSS (OR = 0.909 / 0.942; P = 0.009 / 0.013) and OB-ODTS (OR = 0.948 / 0.975; P < 0.001) were associated with Moderate and Low RHD. Lower PSQ predicted a higher probability of Low RHD (OR = 0.955; P = 0.038). CONCLUSIONS The perception of RHD by women in the study was inaccurate, with more than half not being classified as High RHD. Healthcare professionals can anticipate interventions for maternal well-being based on the characteristics of the different RHD classes.
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Affiliation(s)
- Wenli Xu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Jia Liu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Xinhai Meng
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Yuxin Zhang
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Yaxuan Xu
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China
| | - Lihua Zhou
- School of Nursing, Anhui Medical University, No.81 Meishan Road, Shushan District, Hefei City 230032 Anhui Province, PR China.
| | - Fengying Zhang
- The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City 230022 Anhui Province, PR China
| | - Hui Wang
- The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City 230022 Anhui Province, PR China
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Deliktas Demirci A, Oruc M, Kabukcuoglu K. "I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing. Midwifery 2024; 131:103955. [PMID: 38368848 DOI: 10.1016/j.midw.2024.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice. AIM To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented. METHOD A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews. RESULTS Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period. CONCLUSION The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.
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Affiliation(s)
- Ayse Deliktas Demirci
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Dumlupınar Bulvarı, Antalya 07058, Turkey.
| | - Mine Oruc
- Antalya Science University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey
| | - Kamile Kabukcuoglu
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Dumlupınar Bulvarı, Antalya 07058, Turkey
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Bruijns BA, Bourke M, Loh A, Tucker P. Movement behaviour education for parents in prenatal, postnatal, and pediatric care in Canada: A needs assessment. BMC Pediatr 2024; 24:164. [PMID: 38459485 PMCID: PMC10921676 DOI: 10.1186/s12887-024-04630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Parents/guardians can greatly influence their child's movement behaviours (i.e., physical activity, sedentary behaviour, and sleep). Yet, they have reported to lack sufficient background knowledge to foster healthy movement habits, and little is known about specific educational gaps. The aim of this study was to explore the educational background and needs regarding promoting healthy movement behaviours in early childhood among parents/guardians living in Canada. METHODS A cross-sectional study was conducted with parents/guardians living in Canada who had at least one child under the age of 5 years. Participants completed an online survey capturing their demographics, information they received about movement behaviours in early childhood during their prenatal/postnatal care or child's pediatrician appointments, where they sourced information about these topics, content areas they would like more information on, and preferred format for delivery. Descriptive statistics and frequencies were calculated for all outcome variables and logistic regression was used to explore if sociodemographic variables were associated with receiving movement behaviour-related education across care types. RESULTS Among the 576 parents/guardians who completed the survey, many reported no mention of any movement behaviour in their prenatal (49.4%), postnatal (29.6%), and pediatric care (37.2%). Physical activity was the most cited movement behaviour across care types, with 42.4%, 57.9%, and 54.8% of participants indicating this was discussed in their prenatal, postnatal, and pediatric care, respectively. Only 41.7% of parents/guardians reported asking their child's pediatrician about movement behaviours, while most relied on social media (70.9%), internet websites/news articles (68.7%), and family/friends (67.6%). The most sought-after movement behaviour topics included incorporating movement into traditionally sedentary activities (68.8%) and activity ideas to break up sitting time (65.0%), and participants expressed preference to receive more information via social media (63.2%), an online resource package (47.8%), or email (46.6%). CONCLUSIONS Given the noted inconsistencies in education relating to movement behaviours in maternal and pediatric care, this study highlights the opportunity for greater integration of this type of education across care types. Ensuring all parents/guardians receive evidence-based and consistent guidance on their child's movement behaviours will help ensure young children receive the best start to a healthy active life.
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Affiliation(s)
- Brianne A Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Aidan Loh
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
- Children's Health Research Institute, London, ON, Canada.
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Talbot H, Peters S, Furber C, Smith DM. Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis. Women Birth 2024; 37:303-316. [PMID: 38195300 DOI: 10.1016/j.wombi.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PROBLEM Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes. BACKGROUND Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes. AIM To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care. METHODS A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage. FINDINGS Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice. CONCLUSION Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.
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Affiliation(s)
- Hannah Talbot
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Christine Furber
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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Blair A, Tan A, Homer CSE, Vogel JP. How do postnatal care guidelines in Australia compare to international standards? A scoping review and comparative analysis. BMC Pregnancy Childbirth 2024; 24:121. [PMID: 38336632 PMCID: PMC10854083 DOI: 10.1186/s12884-024-06295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is no single national guideline in Australia on the provision of postnatal care, which means there is potential for significant variation in the standard and quality of care. This review aimed to systematically identify, synthesise, and assess the quality of postnatal care guidelines produced for use in Australia. A second aim was to compare postnatal care recommendations in Australian guidelines to the National Institute for Health and Care Excellence's (NICE) and the World Health Organization's (WHO) postnatal care recommendations, to identify gaps and areas of disagreement. We focussed on recommendations regarding postnatal assessment of the woman or newborn, infant feeding, discharge planning, or community-based care. METHODS A scoping review was undertaken informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. A database search and a manual search of state and national government health departments, professional associations and research institute websites was performed to identify relevant guidelines and recommendations. Guideline quality was assessed using the AGREE II tool. Guideline recommendations from Australia were mapped to 67 NICE/WHO recommendations. Recommendations that partially agreed, were modified, or in disagreement underwent further analysis. RESULTS A total of 31 Australian postnatal guidelines were identified and overall, these were of moderate- to high-quality. Of the 67 NICE/WHO recommendations, most agreed with the recommendations contained in Australian guidelines. There were five NICE/WHO recommendations with which corresponding Australian recommendations disagreed. There were 12 NICE/WHO recommendations that were commonly modified within Australia's guidelines. There were three NICE/WHO recommendations that did not appear in any Australian guideline. CONCLUSIONS Recommendations from postnatal guidelines in Australia have a high level of agreement with corresponding NICE/WHO recommendations. The few disagreements and modifications found in guideline recommendations - both across Australia's guidelines and between Australia's and the NICE/WHO guidelines - are worrying and warrant further examination, as they may result in different standards of care across Australia. Identified gaps in guidance should be prioritised for inclusion in new or updated guidelines where appropriate.
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Affiliation(s)
- Amanda Blair
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Annie Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Muwema M, Nankabirwa JI, Edwards G, Nalwadda G, Nangendo J, Okiring J, Obeng-Amoako GO, Mwanja W, Ekong EN, Kalyango JN, Kaye DK. Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda. BMC Pregnancy Childbirth 2024; 24:113. [PMID: 38321398 PMCID: PMC10845583 DOI: 10.1186/s12884-024-06305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. METHODS A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. RESULTS The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. CONCLUSION Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.
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Affiliation(s)
- Mercy Muwema
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Gorrette Nalwadda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gloria Odei Obeng-Amoako
- Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | | | - Elizabeth N Ekong
- Department of Nursing and Midwifery, Faculty of Public Health, Nursing and Midwifery, Uganda Christian University, Mukono, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders' perspectives and strategies. Women Birth 2024; 37:240-247. [PMID: 37903683 DOI: 10.1016/j.wombi.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
PROBLEM COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BACKGROUND Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AIM To explore community postnatal care provision during and since the pandemic across a large diverse UK region. METHODS A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. FINDINGS 11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DISCUSSION Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. CONCLUSION Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.
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Affiliation(s)
- Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Warwick Medical School, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Lai MM, August D, Sharfuddin Z, Palmer-Field K, Johnston L, Main E, Smith P, Kilgour CM, Kearney L. Outcomes and perspectives of woman-newborn dyads following discharge from a quaternary maternity service in Australia: A cross-sectional survey. Women Birth 2024; 37:248-256. [PMID: 37949741 DOI: 10.1016/j.wombi.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The average postnatal stay for most Australian mothers is two days. Postnatal length of stay is dependent on various factors, such as maternal preferences, mode of birth or complications following birth. However, little is known about the relationship between these elements. AIM To prospectively explore maternal and neonatal postnatal outcomes within the context of length of stay, model of care and personal expectations and experiences within the first 3-5 weeks following birth. METHODS A cross-sectional study within an urban quaternary Australian hospital was conducted between January 2021 to April 2021. A mixed methods convergent approach was taken. FINDINGS Of the 1066 questionnaires distributed, 216(20.2%) responses were usable for analysis. Most mothers (82%) were satisfied with their postnatal stay length (range 6-78 h). Models of care (such as GP shared care, midwifery group practice) were not associated with mothers' satisfaction with their postnatal stay length. Mothers following cesarean section felt less supported, had lower breastfeeding rates and more difficulty accessing postnatal services. Neonatal readmissions (n = 11, 5%) in the first week of life were most often for jaundice, poor feeding or both (n = 7, 64%). Three key themes were generated from the qualitative data and categorised into themes labeled 'Environmental and healthcare delivery constraints', 'Ready or not for discharge' and 'Home now, but support missing'. CONCLUSION Participants identified that improvements in postnatal care require more than extending in-hospital length of stay. Rather a more individualised woman-centred focus, in-home supported options, with flexibility in timing needed, especially for those following a complicated birth.
