Postnatal Home Visits Research Articles

Maternal satisfaction with postnatal home visitation services by community health nurses in Ashanti Region, Ghana: A cross-sectional correlational study.

Efforts have been made to improve maternal and child health care globally, with a focus on promoting postnatal home visitation care. Despite the known significance of postnatal home visits, concerns still exist regarding mothers' satisfaction with home visitation care. This study examined maternal satisfaction with postnatal home visitation care in the Ashanti Region. A cross sectional correlational study design was used to gather data from the study participants using the Jipi's questionnaire to assess maternal satisfaction with healthcare. Ten (10) district hospitals were randomly selected from 27 district hospitals in the region. A sample size of 170 postnatal mothers were then selected randomly from the 10 districts hospitals according to proportion of mothers at each facility. SPSS version 25 was used to analyse the data using descriptive statistics and Chi-square at a p-value = 0.05. The results indicated that the mothers were satisfied with the overall home visitation services, yet, showed dissatisfaction towards some specific postnatal care, including the quality of information on maternal care and support rendered by the CHNs regarding the care of the newborn during their visit. The satisfaction levels of mothers with these services are high, yet there are still opportunities for improving them by addressing specific challenges and tailoring these services to the diverse needs of postnatal mothers. In conclusion, CHNs' work during postnatal period is essential in promoting the health of both the baby and the mother.

Barriers and Enablers of Postnatal Care by Accredited Social Health Activist (ASHA) Workers: A Community-Based Qualitative Study From Tribal Gujarat.

Background The care provided to the mother and child from delivery to six weeks after is defined as postnatal care. The postnatal period is both a happy and critical phase for the mother and the newborn. However, the provision of high-quality care services is often ignored during this time. The objective of this study was to assess postnatal care services quality by Accredited Social Health Activist (ASHA) workers and associated factors such as newborn care in rural tribal areas of Gujarat, India. Methodology An ethnographic approach was adopted. Four primary health centers (PHCs) were selected purposively from Sankheda Block, Chhotaudepur, a tribal district in the eastern part of Gujarat. Information on obstacles and facilitators of postnatal care services was collected using in-depth interviews (IDIs) with a purposive sample of 22 ASHAs working in selected PHCs. Qualitative data were analyzed using thematic analysis. Results The median age of the ASHA workers was 39 years and ranged from 30 to 51 years (N = 22). Most ASHAs encountered logistical challenges when offering postnatal care services (e.g., they struggled to care for the mother and her babies because they were missing essential equipment, such as a thermometer and a salter-type baby weighing machine, or they had broken equipment). The two main issues facing ASHAs were incentives and timely payments. There were concerns about their safety and physical security during fieldwork. The majority of ASHA workers had good experiences during postnatal home visits, and they received support from other healthcare workers. There were many misconceptions and false assumptions in the community regarding breastfeeding, prelacteal feeding, family planning, and contraception methods. ASHAs wanted to become long-term government employees and believed they were entitled to sufficient training, assistance, recognition, and remuneration for the duties they performed. Conclusions Postnatal mothers receive considerably less attention than antenatal mothers because it mostly depends on ASHA workers and field staff. ASHA workers are doing their best regarding postnatal care. This study revealed some issues ASHAs face, including logistic issues, transportation issues, regular and timely payment issues, and local-level acceptance issues.

Effectiveness of Postnatal Home Visits in Reducing Fatigue Among Mothers with Unplanned Pregnancies

