Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

Exploring and prioritising strategies for improving uptake of postnatal care services in Thyolo, Malawi: A qualitative study

Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of these services has remained low worldwide. This study explored and prioritised the strategies for optimising the uptake of postnatal care (PNC) services in Malawi. A qualitative descriptive study followed by nominal group techniques was conducted at three health facilities in Malawi from July to December 2020 and in October 2021. We conducted focus group discussions among postnatal mothers, fathers, healthcare workers, elderly women, and grandmothers. We conducted in-depth interviews with midwives and key health managers. Nominal group techniques were used to prioritise the main strategies for the provision of PNC. The demand strategies include appointment date reminders, provision of free health passport books, community awareness campaigns, and involvement of men in the services. The supply strategies included training health providers, improving clinic operations: task-shifting and hours of operation, having infrastructure for the services, and linkage to other services. Having services delivered near end-user residences was a crosscutting strategy. Refresher training and improvement in the clinic operations especially on hours of operation, appointment date reminders, and linkage to care were the prioritised strategies. There is a need to use acceptable and contextualised strategies to optimise the uptake and delivery of postnatal care services. Educating the healthcare workers and the community on postnatal services is key to increasing the demand and supply of the services.

'Being a mother is not child's play': The capabilities of mothers in a low-resource setting in South Africa

BACKGROUND

The importance of a child's first 1000 days has now been widely accepted by the medical fraternity. Yet, we do not know much about caring practices in low-resource settings.

AIM

This study aimed to investigate the caring capabilities of mothers in a low-resource setting.

METHOD

In this study, in-depth interviews were conducted with 18 mothers with children aged 30 months or younger to better understand the arrangements, means and ends that inform developmental health in a low-resource setting in South Africa. The study was conducted in a low-income area, the former black township of Mangaung in Bloemfontein. The mothers were recruited via pamphlets, and two interviews followed. Because of Covid-19, interviews took place via mobile phones, in Sesotho, the local language in the area. Trained fieldworkers conducted, translated and transcribed the interviews. We used thematic analysis and the capabilities approach as the theoretical framework to analyse the responses from the mothers.

FINDINGS

We used the following organizing themes: pregnancy and ante-natal care, nutrition, cognitive and physical development, the home environment and access to health care. Although short-term reactions to pregnancy were often negative, the longer-term responses showed that the respondents have agency. Most of them could change their nutrition habits, breastfeed and receive adequate nutrition support from the public health system. Most experienced joy when their children reached milestones (cognitive and others), although they became anxious if milestones were not reached. They emphasized children's play and had dreams for their children's futures. Technology was often mentioned as playing a role in their children's development. A large proportion of the respondents had disrupted homes (because of absent or abusive fathers), but some had stable homes. Most of them showed substantial capability to overcome adverse home environments. The public health system helped them deal with their health problems and their children's health problems, although it also created anxiety in many cases. Our data show how they develop their capabilities and overcome obstacles organically in the face of resource limitations. Despite pregnancies being unexpected and unplanned and fathers being absent, the respondents accepted the pregnancy, adjusted their diets and social behaviour, showed agency by attending primary healthcare facilities and ensured that their children received the required vaccinations. Their extended families played an important role in providing care. Despite the sacrifices, the respondents expressed joy and helped their children function by eating, playing, socializing, learning and using their senses.

CONCLUSION

Our sample of mothers have the agency to adapt to the demands of parenthood and childcare and overcome adversity. Our data support the notion that mothers are held disproportionately and unfairly responsible for achieving the first 1000 days ideals. Despite considerable curtailment of their functionings and capabilities, they nevertheless showed agency to ensure their health and their children's health. A holistic approach should consider these findings in designing policy interventions for children's developmental health.

PATIENT AND PUBLIC CONTRIBUTION

We used paid fieldworkers to interact with the research participants.