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Affiliation(s)
- Melissa M Lai
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Medicine, University of Queensland Centre for Clinical Research, Herston, Brisbane, Queensland, Australia.
| | - Deanne August
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Zoya Sharfuddin
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Kristina Palmer-Field
- Lactation Services, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Louise Johnston
- Postnatal Maternity Ward, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Elizabeth Main
- Postnatal Maternity Ward, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Patricia Smith
- Nursing and Midwifery Strategic Service Improvement, Metro North Health, Herston, Brisbane, Queensland, Australia
| | - Catherine M Kilgour
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Kusuma YS, Kumari A, Rajbangshi P, Ashraf Ganie M, Sarala R, Kumar D, Kalaiselvi S, Kanungo S, Jain N, Singh R, Kumar S, Dutt Gupta S, Babu BV. Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts. Eur J Obstet Gynecol Reprod Biol 2024; 292:163-174. [PMID: 38016417 DOI: 10.1016/j.ejogrb.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/22/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. METHODS Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). RESULTS Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. CONCLUSION PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health.
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Affiliation(s)
- Yadlapalli S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali Kumari
- Socio-Behavioural, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India
| | | | | | - Raju Sarala
- Indian Institute for Health Management Research, Bangalore, India
| | - Dinesh Kumar
- Indian Council of Medical Research-National Institute of Research in Tribal Health, Jabalpur, India
| | - Selvaraj Kalaiselvi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Srikanta Kanungo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Nutan Jain
- Indian Institute for Health Management Research University, Jaipur 302029, India
| | - Rajesh Singh
- Garhwal Community Development & Welfare Society, Chamba, Tehri-Garhwal, India
| | - Satish Kumar
- International Institute for Health Management Research, New Delhi, India
| | - Shiv Dutt Gupta
- Indian Institute for Health Management Research University, Jaipur 302029, India
| | - Bontha V Babu
- Socio-Behavioural, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India.
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Tierney KI, Pearce N, Miller E, Steiner A, Tighe K, Presberry J, Kothari C. Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women. Matern Child Health J 2024; 28:93-103. [PMID: 37902919 DOI: 10.1007/s10995-023-03800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design. METHODS Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures. RESULTS In Kalamazoo county, 82.0% of women attended their postpartum visit. White women and women with higher SES were 2.84 (SE = 1.35, p < .001) and 5.73 (SE = 3.10, p < .001) times more likely to attend postpartum visits than women of color and those with lower SES. Qualitative analyses identified four common barriers: (1) misaligned goals for appointments, (2) time and scheduling of appointments, (3) prioritization of children, and (4) material resources and health insurance coverage. The quantitative analyses found mixed support for these barriers and found limited evidence that these barriers mediated the relationship between race or SES and postpartum attendance. CONCLUSIONS FOR PRACTICE The qualitative findings identify barriers that are amenable to practice-level interventions including changes to scheduling procedures and employing patient-centered care. The quantitative findings further suggest that although inequalities in postpartum care are present, interventions on these barriers may benefit women regardless of race and SES.
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Affiliation(s)
- Katherine I Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, 49008-5257, Kalamazoo, MI, USA.
| | - Nicole Pearce
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Emily Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Agnieszka Steiner
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Kathryn Tighe
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Joi Presberry
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Catherine Kothari
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
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Sun L, Wang X, Gao H, Li Z, Chen M, Qian X, Gu C. Development and psychometric testing of a Chinese version of the postnatal care experience scale for postpartum women. BMC Pregnancy Childbirth 2023; 23:868. [PMID: 38104121 PMCID: PMC10724998 DOI: 10.1186/s12884-023-06187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/10/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Postnatal period is a critical transitional phase in the lives of mothers and newborn babies. In recent years the importance on promoting a positive experience of care following childbirth is increasingly emphasized. Yet published evidence of the methodological and psychometric quality of instruments to evaluate women's experience of comprehensive postnatal care is still lacking. OBJECTIVE This study aimed to develop and validate a unique scale (the Chinese version of the Postnatal Care Experience Scale, PCES) to measure women's overall experience of care during postnatal periods. METHODS The PCES instrument was developed and validated over three phases, including item development, scale development, and scale evaluation. The item pool of the PCES was generated through existing literature and in-depth semi-structured interviews, followed by assessment of content validity and rating of importance and feasibility of items through two-round Delphi surveys. Psychometric properties were examined in a convenience sample of 736 postpartum women. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess the construct validity of the developed PCES. The relationship between the total PCES score and the global item construct was estimated using Pearson product-moment coefficient. Reliability was assessed using Cronbach's alpha and Spearman Brown coefficients. RESULTS The content validity index of the Chinese version PCES was 0.867. Following item reduction analysis, this instrument consisted of 30 five-point Likert items. The Kaiser-Meyer-Olkin statistic was 0.964 and the chi-square value of the Bartlett spherical test was 11665.399 (P < .001). The scale explained 75.797% of the total variance and consisted of three subscales, including self-management, social support, and facility- and community-based care. The Pearson correlation coefficient between the total PCES score and the global item construct was 0.909. The CFA showed that the 3-factor model had suitable fitness for the data. Cronbach's alpha value and Spearman-Brown Split-half reliability for the total scale were 0.979 and 0.941, respectively. CONCLUSIONS The newly developed 30-item PCES is a psychometrically reliable and valid instrument that assesses women's overall experience of postnatal care. Future research should aim to use the PCES in various populations to obtain further evidence for its validity and reliability.
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Affiliation(s)
- Liping Sun
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hua Gao
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhaorun Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Meiyi Chen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.
- Global Health Institute, Fudan University, Shanghai, China.
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Díaz-Canales A, Noel-Meza JP, Caira-Chuquineyra B, Fernandez-Guzman D, Salazar-Talla L, Urrunaga-Pastor D, Bendezu-Quispe G. Sociodemographic factors associated with immediate puerperal control: A cross-sectional study based on the Peruvian demographic and health survey, 2019. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100253. [PMID: 37942026 PMCID: PMC10628648 DOI: 10.1016/j.eurox.2023.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Peru is the fifth country in Latin America with the highest maternal mortality. In Peru, immediate puerperal control (IPC) was established in 2013 as a measure to improve postnatal control, with a view in reducing maternal mortality. This study aimed to evaluate the frequency and sociodemographic factors associated with compliance with IPC in Peru, 2019. Methods We conducted an analytical cross-sectional study based on the Demographic and Family Health Survey (ENDES, for its acronym in Spanish) of Peru, 2019. The dependent variable was compliance with IPC (control in the first 2 h) in women aged 15-49 years who had delivered within the last five years preceding the survey. To evaluate the associated factors, Poisson family generalized linear models were used to calculate crude (cPR) and adjusted (aPR) prevalence ratios, with their respective 95% confidence intervals (95%CI). Results Data from 11,854 women were analyzed. The frequency of IPC was 59.6% (95%CI: 58.3-60.9). We found a lower proportion of IPC in urban areas (58.8%) and in the highlands (57%) and jungle (57.2%) of Peru. Residing in rural areas (aPR:1.13; 95%CI:1.08-1.19), having undergone appropriate antenatal care (ANC) (aPR:1.05; 95%CI:1.01-1.10) and having delivered a low-birth-weight newborn (aPR:1.20; 95%CI:1.12-1.29) were associated with a higher frequency of IPC, while living in the highlands (aPR:0.86; 95%CI:0.80-0.92) or jungle (aPR:0.86; 95%CI:0.80-0.92) was associated with a lower frequency of IPC. Conclusions Approximately four out of ten women did not have IPC. There was a lower proportion of IPC in urban areas and in the highland and jungle regions.
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Affiliation(s)
| | | | | | | | - Leslie Salazar-Talla
- Grupo Estudiantil de Investigación en Salud Mental (GISAM), Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Lima, Peru
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Kumar J, Saini SS, Kumar P. Care During Labour, Childbirth, and Immediate Newborn Care in India: A Review. Indian J Pediatr 2023; 90:20-28. [PMID: 37380919 DOI: 10.1007/s12098-023-04721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023]
Abstract
India is committed to achieve a single-digit neonatal mortality rate (NMR) and stillbirth rate (SBR) by 2030 through India Newborn Action Plan (INAP) 2014. However, the current rate of decline is not enough to achieve the target neonatal mortality rate. Course correction and renewed efforts are required. This review outlines the current scenario and proposed scale-up of services included during labour, childbirth, and the immediate newborn period. The article summarises the challenges and bottlenecks in achieving a reduction in neonatal mortality rate and INAP targets. India has achieved over 80% coverage of three of the four ENAP coverage targets, but antenatal care coverage is still poor. There are concerns about the quality and completeness of antenatal care visits and other program interventions. The ongoing quality assurance should be strengthened through continuous supportive supervision by involving the medical colleges in a hub and spoke model and other key stakeholders. There is a need for effective and strategic engagement of the private sector in these initiatives. The states need to systematically assess the gaps as per population requirements and find effective solutions to overcome them quickly. The state and district-wise data maps show immense variations in coverage between states and within states, mirroring the variations in NMR. This indicates the need to ensure contextual micro-plans and provides an opportunity for the districts and states to learn from each other. The recent initiatives to strengthen primary healthcare should be used as a platform for all stillbirth and neonatal mortality prevention interventions in India.
