Integration of postpartum care into child health and immunization services in Burkina Faso: Findings from a cross-sectional study

Background: The Missed Opportunities for Maternal and Infant Health (MOMI) project, which aimed at upgrading maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013 to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive, maternal, newborn and child health services (RMNCH).Methods: We conducted a mixed methods study with cross-sectional surveys before and after the intervention in the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were performed in 2012 (N = 757) and in 2014 (N = 754) among mothers within one year postpartum. The analysis examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the first 48 h, days 6–10 and during weeks 6–8 and beyond. On the qualitative side, in depth interviews, focus group discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded, transcribed and analysed along the themes relevant for the intervention.Results: The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were followed for physical examinations and consultations. They also show a significant increase in the coverage of maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the intervention. However, more women were assessed at days 6–10 than at later visits. Integration of maternal PPC was low, with little improvements in history taking and physical examination of mothers in immunization services. While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration.Conclusion: Unless a comprehensive strategy of integration within RMNCH services is implemented to address the primary health care challenges within the health system, integration will not yield the desired results

Additional file 2: of Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis

Figure S1. Number of lives births per month per place of residence (rural, urban. Figure S1 shows the trend of live births over time in rural and urban HFs. Births follow a seasonal pattern linked to the Sudanese climate zone with dry and rainy seasons. Burkina Faso’s population is mainly rural (> 80%) and during the rainy season, from May to October, people are busy farming. Women become pregnant during the dry season, mainly from December to January, during which farming activities are less intense and temperatures are the lowest (17 °C). Therefore, live birth deliveries were more numerous in September 2013, 2014 and 2015. (DOCX 19 kb

Additional file 3: of Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis

Table S2. Monitored indicators by number of cases by health facility per period. Table S2 shows that there was an increase in the number of women who visited day 6–10 and week 6–8 PPC, and who received PPFP counselling and chose an FP method between September 2012 and August 2013 (1st period) and September 2015–December 2015 (2nd period), in both rural and urban areas. For instance in rural HFs, day 6–10 PPC increased from 751 visits in the 1st period to 2733 in the 2nd period, after two years of intervention. (DOCX 15 kb

A cross-sectional mixed study of the opportunity to improve maternal postpartum care in reproductive, maternal, newborn, and child health services in the Kaya health district of Burkina Faso

Objective To propose a rationale to improve maternal postpartum care in reproductive, maternal, newborn, and child health (RMNCH) services. Methods We conducted a cross-sectional mixed study in the Kaya health district in Burkina Faso based on two data collection exercises conducted between December 2012 and May 2013. A household survey of 757 mothers in their first year after delivery was processed. It was complemented with a qualitative analysis using in-depth interviews with key informants, focus group discussions with mothers, and participant observation. Results Postpartum services showed serious weaknesses. Overall, 52% (n=384) of mothers did not receive any maternal postpartum care; however among them, 47% (n= 349) received infant postpartum care. Conclusion We suggest the integration of maternal postpartum care in RMNCH services as a key step to improving postpartum care. The intervention would require the overcoming of challenges related to the quality and cost of services, and to reaching the poor populations with low education and a high parity