Measures to assess quality of postnatal care: A scoping review

Development and validation of the person-centered postnatal care scale for low- and middle-income countries

Background

High-quality postnatal care (PNC), including Person-centered postnatal care (PCPNC), is essential to achieving optimal maternal and neonatal outcomes. PCPNC refers to postnatal care that is respectful of and responsive to postpartum women's preferences, needs, and values. While interest in person-centered care across the reproductive health continuum has increased, there are no validated tools to comprehensively measure PCPNC. This study aims to develop and validate a tool to comprehensively measure PCPNC that is relevant to the experiences of women in low- and middle-income countries (LMICs).

Methods

The adaptation and validation process included a literature review to define, construct, and develop the scale items. This was followed by expert reviews with maternal health experts, health care providers, and women with past postnatal care experience to assess content validity. We then conducted cognitive interviews with postpartum women to ensure the questions were relevant, clear, and understandable. We iteratively revised the questions at each stage and surveyed 268 postpartum women (who gave birth within the last six months) in the Upper East Region of Ghana for initial analysis. We then analyzed the data, which informed additional edits to the questions. The final questions were administered in a survey to 1,394 women in Ghana and Kenya who had received postnatal care within 12 weeks postpartum. Psychometric analysis was used for item reduction and to assess construct and criterion validity and internal consistency reliability.

Results

Following iterative factor analysis, we developed a 38-item PCPNC scale. The 38 items load onto one dominant factor, with three factors having eigenvalues greater than one and Cronbach alpha of 0.93. We grouped the items into three conceptual domains representing "dignity and respect," "communication and autonomy," and "responsive and supportive care" subscales, each of which has Cronbach alpha > 0.7. PCPNC scores are associated with satisfaction with PNC and intent to receive PNC in the same health facility in the future, suggesting good criterion validity.

Conclusions

The PCPNC scale is a valid and reliable tool to measure respectful and responsive PNC and will thus facilitate efforts to monitor and improve women and their baby's experiences during PNC.

Socioeconomic Disparities in Accessing Early Newborn Care in Pakistan: Secondary Data Analysis of Nationally Representative Sample

Objective: Pakistan ranks third in newborn mortality. The study aims to examine any socioeconomic disparities in 48-hour newborn care practices in Pakistan using 6 signal functions. Materials and Methods: Using R (version 4.3.1), a secondary analysis of 3936 mothers' Pakistan Demographic and Health Survey 2017-2018 data was performed. Newborn care practices in 48 hours of life were measured using 6 indicators: cord examination, temperature measurement, danger sign counseling, breastfeeding counseling, breastfeeding observation, and weight measurement. The outcome variable was defined as completing at least 2 signal functions. The frequencies of explanatory variables were estimated using descriptive analysis. Multivariate logistic regression was performed between independent variables and at least 2 signal functions. Results: Among mothers practicing the most newborn care, 71.8% were from urban areas, 81.9% were among the richest, 68.9% had institutional deliveries, 71.3% had 4 or more antenatal care (ANC) visits, 81.5% had cesarean sections (C-sections), and 68.1% were attended by skilled birth attendants. After adjusting for covariates, the likelihood of having at least 2 signal functions was 2.46 times greater for C-sections and 1.58 times greater for institutional deliveries, 2.41 times more probable for mothers with over 4 ANC visits, 1.75 times more likely for those with skilled birth attendants, and 1.64 times more common for the richest mothers. Conclusion: Wealth, C-sections, institutional births, skilled birth attendants, and frequent ANC visits were related to higher care levels, indicating the need for targeted measures in vulnerable populations.