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Affiliation(s)
- Jogender Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Rahman MH, Akter E, Ameen S, Jabeen S, Ahmed A, Rahman AE, Hossain AT. Disparities in the maternal healthcare continuum among Bangladeshi women: evidence from nationally representative surveys. Midwifery 2023; 127:103814. [PMID: 37806164 DOI: 10.1016/j.midw.2023.103814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Utilisation of maternal healthcare is low, and it consistently decreases across antenatal to postnatal period in Bangladesh. However, there is paucity of knowledge in Bangladesh to understand gaps and associated factors in seeking continuum of maternal healthcare along the pathway. Therefore, we aimed to assess the trend in socioeconomic and demographic factors and wealth inequity in maternal CoC using the Bangladesh Multiple Indicator Cluster Survey (MICS). METHODS We performed a secondary analysis on nationally representative data from the last two MICS survey, carried out in 2012-13 and 2019. The study included women of reproductive age (15-49 years) with a live birth within two years preceding the survey. Total of 7,950 and 9,183 respondents were identified from these two surveys, respectively. We used multivariable logistic regression and concentration index to examine the covariates and inequity, respectively, in the utilisation of CoC. RESULTS Utilisation of ≥4 antenatal care, skilled delivery, and postnatal care for both mother and newborn increased from 13 percent in 2012-13 to 25 percent in 2019 survey. Moreover, wealth inequity persists favouring the rich in utilisation of CoC in Bangladesh. Women belonging to wealthier quintile, urban areas, and non-Muslim families, with higher education, a household head with higher education, media use, and fewer children were most likely to avail complete CoC in both the surveys. CONCLUSION Overall utilisation of maternal CoC increased between 2012 and 13 and 2019, however, women in Bangladesh still lack the CoC with persistent wealth inequality. Integrated provision of ANC, delivery by SBA, and PNC should be introduced, comprising both private and public health facilities, and targeting women in poor and rural communities. Efforts should also focus on women's education, autonomy, fertility rate, and exposure to media.
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Affiliation(s)
- Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
| | - Ema Akter
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Sabrina Jabeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
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Li Y, Li H, Jiang Y. Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen's behaviour model. BMC Womens Health 2023; 23:544. [PMID: 37865780 PMCID: PMC10590515 DOI: 10.1186/s12905-023-02709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Papua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG. METHODS The study was conducted using the 2016-2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05. RESULTS The prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women's employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors. CONCLUSIONS This study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women's education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.
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Affiliation(s)
- Yan Li
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hao Li
- Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China.
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Ahissou NCA, Nonaka D, Takeuchi R, de Los Reyes C, Uehara M, Khampheng P, Kounnavong S, Kobayashi J. Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People's Democratic Republic from 2006 to 2017: MICS data analysis. Trop Med Health 2023; 51:56. [PMID: 37858190 PMCID: PMC10585846 DOI: 10.1186/s41182-023-00548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Maternal mortalities remain high in the Lao People's Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011-12 and 2011-12 to 2017. METHODS We used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011-12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women's age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. RESULTS The coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011-12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values. CONCLUSION There was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011-12 while between 2011-12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011-12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.
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Affiliation(s)
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Calvin de Los Reyes
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
- College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
| | - Manami Uehara
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Phongluxa Khampheng
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
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Öjendal A, Holter H, Elden H, Salim S, Bogren M. Factors affecting the provision of high-quality postnatal care services in Zanzibar: a qualitative study. BMC Pregnancy Childbirth 2023; 23:714. [PMID: 37803316 PMCID: PMC10559537 DOI: 10.1186/s12884-023-06035-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND In Sub-Saharan Africa, the postnatal period is associated with high mortality and accounts for a substantial proportion of maternal deaths. Although postnatal care has been identified as critical in reducing maternal mortality, the quality of care provided is often inadequate. Tanzania and Zanzibar have not made sufficient progress towards achieving the Sustainable Development Goals on maternal health, and there is limited knowledge about the utilization and quality of postnatal follow-up. The aim of this study was therefore to explore factors affecting the provision of high-quality postnatal care services in the urban area of Zanzibar. METHODS Five focus group discussions were performed in Swahili with 25 healthcare providers from primary healthcare units in urban Zanzibar. Interviews were audio-recorded, transcribed verbatim, translated into English, and analysed using qualitative content analysis with an inductive approach. RESULTS Factors affecting provision of high-quality postpartum care services could be divided into three generic categories. Difficulty achieving high attendance comprised three subcategories: long waiting times, low awareness among women, and out-of-pocket payment. Lack of basic resources also comprised three subcategories: shortage of healthcare providers, lack of adequate space, and inadequate medical equipment. Insufficient care routines comprised two subcategories: lack of guidelines and deficient chain of information. CONCLUSIONS The present findings suggest that the women's perceptions of postnatal care do not align with the intended purpose of routine postnatal care. Instead, the postnatal period primarily leads to visits to health facilities only when urgent care is required, and there is a lack of awareness about the importance of postnatal care. Moreover, limited resources, including equipment, staff, and space, as well as long waiting times, hinder the delivery of high-quality care and contribute to a negative reputation of postnatal care services. To effectively reach all women and improve postnatal care, it is necessary to increase basic resources, modify health education approaches, and enhance the flow of information between different levels of care using context-specific strategies.
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Affiliation(s)
- Anna Öjendal
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Herborg Holter
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Asefa A, Gebremedhin S, Marthias T, Nababan H, Christou A, Semaan A, Banke-Thomas A, Tabana H, Al-beity FMA, Dossou JP, Gutema K, Delvaux T, Birabwa C, Dennis M, Grovogui FM, McPake B, Beňová L. Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries. Int J Equity Health 2023; 22:203. [PMID: 37784140 PMCID: PMC10544383 DOI: 10.1186/s12939-023-02015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. METHODS We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. RESULTS The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. CONCLUSIONS Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.
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Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tiara Marthias
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Herfina Nababan
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany
| | - Aliki Christou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrcis/Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine Et en Démographie, Cotonou, Bénin
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Fassou Mathias Grovogui
- Centre National de Formation Et de Recherche en Santé Rurale (CNFRSR), Maferinyah, Forécariah Guinea
| | - Barbara McPake
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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22
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Mzembe T, Chikwapulo V, Kamninga TM, Vellemu R, Mohamed S, Nthakomwa L, Chifungo C, Wazny K, Musau K, Abdullahi L, Peterson M, Madise N, Chipeta MG. Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews. BMC Public Health 2023; 23:1734. [PMID: 37674154 PMCID: PMC10481488 DOI: 10.1186/s12889-023-16558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Maternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but their uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality in LMICs. METHODS We searched Medline PubMed and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review. RESULTS We retrieved 4,022 articles. After removing duplicates and screening, we included 14 systematic reviews. Male-partner interventions were effective in increasing skilled birth attendance (SBA) postnatal visits and maternal antiretroviral (ART) uptake for HIV-positive pregnant women. However, there was no evidence of their effectiveness on increased early ANC initiation or adequate ANC visits. Mobile health interventions were effective in increasing adequate ANC visits, SBA, facility-based service utilisation, early ANC initiation, and adherence to nutritional supplements. Incentive-based interventions, particularly financial incentives, were effective in increasing the number of ANC visits but not postnatal visits. Facility-based interventions were effective in increasing postnatal visits, maternal ART initiation and uptake, immunisation uptake and follow-up ANC visits. None of the reviews assessed their impact on SBA or adequate ANC visits. Community-based interventions were effective in increasing SBA, ANC service utilisation, ART initiation and uptake, and nutritional supplements and immunisation uptake. CONCLUSION Our findings show that the different interventions effectively improved different outcomes on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further.
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Affiliation(s)
- Themba Mzembe
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi.
| | | | | | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Sahra Mohamed
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | | | | | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Leila Abdullahi
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
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23
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Lin K, Chern S, Sun J. Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries. World J Pediatr 2023; 19:835-850. [PMID: 36705781 DOI: 10.1007/s12519-022-00668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/30/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Closing the gap between child mortality in low- and middle-income countries (LMICs) and high-income countries is a priority set by the WHO in sustainable development goals (SDGs). We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs. METHODS The Demographic and Health Survey (DHS) was used to examine data from 26 countries to compare prenatal, postnatal, nutritional, and demographic factors across LMICs. Outcome of child death was classified into death before one month of age, between 1 to 11 months, between one to two years, between three to five years, and overall death before five years. Chi-square analyses identified differences in prenatal care, postnatal care, nutrition, and demographic factors between children who died and those who survived. Logistic regression identified factors that increased child mortality risk. RESULTS The majority of deaths occurred before the ages of one month and one year. Considerably poorer quality of prenatal care, postnatal care, and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s. High child mortality and poor quality of prenatal and postnatal care coincide with low income. Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries. The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk. Significant socio-demographic risk factors were associated with an increased mortality rate in children, including lack of education, maternal marital status, family wealth index, living rurally, and financial problems hindering access to healthcare. CONCLUSIONS Poor nutrition remains a vital factor across all LMICs, with numerous children being exposed to foods low in iron and vitamin A. Significantly, most deaths occur in neonates and infants, indicating an urgent need to address risk factors associated with early child death.
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Affiliation(s)
- Kelly Lin
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia
| | - Serena Chern
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Parkland Drive, Gold Coast, QLD, 4215, Australia.
- Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, 4222, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Lira Huq N, Ahmed A, Tahrin Islam T, Rahman F, Hanson M, Sayeed A, Nusrat N, Mazumder T, Golam Rasul K, Rahman Turza M, Abul Hasnath Siddique R, Hossain Sheikh A, Moshfiqur Rahman S, El Arifeen S. Community-based integrated intervention for skilled maternal health care utilization in riverine remote areas, Bangladesh. Sex Reprod Healthc 2023; 37:100892. [PMID: 37542931 DOI: 10.1016/j.srhc.2023.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Despite the decrease in maternal mortality ratio, many women in Bangladesh are still at high-risk of death due to pregnancy-related morbidities. Increasing the rate of skilled maternal healthcare service utilization is effective to reduce maternal mortality rate. This paper examines the intervention effect of an integrated community-based maternal healthcare project implemented by a non-government organization, Friendship, aiming to provide maternal health services to women living in the remote riverine regions of Bangladesh. METHODS We examined the skilled maternal healthcare service utilization before and after project implementation of the mothers with birth experience of 0-6 months from the intervention (N = 1,304) and comparison areas (N = 1,304). A difference-in-differences logistic model measured the effect of the intervention. RESULTS After the intervention, mothers were three times more likely to receive ≥ 4 ANC visits from skilled providers (AOR: 2.9; 95 % CI: 2.1-4.2), 1.5 times more likely to have skilled birth attendants during deliveries (AOR: 1.5; 95 % CI: 1.1-2.1) and 1.5 times more likely to seek at least one PNC within 42 days after delivery (AOR: 1.5; 95 % CI: 1.1-2.2) as compared to the comparison group. CONCLUSION The intervention showed positive effect on improving the ANC coverage, skilled delivery, and PNC among the mothers residing the remote riverine areas. Therefore, it opens up the opportunity for adaptation of such integrated community and facility-based interventions by other LMICs.
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Affiliation(s)
- Nafisa Lira Huq
- BRAC James P Grant School of Public Health, Dhaka 1213, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden.
| | - Tanjeena Tahrin Islam
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Fariya Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Molly Hanson
- Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Abu Sayeed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Nowrin Nusrat
- North Carolina State University, Raleigh, NC 27695, United States
| | - Tapas Mazumder
- Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia
| | - Kazi Golam Rasul
- Friendship, Ka-14/2A, Baridhara North Road, (Kalachandpur), Dhaka 1212, Bangladesh
| | | | | | - Abul Hossain Sheikh
- Friendship, Ka-14/2A, Baridhara North Road, (Kalachandpur), Dhaka 1212, Bangladesh
| | - Syed Moshfiqur Rahman
- Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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Martens N, Hindori-Mohangoo AD, Hindori MP, Damme AV, Beeckman K, Reis R, Crone MR, van der Kleij RR. Anticipated benefits and challenges of implementing group care in Suriname's maternity and child care sector: a contextual analysis. BMC Pregnancy Childbirth 2023; 23:592. [PMID: 37596532 PMCID: PMC10436662 DOI: 10.1186/s12884-023-05904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Suriname is a uppermiddle-income country with a relatively high prevalence of preventable pregnancy complications. Access to and usage of high-quality maternity care services are lacking. The implementation of group care (GC) may yield maternal and child health improvements. However, before introducing a complex intervention it is pivotal to develop an understanding of the local context to inform the implementation process. METHODS A context analysis was conducted to identify local needs toward maternity and postnatal care services, and to assess contextual factor relevant to implementability of GC. During a Rapid Qualitative Inquiry, 63 online and face-to-face semi-structured interviews were held with parents, community members, on-and off-site healthcare professionals, policy makers, and one focus group with parents was conducted. Audio recordings were transcribed in verbatim and analysed using thematic analysis and Framework Method. The Consolidated Framework for Implementation Research served as a base for the coding tree, which was complemented with inductively derived codes. RESULTS Ten themes related to implementability, one theme related to sustainability, and seven themes related to reaching and participation of the target population in GC were identified. Factors related to health care professionals (e.g., workload, compatibility, ownership, role clarity), to GC, to recipients and to planning impact the implementability of GC, while sustainability is in particular hampered by sparse financial and human resources. Reach affects both implementability and sustainability. Yet, outer setting and attitudinal barriers of health professionals will likely affect reach. CONCLUSIONS Multi-layered contextual factors impact not only implementability and sustainability of GC, but also reach of parents. We advise future researchers and implementors of GC to investigate not only determinants for implementability and sustainability, but also those factors that may hamper, or facilitate up-take. Practical, attitudinal and cultural barriers to GC participation need to be examined. Themes identified in this study will inspire the development of adaptations and implementation strategies at a later stage.
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Affiliation(s)
- Nele Martens
- Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Manodj P Hindori
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Astrid Van Damme
- Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
| | - Katrien Beeckman
- Department of Public Health, Vrije Universiteit Brussel (VUB), Jette, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
- Centre for Research and Innovation in Care, Universiteit Antwerpen, Antwerp, Belgium
| | - Ria Reis
- Leiden University Medical Centre, Leiden, Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
- University of Cape Town, Cape Town, South Africa
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26
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Fouogue JT, Semaan A, Smekens T, Day LT, Filippi V, Mitsuaki M, Fouelifack FY, Kenfack B, Fouedjio JH, Delvaux T, Beňová L. Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey. BMC Pregnancy Childbirth 2023; 23:575. [PMID: 37563737 PMCID: PMC10413693 DOI: 10.1186/s12884-023-05847-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND A minimum length of stay following facility birth is a prerequisite for women and newborns to receive the recommended monitoring and package of postnatal care. The first postnatal care guidelines in Cameroon were issued in 1998 but adherence to minimum length of stay has not been assessed thus far. The objective of this study was to estimate the average length of stay and identify determinants of early discharge after facility birth. METHODS We analyzed the Cameroon 2018 Demographic and Health Survey. We included 4,567 women who had a live birth in a heath facility between 2013 and 2018. We calculated their median length of stay in hours by mode of birth and the proportion discharged early (length of stay < 24 h after vaginal birth or < 5 days after caesarean section). We assessed the association between sociodemographic, context-related, facility-related, obstetric and need-related factors and early discharge using bivariate and multivariable logistic regression. RESULTS The median length of stay (inter quartile range) was 36 (9-84) hours after vaginal birth (n = 4,290) and 252 (132-300) hours after caesarean section (n = 277). We found that 28.8% of all women who gave birth in health facilities were discharged too early (29.7% of women with vaginal birth and 15.1% after a caesarean section). Factors which significantly predicted early discharge in multivariable regression were: maternal age < 20 years (compared to 20-29 years, aOR: 1.44; 95%CI 1.13-1.82), unemployment (aOR: 0.78; 95%CI: 0.63-0.96), non-Christian religions (aOR: 1.65; 95CI: 1.21-2.24), and region of residence-Northern zone aOR:9.95 (95%CI:6.53-15.17) and Forest zone aOR:2.51 (95%CI:1.79-3.53) compared to the country's capital cities (Douala or Yaounde). None of the obstetric characteristics was associated with early discharge. CONCLUSIONS More than 1 in 4 women who gave birth in facilities in Cameroon were discharged too early; this mostly affected women following vaginal birth. The reasons leading to lack of adherence to postnatal care guidelines should be better understood and addressed to reduce preventable complications and provide better support to women and newborns during this critical period.
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Affiliation(s)
- Jovanny Tsuala Fouogue
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Louise-Tina Day
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Matsui Mitsuaki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Bruno Kenfack
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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27
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Abrams M, Sheyn D, Kelley E, Hijaz A, Pope R. Correlates of health-seeking behavior for sexual dysfunction after childbirth: a cross-sectional study. Int Urogynecol J 2023; 34:1867-1876. [PMID: 36780020 DOI: 10.1007/s00192-023-05476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/12/2023] [Indexed: 02/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Persistent sexual dysfunction (SD) after childbirth is common, but many patients do not receive adequate care, for unknown reasons. The aim of this study is to examine correlates for health care-seeking behavior for SD within 3 years after birth. METHODS Subjects filled out an electronic survey regarding sexual function, obstetric, relationship, and demographic characteristics. The Sexual Function Questionnaire's Medical Impact Scale) as well as a number of novel, targeted survey questions were used to measure the impact of childbirth on sexual function. Patients were stratified into those without SD, and those with SD, both seeking and not seeking care. These domains were then compared in a series of univariate, bivariate, and multivariate analyses. RESULTS Of 531 patients who completed the survey, 449 women (84.5%) reported some form of SD after birth. Only 16.0% of those with SD sought care for SD. Variables associated with care seeking include difficulty with perineal healing (adjusted odds ratio [aOR]=4.53, 95% confidence interval [CI]: 1.54-13.38), transfusion after birth (aOR=3.71, 95% CI: 1.44-9.56), current dyspareunia (aOR=3.41, 95% CI: 1.31-8.87). Factors associated with decreased probability of seeking care include children under 18 years in the home (aOR=0.61 per child, 95% CI: 0.43-0.88), number of cesarean births (aOR=0.46 per delivery, 95% CI: 0.29-0.74). CONCLUSIONS This study highlights that many more women suffer from SD after childbirth than seek care, and identified several important risk factors associated with decreased care seeking. Future work should focus on decreasing the difficulty of accessing care for SD after childbirth.
