Abstract
BackgroundIn sub-Saharan Africa, few services specifically address the needs of women in the first year after childbirth. By assessing the health status of women in this period, key interventions to improve maternal health could be identified. There is an underutilised opportunity to include these interventions within the package of services provided for woman-child pairs attending child-health clinics.MethodsThis needs assessment entailed a cross-sectional survey with 500 women attending a child-health clinic at the provincial hospital in Mombasa, Kenya. A structured questionnaire, clinical examination, and collection of blood, urine, cervical swabs and Pap smear were done. Women's health care needs were compared between the early (four weeks to two months after childbirth), middle (two to six months) and late periods (six to twelve months) since childbirth.ResultsMore than one third of women had an unmet need for contraception (39%, 187/475). Compared with other time intervals, women in the late period had more general health symptoms such as abdominal pain, fever and depression, but fewer urinary or breast problems. Over 50% of women in each period had anaemia (Hb <11 g/l; 265/489), with even higher levels of anaemia in those who had a caesarean section or had not received iron supplementation during pregnancy. Bacterial vaginosis was present in 32% (141/447) of women, while 1% (5/495) had syphilis, 8% (35/454) Trichomonas vaginalis and 11% (54/496) HIV infection.ConclusionThroughout the first year after childbirth, women had high levels of morbidity. Interface with health workers at child health clinics should be used for treatment of anaemia, screening and treatment of reproductive tract infections, and provision of family planning counselling and contraception. Providing these services during visits to child health clinics, which have high coverage both early and late in the year after childbirth, could make an important contribution towards improving women's health.
Highlights
In sub-Saharan Africa, few services address the needs of women in the first year after childbirth
Maternal health services in resource-constrained settings have increasingly focused on the importance of skilled birth attendants and the management of intrapartum complications [1]
Much efforts have been made to rationalise the package of services for antenatal care [2,3]
Summary
In sub-Saharan Africa, few services address the needs of women in the first year after childbirth. There is an underutilised opportunity to include these interventions within the package of services provided for woman-child pairs attending childhealth clinics. Maternal health services in resource-constrained settings have increasingly focused on the importance of skilled birth attendants and the management of intrapartum complications [1]. Much efforts have been made to rationalise the package of services for antenatal care [2,3]. Antenatal care coverage remains high in most of Africa and the proportion of births which occur within medical services is steadily increasing [4,5]. Contact with health services in the year after childbirth presents a vital opportunity to assist women return to full health, and to prevent sexual and reproductive health problems in this period
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