Postnatal Visits Research Articles

Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis

BackgroundEvidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy (‘SONU’: Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso.MethodsWe conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test.ResultsGratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01–0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13–2.47, p < 0.001), new consultations in children 1–4 years (Coeff 0.81; 95% CI 0.50–1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44–0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant.ConclusionsOur study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.

Utilization of Postnatal Care Services and Associated Socio-Demographic Factors among Mothers in Sheikhupura

The general state of a population's health system can be seen in the maternal morbidity and mortality rates. Despite the obvious benefits of postnatal healthcare services literature reveal that these services are frequently underused, especially in underdeveloped countries such as Pakistan. Objective: To identify the family traits that were thought to be the biggest factor of using the available postnatal health care services. Methods: According to the nature of the study quantitative research method was used. 323 females who were not currently pregnant but had given birth to one or more children selected in the sample of the present study. Final sample was chosen using a multistage sampling technique. Binomial logistic regression analysis was performed to examine the association between family traits and the use of postnatal healthcare services. Results: Results showed that 76.5% of respondents had their postpartum hemorrhage evaluated. The majority of participants (83.6%) and those who took contraceptives after giving birth (83.1%) got breastfeeding support. Results of the current study showed that the number of postnatal care visits was significantly correlated with the husband's age, education, and family's monthly income. Postnatal care was also connected to the husband's age, education, and family income levels. Conclusions: According to the study's conclusions, education should be targeted towards enhancing the significance of postnatal care services. To address the issue of health care service utilization, policy level actions are required to maximize the ratio of the utilization of postnatal care services.

Persistent Maternal Mental Health Disorders and Toddler Neurodevelopment at 18 Months: Longitudinal Follow-up of a Low-Income South African Cohort.

One of the biggest threats to early childhood development in Africa is poor maternal mental health. The present study reports on the relationships between clinical diagnoses of persistent maternal mental health disorders (at 3- and/or 6- and 18-month post-term age) and toddler neurodevelopment at 18 months of age. Eighty-three mother-toddler dyads from low socio-economic status settings in Cape Town, South Africa, were included. At the 3-, 6- and 18-month postnatal visits, clinician-administered structured diagnostic assessments were carried out according to the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria. Toddler neurodevelopment at 18 months corrected age was assessed with the Bayley Scales of Infant and Toddler Development (BSID-III). No significant differences (p > 0.05) were found between toddlers with exposure to persistent mood or psychotic disorders in the different BSID-III domains compared to toddlers with no exposure. Toddlers exposed to persistent comorbid anxiety and mood disorders scored significantly higher on the cognitive (p = 0.049), motor (p = 0.013) and language (p = 0.041) domains and attained significantly higher fine motor (p = 0.043) and gross motor (p = 0.041) scaled scores compared to toddlers with no maternal mental health disorder exposure. Future investigations should focus on the role of protective factors to explain the pathways through which maternal mental health status is associated with positive toddler neurodevelopmental outcomes.

Timely initiation of complementary feeding practices and associated factors among children aged 6-23 months in Dessie Zuria District, Northeast Ethiopia: a community-based cross-sectional study.

Ethiopia has one of the highest infant and child mortality rates in the world. Starting from the age of 6 months, breast milk alone is not sufficient to cover all nutritional requirements. Infants and young children are at an increased risk of undernutrition. Complementary feeding must, therefore, begin at the age of 6 months. Infant and young child nutrition is a critical factor in human health, nutrition, survival, growth, and development. Therefore, the aim of this study is to evaluate the timely initiation of complementary feeding practices and associated factors in children aged 6-23 months in the Dessie Zuria District of North Ethiopia. A community-based cross-sectional study design was used for the period between 16 March and 30 March 2019. The study included 770 mother-child pairs aged 6-23 months. A multistage sampling method was used to choose the study participants. Using a simple random sampling technique, nine kebeles in the district were selected from a total of 31, and from 103 Gotts or villages, 31 were selected with 770 HHs out of 2,329 HHs with children aged 6-23 months. Data were collected using a pretested semistructured interviewer-administered questionnaire, which was then entered into Epi Data version 3.1 statistical software before being transferred to SPSS version 21 for further analysis. To summarize the data, descriptive statistics were used, which included a simple frequency table and figures. To evaluate factors, bivariate and multivariable logistic regression were used. A p-value of less than 0.05 was used to determine statistical significance. The percentage of children who started complementary feeding practices on time was 70.9. Maternal occupation [AOR = 5.51, 95% CI (1.61-18.81)], radio availability [AOR = 2.03, 95% CI (1.32-3.12)], antenatal care follow-up [AOR = 6.19, 95% CI (4.08-9.40)], place of delivery [AOR = 5.06%, CI (3.34-7.68)], and postnatal care follow-up [AOR = 4.32, 95% CI (2.77-6.72)] were found to be the factors for the timely initiation of complementary feeding. When compared with WHO cutoff points, timely initiation of complementary feeding practice was relatively low in the study area. Maternal occupation, radio availability, ANC follow-up, place of delivery, and postnatal care visit were all significantly associated with the timely initiation of complementary feeding.

Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria.

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 24h, 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. 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. 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. 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.

Everything Midwives Need to Know about Postpartum Women's Health Care During the COVID-19 Pandemic: An Updated Evidence Review and Practical Guide

Abstract: Clinical practices vary significantly between countries, so healthcare providers must be aware of the differences in recommendations among guidelines to give the best care possible. It is up to the clinician to decide whether and to what extent to follow guidelines, based on each patient's special situation. This study aimed to review the updated evidence regarding practical aspects required for midwives to do postpartum care for mothers and newborns during COVID-19. The relevant guidelines in English were searched through databases including Cochrane Library, PubMed, EBSCO, and Scopus, from December 2019 to May 17, 2022, using keywords of ‘puerperium ‘, ‘newborn ‘, ‘2019- nCoV’ ‘SARS-CoV-2‘, ‘coronavirus ‘, and ‘guideline‘. Recommendation reports of WHO, FIGO, RCOG, UNFPA, CDC, and APA were also searched. Out of the 40 guidelines retrieved, 15 met the inclusion criteria. Postnatal care is divided into two general categories: maternal and neonatal care. The principles of postpartum care for maternal consisted of maternal assessment, venous thromboembolism prophylaxis, postnatal visits schedule, visitor restriction, vaccination, and postnatal mental support. Also, care for the neonatal included newborn assessment, visitation in the neonatal intensivecare units, breastfeeding, vaccination, circumcision, the decision for location and the separation of the newborn and mother, and discharge. During the COVID-19 pandemic, midwives and other maternal care professionals faced issues due to discrepancies between the guidelines of various global organizations. By obtaining recommendations and guidance and keeping up with the latest data, midwives can help women and their newborns get the best care possible.

Understanding of Postpartum Depression; Mini Literature Review

The transition to motherhood is a life-changing event that can be stressful, influencing a woman’s mental health and well-being. Postpartum depression (PPD) is a mental health concern affecting mothers, infants, and fathers from diverse backgrounds. Fifty to sixty percent of new mothers experience initial sadness and postpartum blues due to hormonal changes. Prenatal nurses often overlook PPD during postnatal visits due to a lack of knowledge and decreased self- efficacy when assessing and educating mothers about PPD. This is a mini systematic literature review.

Prevalence and factors associated with disrespect and abuse among women who delivered in a University Teaching Hospital in Nigeria

To determine the prevalence and factors associated with disrespect and abuse during childbirth among women who delivered in a University Teaching Hospital using a validated tool. This was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital. Participants included women who presented for the 6-week postnatal visit. The primary outcome was the experience of disrespect and abuse by the women in any of the thematic domains in the tool, namely friendly care, abuse-free care, timely care, discrimination-free care, abandonment, and non-consented care. In all, 200 participants were enrolled in the study. The prevalence of disrespect and abuse among the study population was 36.5%. Verbal abuse and untimely care were the commonest (15.5%). Nurses were mostly the perpetrators of disrespect and abuse. Maternal age, parity, and marital status among others were not significantly predictive of disrespect and abuse by respondents. Disrespect and abuse from health workers during childbirth is a prevalent problem among women who delivered in the hospital. This undesirable experience of childbirth needs to be addressed by stakeholders in maternal health.

Impact of integrated community-facility interventions model on neonatal mortality in rural Bangladesh- a quasi-experimental study.