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Affiliation(s)
- Megan Abrams
- Urology Institute, Case Western Reserve University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44102, USA.
| | - David Sheyn
- Urology Institute, Case Western Reserve University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44102, USA
| | - Erika Kelley
- Department of Reproductive Biology, Case Western Reserve University Hospitals, Cleveland, OH, USA
| | - Adonis Hijaz
- Urology Institute, Case Western Reserve University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44102, USA
| | - Rachel Pope
- Urology Institute, Case Western Reserve University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44102, USA
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28
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Zhao S, Zhang Y, Xiao AY, He Q, Tang K. Key factors associated with quality of postnatal care: a pooled analysis of 23 countries. EClinicalMedicine 2023; 62:102090. [PMID: 37533417 PMCID: PMC10393561 DOI: 10.1016/j.eclinm.2023.102090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 08/04/2023] Open
Abstract
Background Progress in reducing maternal and neonatal mortality, particularly in low-income and middle-income countries (LMICs) and regions, is insufficient to achieve the Sustainable Developmental Goals by 2030. High-quality postnatal care (PNC) for mothers and neonates is crucial for mothers and babies, yet it remains the most neglected intervention on the continuum of maternal and child care. We aimed to estimate the associations between observable factors and high-quality maternal and neonatal PNC in pooled and country-specific analyses. Methods In this cross-sectional study, we used the most recent (2015-2022) Demographic and Health Surveys from 23 countries across Africa (n = 14), Southeast Asia (n = 3), Eastern Mediterranean (n = 2), Europe (n = 2), Americas (n = 1), and Western Pacific (n = 1). Women who, within the last 5 years, were aged 15-49 years at their last live birth that had delivered a singleton child were included. We identified eleven PNC behaviours recommended by the World Health Organization (WHO) to measure PNC quality, and applied thresholds to create binary outcomes for quality maternal and neonatal PNC. 15 factors were included in our analysis to assess their association with high-quality PNC for mothers and neonates in a series of single-adjusted and mutually adjusted logistic regression models, both in pooled and country-specific analysis. We also conducted two sets of subgroup analyses for place of residence and maternal age at last birth, and two sets of supplementary analyses to test the robustness of the results. Findings Among 172,526 women and their most recent child, 41.42% (40.93-41.91) received quality maternal PNC while 42.34% (41.86-42.83) received quality neonatal PNC. In the pooled analysis, we found that the factors showing the strongest associations with quality maternal PNC were delivery by skilled birth attendants (SBAs) (OR: 4.92; 95% CI: 4.32-5.59), four or more antenatal care (ANC) visits (OR: 1.69, 1.58-1.81), and institutional delivery (OR: 1.61; 1.46-1.78). Consistent results were found for all factors of quality newborn care (e.g., delivery by SBA: OR, 4.25; 3.75-4.81; four or more ANC visits: OR, 1.83; 1.70-1.96) except institutional delivery. The association between these leading factors and PNC quality were broadly consistent across countries. Subgroup analyses and sensitivity analyses showed generally consistent results. Interpretation Our study demonstrated that institutional delivery and frequent ANC visits had the strongest positive associations with quality PNC for both mothers and neonates. Our findings highlight that improvements to the quality of maternal and neonatal PNC in the LMICs we assessed are urgently needed to achieve ambitious maternal, newborn, and child health goals. Funding China National Natural Science Foundation.
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Affiliation(s)
- Shuangyu Zhao
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, 100084, PR China
| | - Yixuan Zhang
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, 100084, PR China
- School of Traffic and Transportation, Beijing Jiaotong University, No.3, Shangyuan Village, Haidian District, Beijing, 100044, PR China
| | - Angela Y. Xiao
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, 100084, PR China
| | - Qiwei He
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, 100084, PR China
- Institute of International Development Cooperation, Chinese Academy of International Trade and Economic Cooperation, Beijing, 100710, PR China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, 100084, PR China
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Barman P, Sarif N, Saha A. Association between natural hazards and postnatal care among the neonates in India: a step towards full coverage using geospatial approach. BMC Emerg Med 2023; 23:76. [PMID: 37460972 PMCID: PMC10351138 DOI: 10.1186/s12873-023-00844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Postnatal care is crucial to prevent the child mortality. Despite the improvement in the PNC coverage for the neonates, it is still far away from the universal health coverage. Along with, some specific regions mostly are natural hazard prone areas of India show very under coverage of PNC for the neonates. Considering the substantial spatial variation of PNC coverage and natural hazard prevalence, present study aimed to examine spatial variation of PNC coverage and its association with natural hazard at the district level. METHODS The cross-sectional exploratory study utilized National Family Health Survey, 2019-21, which included 1,76,843 children using multistage stratified sampling method to examine postnatal care within 42 days for neonates born within five years prior to the survey. Additionally, the study utilized Vulnerability Atlas of India,2019 maps to categorize regions into hazardous (flood, earthquake, and landslide) and non-hazardous areas. Spatial univariate and bivariate analyses, logistic and geographically weighted regressions were conducted using ArcGIS Pro, GeoDa, and Stata 16.0 software to identify associations between PNC coverage, hazard exposure, and spatial variation. RESULTS The univariate spatial analysis showed some specific regions such as north, east, and north-east region of India had a high concentration of natural hazard and low access of PNC coverage. Bivariate analysis also showed that PNC coverage was low in flood (75.9%), earthquake (68.3%), and landslide (80.6%) effected areas. Compared to the national PNC coverage (81.1%), all these natural hazards effected areas showed low coverage. Further, logic regression showed that these hazard prone areas were less (OR:0.85 for flood, 0.77 for earthquake, and 0.77 for landslide) likely to get PNC coverage than their counterparts. LISA cluster maps significantly showed low PNC and high disaster concentration in these disaster-prone areas. Geographic weighted regression results also showed similar result. CONCLUSIONS The present study elucidates notable heterogeneity in the coverage of postnatal care (PNC) services, with lower concentrations observed in disaster-prone areas. In order to enhance the accessibility and quality of PNC services in these areas, targeted interventions such as the deployment of mobile health services and fortification of health systems are recommended.
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Affiliation(s)
- Papai Barman
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Nawaj Sarif
- Department of Migration and Urban Studies, International Institute for Population Sciences, 400088, Mumbai, India
| | - Amiya Saha
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India
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Adams YJ, Miller ML, Agbenyo JS, Ehla EE, Clinton GA. Postpartum care needs assessment: women's understanding of postpartum care, practices, barriers, and educational needs. BMC Pregnancy Childbirth 2023; 23:502. [PMID: 37420215 DOI: 10.1186/s12884-023-05813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Complications in the postpartum period pose substantial risks to women and can result in significant maternal morbidity and mortality. However, there is much less attention on postpartum care compared to pregnancy and childbirth. The goal of this study was to gather information on women's knowledge of postpartum care and complications, recovery practices after childbirth, perceived barriers to receiving care during the postpartum period, and educational needs in four health centers. The findings can inform the development of appropriate curriculum and interventions for postnatal care education in similar settings. METHODS A descriptive qualitative study design was employed. Eight focus group discussions were conducted among 54 postpartum women who delivered in four health centers in Sagnarigu District in Tamale, Ghana. Audio recordings of focus group data were transcribed and translated, and thematic analysis was conducted. RESULTS There were six main themes that emerged from the focus group discussions: 1) baby focused postpartum care; 2) postpartum practices; 3) inadequate knowledge ofpostpartum danger signs; 4) barriers to accessing postpartum care 5) experiences of poor mental health; and 6) need for postpartum education. CONCLUSIONS Postpartum care for women in this study was primarily perceived as care of the baby post-delivery and missing key information on physical and mental health care for the mother. This can result in poor adjustment postpartum and critically, a lack of knowledge on danger signs for common causes of morbidity and mortality in the postpartum period. Future research needs to understand how to communicate important information on postpartum mental and physical health to better protect mothers in the region.
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Misu F, Alam K. Comparison of inequality in utilization of postnatal care services between Bangladesh and Pakistan: Evidence from the Demographic and Health Survey 2017-2018. BMC Pregnancy Childbirth 2023; 23:461. [PMID: 37349680 DOI: 10.1186/s12884-023-05778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan. METHODS The study used the latest Demographic and Health Survey (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated. RESULTS In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women's education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624; and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643; and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595; and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women's education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743). CONCLUSION Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.
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Affiliation(s)
- Farjana Misu
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
- Department of Statistics, Jagannath University, Dhaka, 1100, Bangladesh.
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Song JE, Lee S, Lee MK, Chae HJ. Ecological factors affecting first-time mothers' satisfaction with Sanhujoriwons (postpartum care centres) from South Korea: a cross-sectional and correlational study. BMC Pregnancy Childbirth 2023; 23:454. [PMID: 37340327 PMCID: PMC10280916 DOI: 10.1186/s12884-023-05770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND In South Korea, commercial postpartum care centres, known as Sanhujoriwons, have emerged as important institutions aiding mothers' physical recovery after childbirth. Although previous studies have measured mothers' satisfaction level with Sanhujoriwons, this study applies Bronfenbrenner's ecological model to identify the factors influencing first-time mothers' satisfaction with Sanhujoriwons. METHODS This descriptive correlational study involved 212 first-time mothers admitted to Sanhujoriwons for two weeks with their new-borns (healthy babies weighing at least 2.5 kg) after giving birth after 37 weeks of pregnancy. Data were collected using a self-report questionnaire at five postpartum care centres in the metropolitan area of South Korea from October to December 2021, on the day of the mothers' discharge. This study considered ecological factors such as perceived health status, postpartum depression, childcare stress, maternal identity at the individual level; partnership with Sanhujoriwon staff at the microsystem level; and the Sanhujoriwons' education support system at the exo-system level. The data were analysed using descriptive statistics, t-test, one-way ANOVA, correlation analysis, and hierarchical regression analysis using the SPSS 25.0 Win program. RESULTS The mean score of satisfaction with Sanhujoriwons was 59.67 ± 10.14 out of 70, indicating a high level of satisfaction. The hierarchical regression analysis showed that satisfaction with Sanhujoriwons was significantly affected by the perceived health status (β = 0.19, p < 0.001), partnership between mothers and the caregivers (β = 0.26, p < 0.001), and education support system of the Sanhujoriwons (β = 0.47, p < 0.001). The explanatory power of the model for these variables was 62.3%. CONCLUSIONS Our results indicate that not only the mother's health status but also the educational support system of postpartum care centres and partnerships are important for improving first-time mothers' satisfaction with postpartum care centres. Thus, when developing an intervention program for postpartum care centres, practitioners should focus on developing various kinds of support and strategies to improve the physical health condition of mothers, build partnerships between mothers and care staff, and improve the quality of the educational support offered to mothers. Further studies to develop and test the effectiveness of such intervention programs are strongly suggested.