Objective: This study identified the risk factors for fatigue in child-rearing recognizable in early pregnancy and evaluated the effects of postnatal home visits on parenting fatigue. Methods: Data from 348 mothers who delivered live infants during January–March 2013 in Japan were collected retrospectively. The mothers received the Maternal and Child Health handbook in their first trimester and answered an accompanying questionnaire. For each family, we extracted the timing of postnatal home visits conducted by the Public Health Center. We compared the factors in early pregnancy between exhausted and non-exhausted mothers at nine months postpartum. We also compared the postpartum fatigue between mothers with and without early postnatal home visits. Results: There were significantly more unplanned pregnancies among exhausted mothers compared to mothers who did not experience exhaustion. Among those with unplanned pregnancies, we also found significantly more non-exhausted mothers among those who received postnatal home visits within two months postpartum compared with those who received home visits after two months. Conclusion: An unplanned pregnancy can be a risk factor for fatigue at nine months postpartum. Conducting home visits for mothers who had unplanned pregnancies within two months of delivery may reduce fatigue and positively contribute to mothers’ mental health.

Prevalence of and optimal screening tool for postpartum depression in a community-based population in China

BackgroundPostpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. MethodsWe sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires—the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsOut of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one “yes”) with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LimitationsDue to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. ConclusionsThe prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.

Extended prenatal and postnatal home visits in a vulnerable area in Sweden—a pilot study

Objective Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. Design Longitudinal, prospective study and register study from medical records. Setting A vulnerable rural area in Sweden. Intervention A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children’s first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. Subjects All firstborn children at the study site (N = 30 study, N = 55 control group). Main outcome measures The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. Results There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). Conclusion Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.

Postnatal home visit: An effective strategy to a successful postnatal care

Home visiting is a crucial aspect of postnatal care services as recommended by the WHO, but it appears to be the most neglected service. This is due to various challenges like a shortage of manpower, inadequately skilled or trained health care workers, the non-availability of assessment tools and resources, and a lack of community awareness of the importance of postnatal care. However, it's the responsibility of health care workers, especially the midwives, to carry out postnatal home care visits to ensure the well-being of both the mother and the neonates, as well as the assessment of the environment where the newborn will be nurtured. Therefore, to ensure effective postnatal home care visits, there should be availability of adequate tools and resources for the services, training of health care personnel, allocation of experienced health care workers, and community awareness of the importance of postnatal home care visits. This review thus explained the concept of postnatal home care visits, the timing of visits, who should conduct postnatal home visits, what to look out for in mothers, babies, and environments.

Early Postnatal Home Visit Coverage by Health Extension Workers and Associated Factors Among Postpartum Women in Gidan District, Northeast Ethiopia.

Objectives: To determine the coverage and associated factors of early postnatal home visits (PNHVs) by health extension workers (HEWs) among postpartum women in Gidan district, Northeast Ethiopia. Methods: A community-based, cross-sectional study was conducted between 30 March and 29 April 2021 in the Gidan district, Northeast Ethiopia. A multistage sampling technique was employed to select 767 postpartum women participants. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted to identify factors associated with early PNHVs by HEWs. Results: The coverage of early postnatal home visits was 15.13% [95% confidence interval (CI): 12.75, 17.87]. Women's education, institutional delivery, time to reach health posts, and participation in pregnant women forums were significantly associated with early PNHVs by HEWs. Conclusion: In the current study, the coverage of early postnatal home visits by HEWs remains low in the study area. The concerned bodies should consider interventions that promote women's education and institutional delivery, and more efforts should be made to improve community-based participation and links with HEWs.

Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study

BackgroundThe fulfilment of birth expectations is important to women and strongly related to birth satisfaction. ObjectiveThe aim of this study was to investigate women’s expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled. MethodsA longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences. ResultsThe majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women’s expectations and experiences. Most likely to be fulfilled were women’s expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled. ConclusionsPregnant women’s expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.

Effect of health facility linkage with community using postnatal card on postnatal home visit coverage and newborn care practices in rural Ethiopia: A controlled quasi-experimental study design.