Neonatal mortality remains unacceptably high in many countries. WHO recommends that all newborns be assessed during the postnatal period and should seek prompt medical care if there is any danger sign. However, in many developing countries, only a small proportion of women receive postnatal care. Also, the quality of care in public health facilities is sub-optimal. We designed an intervention package that included community health worker-assisted pregnancy and birth surveillance, post-natal visits to assess newborns on the first, third, seventh and twenty-eighth days of birth, referral for facility-based care, and establishing a newborn stabilization unit at the first level referral health facility. We did a quasi-experimental, propensity-score matched, controlled study in the Sylhet region of Bangladesh. We used a cross-sectional survey method at baseline and endline to measure the effect of our intervention. We considered two indicators for the primary outcome-(a) all-cause neonatal mortality rate and (b) case fatality of severe illness. Secondary outcomes were the proportion of neonates with signs and symptoms of severe illness who sought care in a hospital or a medically qualified provider. Our sample size was 9,940 live births (4,257 at baseline, 5,683 at end line). Our intervention was significantly associated with a 39% reduction (aRR = 0.61, 95% CI: 0.40-0.93; p = 0.046) in the risk of neonatal mortality and 45% reduction (aRR = 0.55, 95% CI: 0.35-0.86; p = 0.001) in the risk of case fatality of severe illness among newborns in rural Bangladesh. The intervention significantly increased the care-seeking for severe illness at the first-level referral facility (DID 36.6%; 95% CI % 27.98 to 45.22; p<0.001). Our integrated community-facility interventions model resulted in early identification of severely sick neonates, early care seeking and improved treatment. The interventions led to a significant reduction in all-cause neonatal mortality and case fatality from severe illness.

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.

Interventions to improve enablers and/or overcome barriers to seeking care during pregnancy, birthing and postnatal period for women living with vulnerabilities in high-income countries: A systematic review and meta-analysis

ObjectiveTo reduce maternal morbidity and mortality, World Health Organization recommendations include: commencing pregnancy care before 12-weeks’, at least eight antenatal and four postnatal visits, and attendance of skilled care at birthing. While lower adherence to the recommendation predominates in low- and middle-income countries, it also occurs in some settings in high-income countries. Globally, various strategies are used to optimise maternity care, in line with these recommendations. This systemic review aimed to determine if enhanced care improves maternal care-seeking, thus improving clinical outcomes for women and babies living with vulnerabilities, in high-income countries. Design, setting and participantsWe searched the Cochrane Central Registers of Controlled Trials and Cochrane Pregnancy and Childbirth, MEDLINE, CINAHL, Proquest Dissertation and Thesis and reference lists of relevant articles. The latest search was performed June 20, 2022. Randomised controlled trials, non-randomised intervention trials and cohort studies comparing effects of interventions designed to increase utilisation of maternal health services with routine care, for women at increased risk of maternal mortality and severe maternal morbidity in high-income countries were included. Two authors selected, extracted, assessed and analysed data. Additional information was sought from study authors. This systematic review and meta-analysis was registered with PROSPERO(CRD42021256811). FindingsNine studies with 5,729 participants were included. Interventions to enhance care significantly increased utilisation of health services, increasing attendance at antenatal classes (Odds Ratio[OR]=15·23, 95%Confidence Interval[CI] 10·73–21·61, p<0·0001) and postnatal visits by 6–8 weeks (OR=2·66, 95%CI 1·94–3·64, p<0·0001), compared to routine care. Infants in the intervention groups were significantly less likely to be: born preterm (OR=0·68, 95%CI 0·56–0·82, p<0·0001); low birthweight (OR=0·78, 95%CI 0·64–0·95, p = 0·01) or; require neonatal intensive care (OR=0·80, 95%CI 0·66–0·96, p = 0·02). Conclusions and Implications for practiceAmong women living with vulnerabilities in high-income countries, interventions to enhance care increases utilisation of maternal health services and improves outcomes.

Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi

BackgroundPregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls.MethodsOur study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls.ResultsThe prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27–0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34–7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22–3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61–0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73–0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78–0.96) but not in Malawi.ConclusionDepressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.

Obstetric rectal buttonhole tear and a successful three-layer repair: A case report

An obstetric rectal buttonhole tear (ORBT) is a rare obstetric complication with only 21 cases reported in the literature. The choice of two- or three-layer repair of ORBT is controversial. In this case, the author describes (with high-quality images) an ORBT repaired in three layers in order to provide clinical lessons to healthcare professionals involved in obstetrical care. The patient was a 26-year-old pregnant woman with a previous vertex delivery and 4 previous first-trimester miscarriages. In the index pregnancy, she had a spontaneous vertex vaginal birth of a 3095g male baby at 39weeks of gestation. During childbirth, she sustained an ORBT and a third-degree perineal tear involving <50% of the external anal sphincter. The ORBT was repaired in three layers using continuous 2-0 Vicryl to the rectal mucosa, and interrupted polydioxanone (PDS) 3-0 to the adjoining vagino-rectal fascia. Subsequently, the external anal sphincter was repaired end-to-end with interrupted PDS 3-0. Thereafter, the vagina was repaired with continuous Vicryl 2-0. The wound healed with no complications over the 12weeks of postnatal clinic visits. A three-layer repair is arguably preferable given that closure of the fascia between the rectal and vaginal mucosae (vagino-rectal fascia) may improve the tensile strength at the injury site. However, a two-layer repair may be undertaken in rare cases where the vagino-rectal fascia is not identifiable.