Qualitative assessment of family caregiver-centered neonatal education program in Karnataka, India

Globally 2.5 million newborns die every year before they reach the age of one month; the majority of these deaths occur in low- and middle-income countries. Among other factors, inadequate knowledge and skills to take care of newborns contribute to these deaths. To fill this gap, training patients and family members on the behaviors needed to improve essential newborn care practices at home is a promising opportunity. One program that aims to do this is the Care Companion Program (CCP) which provides in-hospital, skills-based training on care of mothers and newborns to families. This study uses semi-structured interviews to understand how and why knowledge and behaviors of maternal and newborn care behaviors change (or don't change) as a result of CCP sessions and participants' perception of the impact of CCP on change. Interviews focused on knowledge and behaviors around key neonatal and newborn topics and health seeking behaviors for health complications. Forty-two in-depth interviews were conducted among families with recently-delivered babies at their homes from four districts in Karnataka, India. Respondents have a positive perception about CCP, found training useful and appreciated other family members presence during the training. CCP increased knowledge and awareness and provided critical details to key behaviors like breastfeeding. Respondents were more likely to be receptive toward details on already known topics, like hand washing before touching the baby. Awareness increased on newly learned behaviors, like skin-to-skin care, which don't conflict with cultural norms. The CCP did not influence nonrestrictive maternal diet as much, which cultural norms heavily influence. In-hospital family caregiver education programs, like CCP, can positively influence key neonatal behaviors by imparting knowledge and key skills. However, the effect is not universal across health behaviors.

Level of Postnatal Checkup in Ethiopia - Implications for Child Health Services

Background

High neonatal mortality rates continue to be a major public health issue in Ethiopia. Despite different maternal and neonatal care interventions, neonatal mortality in Ethiopia is at a steady state. This could be due to the low utilization of neonatal checkups. Thus, nationally assessing the level and predictors of postnatal checkups could provide important information for further improving neonatal healthcare services.

Materials and Methods

A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) was performed on 7,586 women who had live births in the 2 years before the survey. All variables with a p-value of ≤0.25 in the bivariable analysis were entered into the final model for multivariable analysis, and the level of statistical significance was declared at a P-value of <0.05.

Results

According to the national survey, only 8.3% [95% CI: 8.19, 8.41] of neonates received postnatal checkups. About two-thirds of women, 62.8% had antenatal care visits, 67.9%, gave birth at home, and 95.7% were unaware of neonatal danger signs. Distance from health care institutions [AOR = 1.42; 95% CI: 1.06, 1.89], giving birth in a healthcare facility [AOR = 1.55; 95% CI: 1.12, 2.15], antenatal care visit [AOR = 3.0; 95% CI: 1.99, 4.53], and neonatal danger signs awareness [AOR = 3.06; 95% CI: 2.09, 4.5] were all associated with postnatal care visits.

Conclusion

The number of neonates who had a postnatal checkup was low. Increasing antenatal care visit utilization, improving institutional delivery, raising awareness about neonatal danger signs, increasing access to health care facilities, and implementing home-based neonatal care visits by healthcare providers could all help to improve postnatal checkups.

Impact of family-centred postnatal training on maternal and neonatal health and care practices in district hospitals in two states in India: a pre-post study

BACKGROUND AND OBJECTIVES

The Care Companion Program (CCP) is an in-hospital multitopic skill-based training programme provided to families to improve postdischarge maternal and neonatal health. The states of Punjab and Karnataka in India piloted the programme in 12 district hospitals in July 2017, and no study to date has evaluated its impact.

METHODS

We compared telephonically self-reported maternal and neonatal care practices and health outcomes before and after the launch of the CCP programme in 11 facilities. Families in the preintervention group delivered between May to June 2017 (N=1474) while those in the intervention group delivered between August and October 2017 (N=3510). Programme effects were expressed as adjusted risk ratios obtained from logistic regression models.

RESULTS

At 2-week postdelivery, the practice of dry cord care improved by 4% (RR=1.04, 95% CI 1.02 to 1.06) and skin-to-skin care by 78% (RR=1.78, 95% CI 1.37 to 2.27) in the postintervention group as compared with preintervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91), mother complications by 12% (RR=0.88, 95% CI 0.79 to 0.97) and newborn readmissions by 56% (RR=0.44, 95% CI 0.31 to 0.61). Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46). However, the practice of exclusive breastfeeding, unrestricted maternal diet, hand-hygiene and being instructed on warning signs were not statistically different.