BackgroundPostnatal home visit has the potential to improve maternal and newborn health, but it remains as a missed opportunity in many low-and middle-income countries. This study examines the effect of health extension worker administered postnatal card combined with health facility strengthening intervention on postnatal home visit coverage, newborn care practices, and knowledge of newborn danger signs in rural Ethiopia.MethodsWe employed quasi-experimental design using controlled before-and-after study in intervention and comparison districts of rural Tigray, northern Ethiopia. Training of health extension workers (HEWs) on postnatal home visit (PNHV), training of healthcare providers on maternal and newborn care, and capacity building of healthcare authorities on leadership, management and governance together with health system strengthening were the implemented interventions. Baseline (n = 705) and end line (n = 980) data were collected from mothers who delivered a year before the commencement of the actual data collection in the respective surveys. We used difference-in-differences (DiD) analysis to assess the effect of the intervention on PNHV coverage, essential newborn care practices and maternal knowledge of newborn danger signs.ResultsA total of 1685 (100%) mothers participated in this study. In all districts, more than 1/3rd of the mothers 633(37.57%) were in the age of 30–39 years. The difference-in-differences estimator showed an average of 23.5% increase in coverage of PNHVs within three days (DiD, p<0.001) and the provision of most postnatal contents significantly increased in the intervention district in the end line survey. The knowledge of at least three danger signs increased by 13.6% (p = 0.012).The DiD estimator showed an average of 27.6% increase to check the mothers for heavy bleeding (DiD, p = 0.011). This study also revealed that the checking of maternal blood pressure increased from 5.8% to 11.8% in the comparison districts and from 9.4% to 93.3% in the intervention district. The difference-in-differences estimator result showed a 9% difference in clean cord care practices among the participants (p = 0.025), 12.2% in skin to skin care (p = 0.022), and borderline significant increase in early initiation of breastfeeding (10.5%, p = 0.051).ConclusionWe conclude that the intervention package was effective in improving the coverage of PNHV, increase in knowledge of newborn danger sign and essential newborn care practices. Hence, further strengthening the linkages between health facilities and community is imperative to improve the coverage of essential lifesaving maternal and newborn care services by HEWs at home.

"Mothers will be lucky if utmost receive a single scheduled postnatal home visit": An exploratory qualitative study, Northern Ethiopia.

Postnatal home visits (PNHVs) have been endorsed as strategy for delivery of postnatal care (PNC) to reduce newborn mortality and improve maternal outcomes. Despite the important role of the Health Extension Workers (HEWs) in improving the overall healthcare coverage, PNHV remains as a missed opportunity in rural Ethiopia. Thus, this study aimed to explore the barriers and facilitators of scheduled postnatal home visits in Northern Ethiopia. We conducted an exploratory qualitative study on a total of 16 in-depth interviews with HEWs and mothers who gave birth one year prior to the study. In addition, focus group discussions were conducted with HEWs and key informant interviews were conducted with women development group leaders, supervisors, and healthcare authorities from April to June 2019 in two rural districts of Northern Ethiopia. Discussions and interviews were audio recorded and transcribed verbatim in the local language (Tigrigna) and translated into English. The translated scripts were thematically coded using Atlas ti scientific software. Field notes were also taken during the discussion and while conducting the interviews. Health system factors, community context, and individual level factors were considered as the barriers and facilitators of scheduled PNHVs. Leadership, governance, management, support and supervision, referral linkages, overwhelming workload, capacity building, logistics and supplies are the major sub-themes identified as health system factors. Physical characteristics like geographical location and topography, distance, and coverage of the catchment; and community support and participation like support from women's development groups (WDGs), awareness of the community on the presence of the service and cultural and traditional beliefs were community contexts that affect PNHVs. Self-motivation to support and intrinsic job satisfaction were individual level factors that were considered as barriers and facilitators. The finding of this study suggested that the major barriers of postnatal home visits were poor attention of healthcare authorities of the government bodies, lack of effective supervision, poor functional linkages, inadequate logistics and supplies, unrealistic catchment area coverage, poor community participation and support, and lack of motivation of HEWs. Henceforth, to achieve the scheduled PNHV in rural Ethiopia, there should be strong political commitment and healthcare authorities should provide attention to postnatal care both at facility and home with a strong controlling system.