Evaluation of Baby Sleep Position Practices and Sleep Environment

Objective: The aim of this current study was to determine mothers’ infant sleep position practices and their awareness of a safe sleeping environment. Material and Methods: This descriptive survey was conducted with 418 mothers who had infants aged 0-6 months and who agreed to participate in pediatric outpatient polyclinics of two hospitals. Data were collected between January-December 2020 via-structured questionnaires by face-to-face interview. Results: Of the 418 mothers; 28% placed their babies in the supine sleeping position, 59.6% used a pillow when they put their babies in bed and 76.8% used a soft mattress. 42.3% of mothers covered their babies’ faces during sleep; primary school graduate mothers were more intended on covering their babies’ faces than high school and university graduates (p&amp;lt;0.001). 4.1% of mothers smoked during pregnancy, 9.8% during the lactation period and 15.3% were exposed to household smoke. All of the mothers shared a room with their babies without sharing a bed. There was also a positive correlation between the number of prenatal visits of mothers and their preference to put their babies to sleep in the supine position (p=0.010). Conclusion: Most of the mothers placed their babies in a side sleeping position. Mothers’ avoiding sharing beds and smoking cigarettes and prone positioning their children at a very low frequency were pleasing measures. Mothers who had more prenatal visits were found to place their babies more in the supine sleep position. Increasing the awareness of healthcare providers and other secondary caregivers about a safe sleeping environment and baby sleep position during pre and postnatal visits would make right practices become widespread.

Individual and community-level factors associated with iron-rich food consumption among children aged 6-23 months in Rwanda: A multilevel analysis of Rwanda Demographic and Health Survey.

Iron-rich food consumption has an invaluable effect for neonatal and fetal brain development as well as metabolic activities. Despite the public health importance of the consumption of iron-rich foods, there was no study, that assessed iron-rich food consumption in Rwanda. Therefore this study aimed to assess iron-rich food consumption and associated factors among children aged 6-23 months using Rwanda Demographic and Health Survey (RDHS). Secondary data analysis was done using RDHS-2019/20. Total weighted samples of 2455 children aged 6-23 months were included. Data coding, cleaning, and analysis were performed using Stata 16. Multilevel binary logistic regression were performed to identify factors associated with iron-rich food consumption. Adjusted Odds Ratio (AOR) with a 95% CI, and p-value <0.05 were used to declare statistical significance. The prevalence of good iron-rich food consumption was 23.56%(95% CI: 21.92,25.28). Northern province of Rwanda (AOR = 0.26,95%CI: 0.15,0.46), mothers secondary education and above (AOR: 2.37, 95% CI: 1.41, 4.01), married mothers (AOR:1.31, 95% CI: 1.01,1.71), rich wealth status (AOR = 2.06, 95% CI: 1.48, 2.86), having post-natal visit (AOR = 1.45, 95% CI: 1.10,1.91), mothers media exposure (AOR: 1.75, 95% CI: 1.22, 2.52) and drugs given for intestinal parasite (AOR = 1.37, 95% CI: 1.04, 1.80) were associated with iron-rich food consumption. This study shows that overall iron-rich foods consumption was low in Rwanda. The residing in the North province, mother's secondary and higher educational status, married marital status, rich and middle wealth status, having media exposure, drugs given for intestinal parasites, and having child's post-natal checkup were variables significantly associated with iron-rich food consumption. The region-based intervention will improve the consumption of iron-rich food. In addition, health policies and programs should target educating mothers/caregivers, encouraging parents to live together, improving their wealth status, working on mass media access by the women, and encouraging mothers post-natal checkups to improve iron-rich food consumption.

Out-of-pocket payments during childbirth in Kenya under the free maternity services: Perspectives of mothers, healthcare workers and county officials