CONCLUSION

Postnatal care should incorporate predischarge training of families. Our findings demonstrate that it is possible to improve maternal and neonatal care practices and outcomes through a family-centered programme integrated into public health facilities in low and middle-income countries.

Mothers' Perceptions of the Quality of Postnatal Care Provided in Health Centers and the Associated Factors: A Cross-Sectional Study

Background

Postnatal care plays a great role in the health of mothers and their neonates. This study aimed to evaluate the mothers' perceptions of the provided postnatal care and the associated factors.

Methods

In this cross-sectional study, the health centers of Sirik city in Hormozgan province, Iran, were selected using convenience sampling. The study was conducted on 160 mothers who had referred to the selected centers for postnatal care from 7 August 2018 to 2 August 2020 and had given birth to live full-term neonates (>37 weeks of gestation) 40 days to 12 months before sampling. The Mothers' Perceptions of the Quality of Postnatal care questionnaire was designed by the research team; it included 18 questions about mothers' perception of care. The collected data were analyzed using the SPSS software, version 21.

Results

The mothers' mean score of perception was 69.84±16.04; most mothers rated the provided postnatal care and their relationship with the personnel as good or excellent. The mean total scores of the mothers' perceptions were not different based on their satisfaction with postnatal care (P=0.646) and time of the first referral after birth (P=0.251), but they were significantly different according to the number of referrals (P=0.023) and their satisfaction with the health personnel (P<0.001).

Conclusion

The study results revealed that mothers had a good perception about postnatal care provided by health center staff. Hence, it is necessary to educate all health staff in this regard to provide high-quality postnatal care to all mothers who refer to these centers.

Early Newborn Bath Practice and Its Associated Factors in Jimma, South West Ethiopia, 2021

Aims

The timing of the first bath is an important variable in newborn care despite variations from setting to setting. Early first bath can affect the newborn’s temperature, blood sugar levels, bonding with his/her mother, comfort, and security. Thus, timing affects several aspects of newborn care and is still a major concern. However, in Ethiopia, there is insufficient evidence regarding newborn bath timing. Therefore, this study aimed to assess early newborn bath practice and its associated factors in Jimma, Southwest Ethiopia, 2021.

Materials and Methods

An institutional-based cross-sectional study was conducted from July to August 2021 on 388 postpartum women who came for newborn immunization. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epi-data 4.4.2.1 and exported to Stata version 14 for cleaning and analysis. Logistic regression was used to determine the association between explanatory and response variables. The level of significance was declared at a p-value of less than 0.05 in multivariable logistic regression.

Results

This study revealed 126 (32.5%) of mothers were practicing early newborn bathing. Vaginal mode of delivery (AOR: 3.84 (95% CI: 1.96–7.52)), poor knowledge about danger signs (AOR: 6.78 (95% CI: 3.77–12.19), poor knowledge about hypothermia (AOR: 0.35 (95% CI: 0.20–0.58) and educational level of women (AOR: 0.33 (95% CI: 0.15–0.73) were variables significantly associated with early newborn bathing practice.

Conclusion

Early neonatal bathing practice in this study is high and needs priority as it results in neonatal hypothermia and its complications. Therefore, Education for women and their families on delayed bathing of their newborns could begin in antenatal care visit, on admission into the labor and delivery unit and again on the postpartum unit.

Effect of educational video on newborn care for the knowledge of pregnant and postpartum women and their families

OBJECTIVES

to evaluate the effect of educational video on newborn care to increase the knowledge of pregnant, postpartum, and family members.

METHODS

a quasi-experimental study, with pre-intervention and post-intervention evaluation with a single group. Fifty-eight pregnant, postpartum, and family members treated in basic health units and a hospital in Ceará, Brazil, participated. The study used the McNemar and binomial tests for the analysis.

RESULTS

after the intervention, there was an increase in the frequency of hits, from 70.82% to 92.97%. Most of the questions presented a significant increase of hits (p < 0.05) with an emphasis on sleeping position, drying of clothes, free demand for breastfeeding, and things to avoid (such as accessories in the sleeping place and talc in diaper change).

CONCLUSIONS

the educational video was effective to participants in acquiring knowledge on the care of newborns and can assist in health education activities carried out by nurses.