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Affiliation(s)
- Ju-Eun Song
- College of Nursing & Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Soyeon Lee
- College of Nursing & Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
- Department of Nursing, Ajou University Medical Center, Suwon, Republic of Korea
| | - Min Kyong Lee
- College of Nursing & Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
- Department of Nursing, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun-Ju Chae
- Department of Nursing, Joongbu University, 201, Daehak-ro, Chubu-myeon, Geumsan-gun, Chungnam, 32713, Republic of Korea.
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Negero MG, Sibbritt D, Dawson A. Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data. BMC Public Health 2023; 23:1174. [PMID: 37337146 DOI: 10.1186/s12889-023-15938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future. METHODS Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design. RESULTS Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49. CONCLUSIONS We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.
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Affiliation(s)
- Melese Girmaye Negero
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Yago S, Takahashi Y, Tsukamoto E, Saito A, Saito E. Use of the Newborn Behavioral Observations System as an early intervention for infants and their parents: A scoping review. Early Hum Dev 2023; 183:105811. [PMID: 37385114 DOI: 10.1016/j.earlhumdev.2023.105811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The Newborn Behavioral Observations (NBO) system is an infant-focused, family-centered, relationship-based tool designed to help parents become aware of their baby's abilities and to promote a positive parent-child relationship from the very beginning of birth. AIMS The aim of this scoping review was to provide an overview of the key characteristics of the research and evidence accumulated over the past 17 years on the early NBO intervention for infants and their parents to identify the existing research gaps and to inform the future direction of research on the NBO System. STUDY DESIGN A scoping review guided by Arksey and O'Malley's methodological framework and the PRISMA-ScR Checklist was conducted. This review used six databases (PubMed, CINAHL, MEDLINE, Google Scholar, Ichushi-Web, and CiNii) and was limited to English and Japanese language articles from January 2006, when the NBO was developed, to September 2022. Reference lists were also hand-searched to further identify relevant articles from the NBO site. RESULTS A total of 29 articles were selected. Through the analysis of included articles, four overarching themes were identified: (1) usage pattern of the NBO; (2) participants, setting, duration, and frequency of the NBO intervention; (3) outcome measures and effects of the NBO intervention; and (4) findings from a qualitative perspective. The review suggested that early NBO intervention had a positive impact on maternal mental health and sensitivity to the infant, confidence and knowledge of practitioners, and infant development. CONCLUSIONS This scoping review shows that the early NBO intervention has been implemented in a variety of cultures and settings and by professionals of various disciplines. However, research to evaluate the long-term effects of this intervention on a wider range of subjects is needed.
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Affiliation(s)
- Satoshi Yago
- Department of Child and Family Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Yuki Takahashi
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, 1-1-20 Daiko-Minami, Higashi, Nagoya, Aichi 461-8673, Japan
| | - Emi Tsukamoto
- Department of Nursing Science, Faculty of Health and Welfare Science, Okayama Prefectural University, 111 kuboki, Soja, Okayama 719-1197, Japan
| | - Asuka Saito
- Department of Nursing, Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan
| | - Eiko Saito
- Graduate School of Nursing, International Health Care and Midwifery, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya, Tokyo 150-0012, Japan
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McCarthy KJ, Blanc AK, Warren CE, Bajracharya A, Bellows B. Exploring the accuracy of self-reported maternal and newborn care in select studies from low and middle-income country settings: do respondent and facility characteristics affect measurement? BMC Pregnancy Childbirth 2023; 23:448. [PMID: 37328744 DOI: 10.1186/s12884-023-05755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Accurate data on the receipt of essential maternal and newborn health interventions is necessary to interpret and address gaps in effective coverage. Validation results of commonly used content and quality of care indicators routinely implemented in international survey programs vary across settings. We assessed how respondent and facility characteristics influenced the accuracy of women's recall of interventions received in the antenatal and postnatal periods. METHODS We synthesized reporting accuracy using data from a known sample of validation studies conducted in Sub-Saharan Africa and Southeast Asia, which assessed the validity of women's self-report of received antenatal care (ANC) (N = 3 studies, 3,169 participants) and postnatal care (PNC) (N = 5 studies, 2,462 participants) compared to direct observation. For each study, indicator sensitivity and specificity are presented with 95% confidence intervals. Univariate fixed effects and bivariate random effects models were used to examine whether respondent characteristics (e.g., age group, parity, education level), facility quality, or intervention coverage level influenced the accuracy of women's recall of whether interventions were received. RESULTS Intervention coverage was associated with reporting accuracy across studies for the majority (9 of 12) of PNC indicators. Increasing intervention coverage was associated with poorer specificity for 8 indicators and improved sensitivity for 6 indicators. Reporting accuracy for ANC or PNC indicators did not consistently differ by any other respondent or facility characteristic. CONCLUSIONS High intervention coverage may contribute to higher false positive reporting (poorer specificity) among women who receive facility-based maternal and newborn care while low intervention coverage may contribute to false negative reporting (lower sensitivity). While replication in other country and facility settings is warranted, results suggest that monitoring efforts should consider the context of care when interpreting national estimates of intervention coverage.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Blavatnik Women's Health Research Institute, New York, NY, USA.
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Gayesa RT, Ngai FW, Xie YJ. The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:611. [PMID: 37296420 DOI: 10.1186/s12913-023-09581-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. OBJECTIVE The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. METHODS Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles. RESULTS The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). CONCLUSIONS The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.
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Affiliation(s)
- Reta Tsegaye Gayesa
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China.
- Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Fei Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
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Dasgupta DP, Sultana N, Suman SM, Fatema K, Ferdous Khan MT. Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis. Public Health 2023; 220:112-119. [PMID: 37300975 DOI: 10.1016/j.puhe.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality. STUDY DESIGN Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used. METHODS Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths. RESULTS Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days. CONCLUSIONS The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.
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Affiliation(s)
- D P Dasgupta
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh; Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - N Sultana
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - S M Suman
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - K Fatema
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - M T Ferdous Khan
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh; Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Teslim SA, Adeola ASR, Adesina O. Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100197. [PMID: 37273910 PMCID: PMC10238573 DOI: 10.1016/j.eurox.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/19/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Background The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38 % of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24 h, at day 3, days 10-14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. Methods This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p < 0.05. Results Of the respondents, 71.9 % had poor or incorrect knowledge. About 87.4 % perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9 %) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3 %), days 10-14 (86.2 %) and six weeks postpartum (91.6 %). Also, 69.5 % were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Conclusion Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality.
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Affiliation(s)
- Sanusi Akinsola Teslim
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Abdus-salam Rukiyat Adeola
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine University of Ibadan/ University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oladokun Adesina
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine University of Ibadan/ University College Hospital, Ibadan, Oyo State, Nigeria
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Backhausen MG, Broberg L, Rosted EE, Råsø KZL, Thomsen TG, Beck M. Postnatal quietness - the dilemma of visiting hours. A qualitative interview study with maternity care staff. Sex Reprod Healthc 2023; 36:100860. [PMID: 37235951 DOI: 10.1016/j.srhc.2023.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND As part of the Person and Family Centred Care, involvement of relatives is a key concept. This means that an unrestricted visiting policy in hospitals wards is widely accepted and implemented. In maternity care, benefits and drawbacks of unrestricted visiting is still discussed, while it is acknowledged that a quiet environment is important for both new parents and newborns to enhance breastfeeding. The COVID-19 lockdown provided an opportunity to study how the restrictions for visitors influenced the work of maternity care staff in Denmark. OBJECTIVE This study aimed to explore the experience of maternity care staff on how visitation restrictions for visitors influenced the care of new families in a maternity ward. METHODS Individual interviews (n = 10) were performed between 20 November 2020 and 25 February 2021. A qualitative descriptive study was performed using thematic analysis. RESULTS One overarching theme was identified: "Framing time to the experience of becoming a parent". Further, five sub-themes were identified and illuminated in the analysis: "Increasing confidentiality and presence", "Changing availability and space for guidance", "Welcoming peacefulness", "Being gatekeepers", and "Structuring time is caring". CONCLUSION Restrictions for visitors influenced the care of new families because it encourages the space and place of becoming a parent. The hospital environment was shaped in a calm way, which increased the staffs' bedside time. The experience of an increased confidentiality with new parents led to in-depth conversations, making it easier to identify new parents' needs, focus on the initiation of breastfeeding, and individual guidance.
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Affiliation(s)
- Mette G Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark.