Exploring health provider\u2019s knowledge on the home-based maternal and neonatal health care package in Rwanda

BackgroundRwanda implemented post-natal care home visits by maternal community health workers (M-CHWs) in charge of maternal and newborn health care in 2010 as a component of a home–based maternal and neonatal health care package (HB-MNHCP), this being a complementary strategy to facility-based postnatal care to improve survival. The country has not met its Sustainable Development Goal (SDG) 3 target of less than 70 maternal mortalities per 100,000 live births and less than 12 neonatal deaths per 1,000 live births. This study therefore aimed to establish the knowledge of the health providers, providing HB-MNHC services as part of their antenatal, delivery and postnatal care program, specifically the M-CHWs services.MethodsThe cross-sectional descriptive study included 79 purposively sampled health care providers who were directly involved in the various components of the HB-MNHCP, namely: professional nurses, midwives, M-CHW, social workers, supervisors and data managers. The Kibogora, Muhima and Nyamata District Hospitals and two rural, semi-urban and urban health facility were included. Data was collected using questionnaires from April to July 2018. This study followed the STROBE checklist form: Cross –sectional studies.ResultsOverall, 88.6% (n=70/79) of participants knew about the M-CHW three home visits scheduled during pregnancy, 73.4% (n=58/79) about the three postnatal home visits after birth when the weight was normal, and 64.6% (n=51/79) about the five PNC home visits for low birth weights. Most (97.5%, n=77/79) knew that the mother and newborn should be screened during the same M-CHW home visits, and 87.2% (n= 68/79) were aware of the seven postnatal core competencies of delivering key maternal and newborn interventions during PNC home visits.ConclusionsThere were varying levels of knowledge among the HB-MNHCP staff, indicating the need for ongoing monitoring and training to ensure that the correct information is provided to the mothers throughout the antenatal and postnatal periods. While most of the M-CHWs appear to have had the correct knowledge, their executing of some activities needs to be monitored to ensure that they provide the required services, as this is an important step in lowering the maternal and infant mortality and enabling Rwanda to meet its SDG 3. Home visits by the M-CHWs could increase referrals and reduce maternal and newborn mortality.

Reduced incidence of maternal health conditions associated with the home-based newborn care intervention package in Rural Gadchiroli, India: a 13 years before – after comparison

Background To evaluate the association between home-based neonatal care interventions and the incidence of maternal health conditions as well as to estimate the longitudinal trend of the incidence of maternal health conditions over 13 years in 39 villages of the field program area of the of home-based neonatal care from rural Gadchiroli, India. Methods This was a before-after comparative analysis of a program implemented in thirty-nine villages in Gadchiroli, India. The home-based newborn care interventions were incrementally introduced during the field trial (1995 – 1998) and continued as a service program until 2008. Over thirteen years (1995–2008), pregnant women were recruited and followed up from the seventh month of pregnancy to 28 days postpartum by trained female community health workers who made antenatal, natal and post-natal home visits, provided health education to mothers for behavior change, managed normal and sick neonates as well as encouraged seeking medical care when necessary. They recorded maternal symptoms and signs, which a physician supervisor verified. Based on these symptoms and signs, a computer algorithm diagnosed 20 different maternal health conditions. The incidence of these conditions in the first year (1995-96) was compared with the intervention’s last two years (2006 - 2008). Result The mean coverage of home-based newborn care, assessed on eight indicators, increased from 48.5% in 1995 – 96 to 87.1% in 2006 – 08. The proportion of women with any maternal health conditions during pregnancy reduced by 44.76% (P&lt;0.001), during labor by 44.59% (P &lt;0.001) and during the postpartum period by 77.82% (P&lt;0.001). The mean number of maternal conditions per 100 women reduced by 69% (P&lt;0.001). The need for emergency obstetric care was reduced by 78.83% (P&lt;0.001). The proportion of women free of any maternal health condition increased from 32.9 % to 64.6 %. Conclusions Home-based neonatal care interventions were associated with a significant reduction in the incidence of maternal health conditions. Developing a dedicated package of home-based maternal care in combination with neonatal care may further improve maternal health.