Socioeconomic Disparities in Accessing Early Newborn Care in Pakistan: Secondary Data Analysis of Nationally Representative Sample

Objective: Pakistan ranks third in newborn mortality. The study aims to examine any socioeconomic disparities in 48-hour newborn care practices in Pakistan using 6 signal functions. Materials and Methods: Using R (version 4.3.1), a secondary analysis of 3936 mothers' Pakistan Demographic and Health Survey 2017-2018 data was performed. Newborn care practices in 48 hours of life were measured using 6 indicators: cord examination, temperature measurement, danger sign counseling, breastfeeding counseling, breastfeeding observation, and weight measurement. The outcome variable was defined as completing at least 2 signal functions. The frequencies of explanatory variables were estimated using descriptive analysis. Multivariate logistic regression was performed between independent variables and at least 2 signal functions. Results: Among mothers practicing the most newborn care, 71.8% were from urban areas, 81.9% were among the richest, 68.9% had institutional deliveries, 71.3% had 4 or more antenatal care (ANC) visits, 81.5% had cesarean sections (C-sections), and 68.1% were attended by skilled birth attendants. After adjusting for covariates, the likelihood of having at least 2 signal functions was 2.46 times greater for C-sections and 1.58 times greater for institutional deliveries, 2.41 times more probable for mothers with over 4 ANC visits, 1.75 times more likely for those with skilled birth attendants, and 1.64 times more common for the richest mothers. Conclusion: Wealth, C-sections, institutional births, skilled birth attendants, and frequent ANC visits were related to higher care levels, indicating the need for targeted measures in vulnerable populations.

Role of proper postnatal care in continued exclusive breastfeeding among young Indonesian mothers

BACKGROUND

Exclusive breastfeeding (EBF) provides numerous health benefits to children. However, the EBF rate is unsatisfactory among young mothers because they often experience difficulties. Thus, interventions during the postnatal period are imperative to encouraging EBF practices in these populations. Postnatal care (PNC) should be delivered appropriately to ensure a positive postnatal experience; however, there has been little discussion of evidence therein to date.

PURPOSE

This study investigated the association between proper PNC and EBF practices among young Indonesian mothers.

METHODS

This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. All mothers aged 15-24 years who delivered an infant within the 2 years preceding the survey were included. Mothers were considered to be receiving proper PNC if they started breastfeeding soon after delivery, attended a PNC appointment within 2 days after giving birth, and received breastfeeding counseling and observation during the PNC visit.

RESULTS

Approximately 51.6% of infants under 6 months of age born to young mothers (those aged 15-24 years) were exclusively breastfed. Appropriate PNC was received by approximately 24.3% of the total population. The correlation between proper PNC and EBF practices was significant among adolescent mothers aged 15-19 years after an age stratification analysis (odds ratio, 8.22; 95% confidence interval, 1.957-34.524). Maternal age became a noticeable confounder after a risk-stratification analysis.

CONCLUSION

Our findings imply the importance of breastfeeding service delivery during the early postnatal period in continuing EBF. Ensuring high PNC quality helps ensure positive postnatal experiences, particularly for adolescent mothers.

Utilisation of maternal healthcare services and influencing factors in public health facilities in Addis Ababa, Ethiopia

Background

Ethiopian maternal mortality remains high, despite the implementation of extensive health programmes. This indicates that the full potential of maternal health services is not being effectively utilised.

Aim

This study aimed to evaluate the utilisation and factors influencing maternal healthcare services in public health facilities in Addis Ababa.

Setting

This study was conducted in five public hospitals and 10 public health centres of Addis Ababa city administration from 31st August 2023 to 13th October 2023.

Methods

The study's design utilised a cross-sectional quantitative technique, which involved interviewing 354 women from each group who received visits throughout their pregnancy, delivery and postpartum period. The data were analysed using SPSS version 26.

Results

This study analysed maternal health service utilisation indicators, revealing a 70.8% overall utilisation of services, with antenatal care (ANC) at 85.5%, delivery at 71.58% and family planning services (PNC) at 55.4%. The study found that the length of time spent travelling to public health facilities significantly impacts the use of maternal health services. Pregnant women who travelled less than 30 min used services 2.29 times more than those over 2 h. The average client wait time also influenced service usage. Pregnant women with four or more prenatal care visits were more likely to use services.

Conclusion

The study conducted in Addis Ababa's capital city revealed that the utilisation of maternity health care services is not optimal, despite the concentrated resources.

Contribution

The findings of the study could be beneficial for the Addis Ababa Health Bureau, Ministry of Health, legislators, and other stakeholders. It can help in the development of affordable intervention programmes, filling knowledge gaps and updating scientific understanding.