Background: This study seeks to determine the extent of women's out-of-pocket (OOP) payments for delivery under the free maternity policy (FMP). Methods: We conducted a convergent parallel mixed-methods study using quantitative and qualitative data collection. The study was set in three facilities (levels 3, 4, and 5) in Kiambu County, Kenya. The study involved exit interview (EI) surveys with mothers (n = 553) who utilised FMP delivery services and focus group discussions (FGDs) with mothers who returned for postnatal visits (6, 10, and 14 weeks). There were 21 in-depth interviews (IDIs) with county officials and healthcare workers (HCWs). Quantitative data were analysed using descriptive statistics, while qualitative data were audio-recorded, transcribed and analysed using thematic analysis. Results: Despite the FMP being free on paper, mothers incurred OOP payments in practice. The overall mean OOP payments incurred by mothers who underwent normal delivery was 9.50 USD (SD 8.20 USD), and caesarean section (CS) was 10.88 USD (SD 15.16 USD). The main cost drivers were transport, lack of adequate supply and medications, lack of policy clarity by health workers, failure to notify the NHIF office of available clients, and ultrasound scan services. While the OOP payments were not deemed catastrophic, some women perceived it as a barrier to care as they ended up using savings or selling their assets to meet the costs. There were no patient characteristics associated with OOP payments. Conclusions: OOP payments during childbirth in Kenya place a considerable economic burden on mothers and their households. There is need to promote awareness of the policy and provide a sustainable form of transport, especially during emergencies, through collaboration with partners. Prioritising the supply of required medication used in maternal services in the universal health care benefits package to which Kenyan citizens are entitled, or sustainably financing the FMP is crucial.

Factors influencing uptake of postnatal care services at a maternal and child health clinic in Kajiado County Referral Hospital, Kenya

Background/Aims Despite birth aftercare recommendations that a postnatal visit should take place to examine both a woman and her child 6 weeks after birth, use of postnatal care services remains low at the Kajiado County referral hospital. This study's aim was to understand the factors influencing uptake of postnatal care among women of reproductive age. Methods This qualitative study used purposive sampling to select study respondents who were asked to attend focus group discussions to collect data. A total of 12 women were interviewed during their postnatal period. The qualitative data were analysed by theme categorisation. Results Respondents cited low income and forgetfulness, as well as the long distance to travel for postnatal services and long waiting times at the hospital as the main factors hindering attendance at and use of postnatal services. Conclusions Affordable and accessible postnatal care services need to be provided to follow up postnatal mothers, reducing the waiting time for services in postnatal clinics and ensuring women's partners support them to promote postnatal care service use.

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review.

The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by two reviewers using a study-specific data extraction form. All conflicts were solved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,845,490 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week was the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8-28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2-7 (48.1%), and diarrhea between days 8-28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.

La morbidité maternelle : situation et déterminants entre 2020 et 2021 dans la province d’Essaouira, Maroc

Introduction&#160;: Maternal morbidity is a public health problem in developing countries.Purpose of research&#160;: The aim of this study was to determine the prevalence of maternal morbidity among women of reproductive age in the province of Essaouira (Morocco) and to describe the factors associated with it. The authors conducted a cross-sectional structured interview survey of 1300 married women aged 18 to 49. Data entry and statistical processing were performed by the SPSS-PC 18 program.Results&#160;: The prevalence of maternal morbidity was 66.8%. The main morbidities were sexually transmitted infections (48.8%) and anemia (46.6%). Multivariate analysis showed that frequency of postnatal visits, literacy of the couple and socioeconomic level were statistically associated with maternal morbidity.Conclusion&#160;: The use of postnatal care, the fight against illiteracy and the improvement of the socio-economic level of households, are factors that would reduce maternal morbidity.

Socioeconomic inequity in coverage and quality of maternal postnatal care in Ethiopia.

High-quality postnatal care is vital for improving maternal health. This study examined the relationship between household socioeconomic status and both coverage and quality of postnatal care in Ethiopia. Cross-sectional household survey data were collected in October-November 2013 from 12 zones in 4 regions of Ethiopia. Women reporting a live birth in the 3-24 months prior to the survey were interviewed about the care they received before, during and after delivery and their demographic characteristics. Using mixed effect logistic and linear regression, the associations between household socioeconomic status and receiving postnatal care, location of postnatal care (health facility vs. non-health facility), cadre of person providing care and the number of seven key services (including physical checks and advice) provided at a postnatal visit, were estimated. A total of 16% (358/2189) of women interviewed reported receiving at least one postnatal care visit within 6 weeks of delivery. Receiving a postnatal care visit was strongly associated with socioeconomic status with women from the highest socioeconomic group having twice the odds of receiving postnatal care compared to women in the poorest quintile (OR [95% CI]: 1.98 [1.29, 3.05]). For each increasing socioeconomic status quintile there was a mean increase of 0.24 postnatal care services provided (95% CI: 0.06-0.43, p= 0.009) among women who did not give birth in a facility. There was no evidence that number of postnatal care services was associated with socioeconomic status for women who gave birth in a facility. There was no evidence that socioeconomic status was associated with the provider or location of postnatal care visits. Postnatal care in Ethiopia shows evidence of socio-economic inequity in both coverage and quality. This demonstrates the need to focus on quality improvement as well as coverage, particularly among the poorest women who did not deliver in a facility.