Key lessons from a mixed-method evaluation of a postnatal home visit programme in the humanitarian setting of Gaza

Background: The World Health Organization recommends postnatal home visits to improve maternal and newborn health. Evidence of postnatal home visit effectiveness in humanitarian settings is limited. Aims: To evaluate postnatal home visits implemented in the constrained humanitarian context of Gaza. Methods: Qualitative data were obtained through key informant interviews, in-depth interviews and/or focus group discussions with women targeted by the programme, nontargeted women, husbands, and home visitors. These data were complemented by a secondary analysis of quantitative data from existing household surveys and project monitoring data. Qualitative data were analysed using thematic analysis, and quantitative data were analysed to describe trends over time. Results: Women in the programme demonstrated improved breastfeeding practices and increased uptake of breastfeeding, and behavioural changes reduced harmful traditional norms and practices. The programme increased mutual understanding and respect between health providers and women, allowed for a more personalized approach and increased self-esteem among the women. To improve postnatal care throughout the population, interventions should focus not only on home visits but also address immediate postnatal care in maternity, postnatal follow-up in clinics, and improvements in the coordination and communication between the different levels of care. Conclusion: Implementation of postnatal home visits in a constrained humanitarian context such as Gaza is feasible and positively contributes to breastfeeding and newborn care practices, as well as to improved interactions between health providers and their clients. Positive effects could be leveraged if postnatal care were strengthened throughout the continuum of care.

Midwives’ experiences of father participation in maternity care at a large metropolitan health service in Australia

ObjectiveEngagement of fathers to participate in pregnancy, birth and early postnatal care has significant advantages for women and infants as well as fathers. In Australia, guidelines for midwifery practice do not include specific recommendations about father-inclusive care, and models for publicly funded maternity care do not extend to the provision of care tailored specifically towards the needs of fathers. This study investigated the perceptions of midwives regarding their role in fathers’ wellbeing, the extent of fathers’ attendance at and participation in their services, advantages and disadvantages of father participation and barriers and enablers to father engagement. DesignConvergent mixed methods, cross-sectional. SettingA large metropolitan public maternity hospital that provides care to some of the most socio-economically disadvantaged suburbs and multi-cultural communities in Melbourne, Australia. ParticipantsAll midwives employed at the hospital (n=196) were invited to participate. MethodsAnonymous online survey and semi-structured interviews. Descriptive statistics were calculated for quantitative survey responses. Interview data and qualitative survey responses were analysed thematically. FindingsForty midwives working in all areas of maternity services across the hospital completed surveys, and six participated in interviews.The data illustrate the dilemma faced by midwives in their specific role of supporting women and babies. On the one hand, participants indicated that fathers’ wellbeing should be part of their role and named many advantages of father participation in maternity services, including support and advocacy for mothers and bonding with infants. Participants estimated that most fathers attend births and visit their partner and infant on the postnatal ward, 52% attend antenatal appointments and 76% are present at postnatal home visits. Participants reported several midwife strategies and health service factors which facilitate father attendance and active engagement.On the other hand, participants reported several barriers to father engagement, including antenatal appointment schedules which are at odds with fathers’ work commitments and the lack of on-site group antenatal education. Some of the barriers they reported are specific to the vulnerable communities for which they provide maternity care. Extraordinary circumstances were reported, including fathers working overseas, fathers in prison, new immigrant status that is often accompanied by a lack of family support to care for other children even during labour and birth, and poor socio-economic status. In addition, in many cultures, pregnancy and birth are seen as “women's work”; fathers would not traditionally be involved. Participants also reported that midwives lack training and confidence in engaging fathers, particularly in responding to fathers with mental health concerns. When providing care for families at risk of family violence, father attendance was perceived a significant disadvantage. Key conclusionsMidwife-provided health services represent a significant opportunity to include and address fathers, and midwives recognise the significant advantages of engaging fathers, unless there is a risk of family violence. However, midwives currently report lack of training and confidence in addressing fathers’ needs, and several individual, social, cultural, and health service factors can present barriers to engaging fathers. Implications for practiceGiven the substantial benefits of engaging fathers for women and infants, we argue that maternity services should promote father engagement, for example by offering after hours appointment schedules, free antenatal and parenting education, and workshops to upskill midwifery staff. Education regarding the importance of father participation and skills for working with fathers should be included in the undergraduate preparation of midwives and other key maternity care professionals. Addressing the challenges of providing care to a multicultural community requires sensitive discussion with families from each of those cultures.