Postnatal quality of care measures for mothers and newborns at home: A scoping review

The postnatal period is one of the most critical periods in the lives of mothers and newborns. Yet, the postnatal period remains the most neglected period along the maternal health care continuum. Globally, measures assessing quality of postnatal care (PNC) often focus on care at health facility level, the provision of home-based PNC and associated quality of care measures seem largely overlooked. This scoping review aims to give an overview of the literature on measures assessing quality of PNC for mothers and newborns in a home-based setting. This review was conducted according to the Arksey and O'Malley's methodology for scoping reviews. Three electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened the identified articles. All data on home-based PNC measures were extracted and mapped according to the 2022 World Health Organization PNC Guideline recommendations in three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. Several additional quality of care domains, characterizing home-based PNC, were identified: i) social and emotional empowerment, ii) assessment of the home setting, iii) early breastfeeding, iv) health education and counseling, v) personal hygiene and prevention of infections, vi) referral to health facility when necessary, vii) thermal care, viii) parent-child relationship and ix) promote economic self-sufficiency. This review illustrates that home-based PNC has a very broad spectrum of care and plays a vital role in improving maternal and newborn health and well-being. In addition, there is a clear need for more research on the optimal timing and content of home-based care in the postnatal period for maximizing its potential.

Psychometric evaluation of the early postnatal questionnaire for Swedish population

BACKGROUND

Previously developed instruments measuring the quality of postnatal care, based on women's experiences and views, are mainly country-specific which makes it important to have studies for specific populations. The aim of this study was to explore validity and reliability evidence of a previously developed postnatal questionnaire for women living in Sweden.

METHOD

A cross-sectional study based on self-report questionnaire. The questionnaire included the Early Postnatal Questionnaire (EPQ), and was administered to 1061 women who gave birth in two regional hospitals in Swedish during 2017. Validity evidence of the EPQ was undertaken using principal component analysis. Regarding reliability, Cronbach's alpha was used.

RESULTS

The questionnaire was returned by 483 postnatal women. The analysis resulted in three components: Information, Postnatal Environment and Caring Relationship. The Cronbach alpha values of the components ranged from 0.762 to 0.879. Foreign-born women scored higher (more positively) in all three components, compared to women born in Sweden.

CONCLUSIONS

The results of this study suggest that the instrument EPQ is a psychometrically useful tool, suitable for both research and clinical settings. The three-component structure provides researchers with the opportunity to conduct a more detailed exploration of various aspects of postnatal care to develop postnatal care. Further studies focusing on foreign-born women's experiences of postnatal care are warranted.

Determinants and geographic distribution of early newborn care in Ethiopia: evidence from the 2019 Ethiopian Mini Demographic Health Survey

Early newborn care provided in the first 2 days of life is critical in reducing neonatal morbidity and mortality. This care can be used to monitor and evaluate the content and quality of neonatal postnatal care. This study aimed to identify determinants and geographic distributions of early newborn care uptake in Ethiopia. We used data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). We conducted a multilevel binary logistic regression model and geographic analysis to identify the determinants of receiving early newborn care. A total of 2105 children were included in the study. Of the included children, 39.6% (95% confidence interval (CI) 38%, 42%) received at least two components of early newborn care services in the first 2 days after birth. Greater odds of receiving early newborn care were experienced by infants to mothers with secondary or above education (adjusted odds ratio (AOR) = 1.72; 95% CI 1.44, 2.18), from households with highest wealth quantiles (AOR = 1.47; 95% CI 1.16, 1.79), with at least one antenatal care contact (AOR = 2.73; 95% CI 1.79, 4.16), with birth at health facility (AOR = 25.63; 95% CI 17.02, 38.60), and those births through cesarean section (AOR = 2.64; 95% CI 1.48, 4.71). Substantial geographic variation was observed in the uptake of early newborn care in Ethiopia. Several individual- and community-level factors were associated with newborn postnatal care. Policymakers should prioritise these areas and the enhancement of postnatal healthcare provisions for mothers with low socioeconomic status.