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen Denmark
| | - Elizabeth E Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Kamma Z L Råsø
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Thora G Thomsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Malene Beck
- Department of Regional Health Research, University of Southern Denmark, Denmark; Research Unit PROgrez, Næstved, Slagelse and Ringsted Hospitals, Region Zealand, Denmark
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Nyondo-Mipando AL, Chirwa M, Kumitawa A, Salimu S, Chinkonde J, Chimuna TJ, Dohlsten M, Chikwapulo B, Senbete M, Gohar F, Hailegebriel TD, Jackson D. Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi. BMC Pregnancy Childbirth 2023; 23:271. [PMID: 37076801 PMCID: PMC10114368 DOI: 10.1186/s12884-023-05587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 04/09/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 h of birth, 48-72 h, 7-14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies. METHODS A concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study was conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 h of birth, at 48-72 h, 7-14 days, and six weeks after birth were conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach. RESULTS The uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 h of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded the utilisation of PNC services. The enablers included the mother's level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities. CONCLUSION Optimisation of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, time points, and services that need to be delivered to create demand for the services. There is a need to assess the contextual factors for a better response in improving the uptake of PNC services and in turn inform the development of strategies for optimizing the uptake of PNC services.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Maternal and Fetal Health Group, Malawi Liverpool Wellcome Programme, Blantyre, Malawi.
| | - Marumbo Chirwa
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrew Kumitawa
- Department of Epidemiology and Statistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sangwani Salimu
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Maternal and Fetal Health Group, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | | | | | - Martin Dohlsten
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Debra Jackson
- London School of Hygiene and Tropical Medicine, London, UK
- University of the Western Cape, Cape Town, South Africa
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Iqbal S, Maqsood S, Zakar R, Fischer F. Trend analysis of multi-level determinants of maternal and newborn postnatal care utilization in Pakistan from 2006 to 2018: Evidence from Pakistan Demographic and Health Surveys. BMC Public Health 2023; 23:642. [PMID: 37016374 PMCID: PMC10071715 DOI: 10.1186/s12889-023-15286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/16/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is crucial for maternal and newborn health. Healthcare-seeking practices within the postpartum period help healthcare providers in early detection of complications related to childbirth and post-delivery period. This study aims to investigate trends of PNC utilization from 2006 to 2018, and to explore the effects of multi-level determinants of both maternal and newborn PNC in Pakistan. METHODS Secondary data analysis of the last three waves of the nationally representative Pakistan Demographic and Health Surveys (PDHSs) was conducted Analysis was limited to all those women who had delivered a child during the last 5 years preceding each wave of PDHS Bivariate and multivariate logistic regression was applied to determine the association of maternal and newborn PNC utilization with multi-level determinants at individual, community, and institutional levels. RESULTS In Pakistan, an upward linear trend in maternal PNC utilization was found, with an increase from 43.5 to 63.6% from 2006 to 2018. However, a non-linear trend was observed in newborn PNC utilization, with an upsurge from 20.6 to 50.5% from 2006 to 2013, nonetheless a decrease of 30.7% in 2018. Furthermore, the results highlighted that the likelihood of maternal and newborn PNC utilization was higher amongst older age women, who completed some years of schooling, were employed, had decision-making and emotional autonomy, had caesarean sections, and delivered at health facilities by skilled birth attendants. Multivariate analysis also revealed higher odds for women of older age, who had decision-making and emotional autonomy, and had caesarean section deliveries over the period of 2006-2018 for both maternal and newborn PNC utilization. Further, higher odds for maternal PNC utilization were found with parity and size of newborn, while less for ANC attendance and available means of transportation. Furthermore, increased odds were recorded for newborn PNC utilization with the number of children, ANC attendance, gender of child and mass media exposure from 2006 to 18. CONCLUSION A difference in maternal and newborn PNC utilization was found in Pakistan, attributed to multiple individual (socio-demographic and obstetrics), community, and institutional level determinants. Overall, findings suggest the need to promote the benefits of PNC for early diagnosis of postpartum complications and to plan effective public health interventions to enhance women's access to healthcare facilities and skilled birth assistance to save mothers' and newborns' lives.
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Affiliation(s)
- Sarosh Iqbal
- Department of Sociology, School of Social Sciences & Humanities, University of Management & Technology, Lahore, Pakistan
| | - Sidra Maqsood
- Department of Sociology, School of Social Sciences & Humanities, University of Management & Technology, Lahore, Pakistan
- Department of Sociology, Government College University, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Sociology, School of Social Sciences & Humanities, University of Management & Technology, Lahore, Pakistan
- Department of Public Health, Institute of Social & Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Department of Sociology, School of Social Sciences & Humanities, University of Management & Technology, Lahore, Pakistan.
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Adams YJ, Ray HE, Sladek L, Amason J. Knowledge of immediate newborn care and management of complications among midwives in Ghana. Midwifery 2023; 121:103654. [PMID: 36965432 DOI: 10.1016/j.midw.2023.103654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/19/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Midwives are instrumental in improving maternal/newborn health outcomes. Since complications after childbirth are leading causes of maternal deaths, midwives' knowledge of how to manage complications and care for the newborn is important. This study assessed midwives' knowledge of immediate newborn care and management of postpartum complications. DESIGN A cross-sectional descriptive survey design was used. SETTING Four hospitals that provide inpatient maternity services in Tamale, Ghana. PARTICIPANTS 245 midwives who worked in the four hospitals. MEASUREMENTS Data were collected in December 2018 using an electronic survey questionnaire by the Johns Hopkins Program for International Education in Gynecology and Obstetrics, and analyzed using descriptive, bivariate, and multivariate statistics. FINDINGS About 98% of midwives were female. The mean age of midwives was 31.87 years. The percentage of midwives who responded correctly to questions on newborn care and management of postpartum complications ranged from 29.80% to 89.39%, and 32.17% to 91.43% respectively. Midwives were most knowledgeable about breastfeeding and immediate hemorrhage intervention, and least knowledgeable about cord care, thermal protection, newborn resuscitation, contraindications for vacuum extraction, treating metritis, and performing a cervical repair. Years of experience and age are predictive factors of midwives' knowledge. CONCLUSION/IMPLICATIONS There remains the opportunity for continuing education on complication management. Additional training of midwives on newborn resuscitation is recommended.
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Affiliation(s)
- Yenupini Joyce Adams
- Eck Institute for Global Health, University of Notre Dame, 915 Flanner Hall, Notre Dame, IN 46556, USA.
| | - Herman E Ray
- Analytics and Data Science Institute and Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, Georgia
| | - Lynn Sladek
- Labor and Delivery Unit, Piedmont Atlanta Hospital, Atlanta, Georgia
| | - Janeen Amason
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia
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Chang CW, Tsai YJ, Hsu YY, Hou TW. Self-management system for postpartum women with hypertension disorders: an eHealth application intervention study. BMC Pregnancy Childbirth 2023; 23:184. [PMID: 36927463 DOI: 10.1186/s12884-023-05483-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Hypertension disorders are relatively common in pregnant women and often persist in the postpartum period. Few studies are available regarding the self-management of postpartum hypertension via the eHealth system. This study aimed to develop a self-management eHealth system for women with postpartum hypertension during the postpartum period. METHODS We adopted a multi-platform system for this research, not only for use on the web interface but also on smartphones. The proposed system possessed three features: (1) the population was limited to postnatal women with hypertension; (2) a self-care record, which allowed postnatal women to keep track of their blood pressure, pulse, weight, medication record, exercise record, and risk factor assessment; and (3) through this system, nurse-midwives could keep track of postnatal women's health status maintaining the complete record and could communicate directly with the users if their health monitor values reach beyond normal range. RESULTS Thirty-nine postnatal women with postpartum hypertension were recruited to the study. A survey to evaluate the usability and satisfaction of the proposed e-health application system was completed by these women. The usability rate of the system reached 92.4% (46.2% satisfied and 46.2% strongly satisfied), which suggested that the system was helpful to the users. The satisfaction rate of the system reached 94.9% (43.6% satisfied and 51.3% strongly satisfied), which suggested that the system was acceptable to the users. CONCLUSION This proposed system has been developed completely with user experience and professional advice from experts. Postnatal women could gain important postpartum-related knowledge and access their related health records and other information easily via their smartphones or computers. During the postpartum period, an eHealth application system can effectively assist women with hypertension to manage their blood pressure and related postnatal healthcare issues.