Maternal healthcare and associated factors among married migrant women in Changzhou, China

China has experienced huge internal migration with rapid economic development since 1980s. Little is known about recent changes in maternal healthcare among married migrant women. In 2018, 373 married migrant women of 20–39 years having a fertility history in the past 5 years were selected in a cross-sectional dataset of the reproductive health survey in Changzhou, China. Bivariate and multivariate associations were examined between demographic characteristics and childbearing history, and maternal healthcare among migrant women. Regarding results, 30% of migrant women reported not getting a handbook of maternal and child health care timely in the first trimester of pregnancy, 20.1% having inadequate prenatal visits, 37% not receiving a postnatal seventh-day home visit, and 16.4% had no 42nd-day examination after delivery. Migrant women who had an earlier birth, who had a second child and who returned hometown in maternal duration were more likely to have inadequate utilization of maternal health services. Substantial migrant women had inadequate maternal healthcare. It is important to take measures to improve their awareness and ability of maternal healthcare, and to improve facility service providing.

Community-based assessment of postnatal care in Puducherry-A cross-sectional study.

Introduction:Postnatal period is a neglected period compared to the antenatal period. Providing adequate care to infant and mother during this vital period is essential.Objectives:To assess the postnatal care (PNC) received by the mothers and newborn children in Puducherry.Materials and Methods:Community-based cross-sectional study done among the postnatal mothers under the care of two urban Primary Health Centers (PHC A and PHC B) in Puducherry in 2015–2016. Eligible mothers were contacted at their houses within 4 weeks of completion of their postnatal period to assess the postnatal care.Results:Out of 227 postnatal mothers in the study, only 37.4% (85) (95%CI 31.3–43.9) of the mothers had received adequate counselling services on topics of nutrition, hygiene, contraception, essential newborn care, breastfeeding, and immunization. Cord care was given for 99.1% of the babies and breastfeeding position was checked for 88.5% of the babies. Among the mothers who had normal deliveries, 48.1% (76) (95% CI 40.4–55.9) of the mothers had initiated breastfeeding within 1 h of normal delivery and within 4 h of delivery for 72.4% (50) (95% CI 61.1–82.0) among the mothers who had a cesarean section. Only 20.7% (47) (95%CI 15.8–26.3) of the mothers and newborns had received at least one postnatal home visit and none of the mothers had received adequate postnatal home visits as per Indian Public Health Standards guidelines. Out of the 126 eligible mothers for JSY benefits, only 46% (58) (95% CI 37.5–54.8) of them had registered. Among those who were not registered, 20.6% had reported that they were unaware of the scheme. Out of 227 births, 14.1% (32) of them were of low birth weight (<2.5 kg) and 1.3% (3) were of very low birth weight (<1.5 kg) category.Conclusion:Although the antenatal care is satisfactory in the study setting, implementation of PNC needed further attention and active guidance via health system strengthening.

Prevalence and Associated Factors of Early Postnatal Care Service Use Among Mothers Who Had Given Birth Within the Last 12 Months in Adigrat Town, Tigray, Northern Ethiopia, 2018.

