Influences of health facility type for delivery and experience of cesarean section on maternal and newborn postnatal care between birth and facility discharge in Malawi

Eunsoo Timothy Kim,Kavita Singh,Clara Lemani,Ilene S. Speizer

doi:10.1186/s12913-020-4958-4

Abstract

BackgroundA number of studies in the past have looked at determinants of postnatal care. However, many of them do not distinguish between postnatal care (PNC) before discharge and after discharge for women delivering at health facilities. Conceptually and practically, factors associated with PNC before discharge and after discharge should be different. This study examines key factors for maternal and newborn PNC before discharge.MethodsData from the 2015–16 Malawi Demographic and Health Survey were used for the study. Three categorical endogenous variables examined in the study were whether or not mothers received a postnatal check between birth and facility discharge, whether or not newborns received a postnatal check between birth and facility discharge and whether or not women delivered by cesarean section. Delivery by cesarean section was considered as a mediator in the model. The main predictor of interest was type of health facility where women delivered. Other exogenous variables included were women’s age at most recent birth, number of antenatal visits, women’s education, household wealth, parity, newborn size, region of the country and residence. Simultaneous equation modeling was used to examine the associations of interest.Results47% of the mothers and 68% of the newborns had PNC before facility discharge. The total and direct effects of delivering in private hospitals on maternal and newborn PNC before facility discharge were significantly higher than the effects of delivering in government hospitals. The total effects of delivering in government health centers or health posts on maternal and newborn PNC before facility discharge were significantly lower than the effects of delivering in government hospitals. Delivering by cesarean section compared to delivering vaginally was positively associated with maternal and newborn PNC before facility discharge.ConclusionIt is important that all women and newborns receive PNC before they are discharged from the facility regardless of whether or not they had a complication. The same standard of quality PNC should be provided equitably across all types and affiliations of health facilities.

Highlights

A number of studies in the past have looked at determinants of postnatal care
A recent secondary analysis of 25 sub-Saharan African countries found that increases in facility delivery over time can mostly be attributed to increases in the facility delivery in the public sector and that the gap in facility delivery between the poorest and the wealthiest narrowed over time [6]
We found that women delivering in private, Christian Health Association of Malawi (CHAM) or mission hospitals had significantly higher direct and total effects on both maternal and newborn postnatal checks between birth and discharge compared to the effects of delivering in government hospitals

Summary

Introduction

A number of studies in the past have looked at determinants of postnatal care. many of them do not distinguish between postnatal care (PNC) before discharge and after discharge for women delivering at health facilities. The World Health Organization (WHO) for one has had a few changes to its policy position regarding the matter, going from supporting the training of traditional birth attendants in the 1960s, and linking them to the larger health care system to encouraging delivery by medically-trained professionals for all births today [1, 2] This is because skilled assistance by medically trained doctors, nurses and midwives at birth could potentially prevent and manage many of the complications that would lead to mortality [3]. The study concluded that women should only be recommended to seek delivery care at facilities that are capable of performing comprehensive emergency obstetric care, emergency newborn care or have competent providers [5] Regardless, this strategy has been promoted and has seen noticeable shifts in recent years [3, 6]. A recent secondary analysis of 25 sub-Saharan African countries found that increases in facility delivery over time can mostly be attributed to increases in the facility delivery in the public sector and that the gap in facility delivery between the poorest and the wealthiest narrowed over time [6]

Objectives

Methods

Results

Discussion

Conclusion