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Rossau HK, Nilsson IMS, Busck-Rasmussen M, Ekstrøm CT, Gadeberg AK, Hirani JC, Strandberg-Larsen K, Villadsen SF. Effectiveness of a community-based support programme to reduce social inequality in exclusive breastfeeding: study protocol for a cluster-randomised trial. BMC Public Health 2023; 23:450. [PMID: 36890478 PMCID: PMC9993656 DOI: 10.1186/s12889-023-15256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/09/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Breastmilk is the ideal nutrition for infants, and breastfeeding protects infants and mothers from a range of adverse health outcomes. In Denmark, most mothers initiate breastfeeding but many cease within the first months resulting in just 14% reaching the World Health Organization recommendation of six months of exclusive breastfeeding. Furthermore, the low breastfeeding proportion at six months is characterised by a marked social inequality. A previous intervention tested in a hospital setting succeeded in increasing the proportion of mothers breastfeeding exclusively at six months. However, most breastfeeding support is provided within the Danish municipality-based health visiting programme. Therefore, the intervention was adapted to fit the health visiting programme and implemented in 21 Danish municipalities. This article reports the study protocol, which will be used to evaluate the adapted intervention. METHODS The intervention is tested in a cluster-randomised trial at the municipal level. A comprehensive evaluation approach is taken. The effectiveness of the intervention will be evaluated using survey and register data. Primary outcomes are the proportion of women who breastfeed exclusively at four months postpartum and duration of exclusive breastfeeding measured as a continuous outcome. A process evaluation will be completed to evaluate the implementation of the intervention; a realist evaluation will provide an understanding of the mechanisms of change characterising the intervention. Finally, a health economic evaluation will assess the cost-effectiveness and cost-utility of this complex intervention. DISCUSSION This study protocol reports on the design and evaluation of the Breastfeeding Trial - a cluster-randomised trial implemented within the Danish Municipal Health Visiting Programme from April 2022 to October 2023. The purpose of the programme is to streamline breastfeeding support provided across healthcare sectors. The evaluation approach is comprehensive using a multitude of data to analyse the effect of the intervention and inform future efforts to improve breastfeeding for all. TRIAL REGISTRATION Prospectively registered with Clinical Trials NCT05311631 https://clinicaltrials.gov/ct2/show/NCT05311631.
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Affiliation(s)
- Henriette Knold Rossau
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark.
| | | | - Marianne Busck-Rasmussen
- The Danish Committee for Health Education, Classensgade 71, 5th floor, 2100, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Anne Kristine Gadeberg
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Jonas Cuzulan Hirani
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
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Lindblad V, Kragholm KH, Eidhammer A, Melgaard D. Discharge time after birth is associated with parity - A retrospective cohort study. Heliyon 2023; 9:e14004. [PMID: 36915540 PMCID: PMC10006520 DOI: 10.1016/j.heliyon.2023.e14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
Background All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice. Objective The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth is associated with parity, and 3) which factors are associated with discharge time. Methods This retrospective study is based on data from the North Denmark Regional Hospital and included mothers giving vaginal birth from March 25, 2019 to April 10, 2021. Results A total of 1990 mothers were included. Nearly 50% of the new mothers stayed at the hospital less than 6 h after birth (26% of primiparous women vs 64% of multiparous women). Primiparous women had an adjusted RR 0.44 (95% CI 0.39-0.49) for discharge ≤6 h, RR 1.71 (95% CI 1.15-2.54) for discharge >6-12 h, and RR 3.76 (95% CI 3.03-4.67) for discharge >48 h after birth compared to multiparous women. Multiparous women's adjusted RR for discharge >6-12 h was 0.15 (95% CI 0.12-0.20) and for discharge >48 h 0.16 (95% CI 0.14-0.20) compared to discharge less than 6 h after birth. Furthermore, smoking, low education level, and younger age were associated with early discharge. Conclusion There is a significant association with parity and discharge time after birth and factors related to discharge time which healthcare professionals should be aware of when planning inpatient and outpatient care. In addition, healthcare professionals should be aware of mothers discharged early who are smoking, of younger age, lower education level or multiparity.
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Affiliation(s)
- Victoria Lindblad
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Anya Eidhammer
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
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Mäkelä H, Axelin A, Kolari T, Niela-Vilén H. Exclusive breastfeeding, breastfeeding problems, and maternal breastfeeding attitudes before and after the baby-friendly hospital initiative: A quasi-experimental study. Sex Reprod Healthc 2023; 35:100806. [PMID: 36521260 DOI: 10.1016/j.srhc.2022.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breastfeeding practices remain globally suboptimal despite many known maternal and neonatal health benefits and the Baby-Friendly Hospital Initiative as a global effort to support breastfeeding. OBJECTIVE We aimed to evaluate the effects of the implementation of the Baby-Friendly Hospital Initiative for a proportion of mothers who exclusively breastfed during a 6-month period, including breastfeeding problems, and maternal breastfeeding attitudes. METHODS Using a quasi-experimental non-equivalent two-group design, we recruited two independent samples of postpartum mothers in a maternity hospital to compare the situation before (N = 162) and after (N = 163) the implementation. We measured breastfeeding status and possible breastfeeding problems via text-message questions at 2 weeks, 1, 4 and 6 months after birth. We measured Mothers' attitudes toward breastfeeding at the maternity hospital and 4 months after birth using the Iowa Infant Feeding Attitude Scale. RESULTS The implementation of the Baby-Friendly Hospital Initiative had no effect on the proportion of mothers who exclusively breastfed, and we found no significant differences in exclusive breastfeeding at 6 months (41.3 % vs 52.9 %, p =.435). The intervention did not influence the reported number of breastfeeding problems (p =.260) or maternal breastfeeding attitudes (p =.354). More favourable breastfeeding attitudes (p <.001) and less problematic breastfeeding (p <.001) were associated positively with exclusive breastfeeding. CONCLUSION Exclusive breastfeeding rates did not increase after the intervention; however, the rates at baseline were already high. Ensuring the Baby-Friendly Hospital Initiative practices through pre- and postnatal periods and preparing mothers to manage common breastfeeding problems might improve breastfeeding rates. This trial was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.
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Affiliation(s)
- Heli Mäkelä
- University of Turku, Department of Nursing Science, Turku, Finland; Satakunta Hospital District, Satasairaala, Pori, Finland.
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku, Finland
| | - Terhi Kolari
- University on Turku, Department of Biostatistics, University of Turku, Turku, Finland
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Yang Y, Yu M. Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:115. [PMID: 36788495 PMCID: PMC9926695 DOI: 10.1186/s12884-023-05434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Reducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson's Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China. METHODS A cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson's model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization. RESULTS Place of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC. CONCLUSIONS Inequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization. We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women's health literacy.
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Affiliation(s)
- Yuxuan Yang
- grid.410740.60000 0004 1803 4911Department of Health Service Support Research, Academy of Military Medical Sciences, #27 Taiping Road, Haidian District, Beijing, 100850 China
| | - Min Yu
- Department of Health Service Support Research, Academy of Military Medical Sciences, #27 Taiping Road, Haidian District, Beijing, 100850, China.
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Gurara MK, Draulans V, Van Geertruyden JP, Jacquemyn Y. Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis. BMC Pregnancy Childbirth 2023; 23:96. [PMID: 36739369 PMCID: PMC9898958 DOI: 10.1186/s12884-023-05414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/30/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia. METHODS The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance. RESULTS Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service. CONCLUSIONS Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.
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Affiliation(s)
- Mekdes Kondale Gurara
- grid.442844.a0000 0000 9126 7261Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium ,grid.5596.f0000 0001 0668 7884Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Veerle Draulans
- grid.5596.f0000 0001 0668 7884Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Jean-Pierre Van Geertruyden
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Yves Jacquemyn
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium ,grid.411414.50000 0004 0626 3418Department of Obstetrics and Gynaecology, Antwerp University Hospital, UZA, Antwerp, Belgium
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Roxburgh E, Morant N, Dolman C, Johnson S, Taylor BL. Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study. Community Ment Health J 2023; 59:243-252. [PMID: 35900686 PMCID: PMC9859833 DOI: 10.1007/s10597-022-01002-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
Postpartum psychosis has been found to affect 0.89-2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. Our aim in this study was to understand women's experiences of mental health care and services for psychosis in the postnatal period. Semi-structured interviews were conducted with 12 women who reported being treated for postpartum psychosis. Findings were analysed thematically. Women reported that healthcare professionals across maternity and mental health services often lacked awareness and knowledge of postpartum psychosis and did not always keep them or their partners/families informed, supported, and involved. Women wanted better collaboration between and within services, and more efficient, appropriate, and timely care. They valued inpatient services that could meet their needs, favouring Mother and Baby Units over general psychiatric wards. Early Intervention in Psychosis services and specialist perinatal community mental health teams were also well liked.
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Affiliation(s)
- Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Clare Dolman
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Oyedele OK, Fagbamigbe AF, Akinyemi OJ, Adebowale AS. Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming. BMC Pregnancy Childbirth 2023; 23:36. [PMID: 36653764 PMCID: PMC9847068 DOI: 10.1186/s12884-023-05372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Completing maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria. METHODS A cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p < 0.10), multivariable binary logistic regression and complementary-log-log model quantifies association at a 95% confidence interval (α = 0.05). RESULTS Coverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR = 1.27, 95%CI = 1.01-1.62), average wealth index (AOR = 1.83, 95%CI = 1.48 -2.25), southern geopolitical zone (AOR = 1.61, 95%CI = 1.29-2.01), making health decision alone (AOR = 1.39, 95%CI = 1.16-1.66), having nurse as ANC provider (AOR = 3.53, 95%CI = 2.01-6.17) and taking at least two dose of tetanus toxoid vaccine (AOR = 1.25, 95%CI = 1.06-1.62) while women in rural residence (AOR = 0.78, 95%CI = 0.68-0.90) and initiation of ANC as late as third trimester (AOR = 0.44, 95%CI = 0.34-0.58) negatively influenced continuation and completion. CONCLUSIONS 6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.
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Affiliation(s)
- Oyewole Kazeem Oyedele
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria ,grid.421160.0International Research Centre of Excellence, Institute of Human Virology, Nigeria, Abuja (FCT), Nigeria
| | - Adeniyi Francis Fagbamigbe
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Odunayo Joshua Akinyemi
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria ,grid.25881.360000 0000 9769 2525Faculty of Humanities, Population Health and Research Entity, North West University, Mafikeng, South Africa
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