BackgroundThe care given for the first hours, days, and weeks after childbirth is life-threatening. So far, this period receives less attention from health-care providers than the care given to pregnancy and delivery. This study aimed to determine the prevalence and associated factors of early postnatal care service use among mothers who had given birth in the last 12 months in Adigrat Town, Tigray, Ethiopia.MethodsA community-based cross-sectional study was conducted from March to April 2018 among 481mothers who had given birth in the last 12 months. A systematic random sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect the data. Data analysis was computed using SPSS version 20. An adjusted odds ratio with a 95% confidence interval and p-value less than 0.05 was used to determine the level of significance.ResultsThe proportion of early postnatal care service utilization was 34.3% (95% CI: 29.9%–38.5%). Mothers’ use of early postnatal care service was predicted by previous early postnatal care use (AOR=2.60, 95% CI: 1.41–4.77), ANC visit (AOR=0.122, 95% CI:0.059–0.251), delivery complication (AOR=5.57, 95% CI: 2.85–10.89), distance (AOR =5.05, 95% CI: 2.45–10.42), postnatal home visit (AOR=0.21, 95% CI: 0.11–0.40), awareness on early postnatal care (AOR=16.38 95% CI: 6.23–43.07), age (AOR=9.34, 95% CI: 1.73–50.27), (AOR=6.50, 95% CI: 2.29–18.41), (AOR= 6.23, 95% CI: 2.38–16.33) and income (AOR=7.97 95% CI: 2.42–26.26, AOR=3.30 95% CI:1.42–7.67).ConclusionOur study’s finding revealed that the prevalence of early postnatal care service use was low. Early postnatal care service use was significantly associated with previous early postnatal care use, delivery complication, distance, postnatal home visit, number of ANC visits, awareness on early postnatal care use, age, and income.

Community Acceptance and Utilization of Maternal and Community-Based Neonatal Care Services Provided by Health Extension Workers in Rural Sidama Zone: Barriers and Enablers: A Qualitative Study.

PurposeThis study assessed the community acceptance and utilization of maternal and community-based neonatal care services, its barriers, and enablers in southern Ethiopia, 2019.MethodsAn exploratory qualitative study was conducted among mothers, health extension workers, their supervisors and coordinators in four districts of Sidama Zone, Hawassa University Demographic Surveillance Site. An in-depth interview has been carried out with eight health extension workers and eight program coordinators and supervisors, while four focus group discussions were held with eligible mothers. Digital recording was applied to record the interview and discussion followed by transcription and thematic analysis through open code.ResultsStudy findings reveal that services provided by health extension workers at community level for mothers and their children are highly appreciated and recognized by the community. Most of the communities are free from wrong perception regarding the practices. Their performance was better in focused antenatal care, but postnatal care and community-based neonatal care were reported to be insignificant. Knowledge and skills of HEWs was based on their extended experiences. The challenges and opportunities include workload, road inaccessibility, poor supervision, inadequate drugs and equipment supply, shortage of man power and budget at health posts, distance and topography factors of homes from health posts making the visits more difficult, etc. To improve uptake of the services, increasing the number of health extension workers in the heath post, supportive supervision, continuous essential drugsm and medical supplies were suggested by participants.ConclusionThis study shows that services provided by health extension workers for mothers and their neonates are highly appreciated by the community, and there is better change in focused antenatal care services, but postnatal care and sick newborn care are still low. Therefore, maternal and neonatal programs should focus on the postnatal home visits and sick newborn care through solving identified barriers.

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design

BackgroundIn low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia.MethodsWe conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing the mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression.ResultsOne hundred and two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.49; CI 3.55–15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67–5.99), notified their birth (AOR, 6.16; CI 3.50–10.84) and those members of community health insurance (AOR, 1.87; CI 1.13–3.10) were factors associated with postnatal home visit by a health extension worker.ConclusionThe coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. The existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.

Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh.

BackgroundIndia suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received.Methods and findingsData were collected in 2016–2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality.Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26).ConclusionsIn this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services.