A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa

Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions were those on immediate postpartum maternal care combining several intervention packages such as community mobilization and provision of services, community outreach services and health training. The integration within health facilities of mother and child clinics was shown to contribute significantly to improving the frequency of mothers’ postpartum visits

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

Background: The Missed Opportunities in Maternal and Infant Health (MOMI) project aimed at reducing maternal and newborn mortality and morbidity within the year after childbirth in four sub-Saharan African countries. MOMI interventions including the integration of maternal and infant services in the postpartum (PP) period at day 6–10, week 6–8, and month 9 were implemented from September 2013 to December 2015. We hereby assess the effect of integrating maternal postpartum care (PPC) in infant immunization services in Kaya health district in Burkina Faso. Methods: We apply a longitudinal mixed method on monthly monitoring data collected from 12 months before the project start to the end. Outcome indicators were: attendance of PPC at day 6–10 and week 6–8, provision of PP family planning counselling, and management of PP morbidity in mother and infant. We tested the significance level of changes in the different indicators by performing an interrupted time series analysis with Newey–West standard errors and one lag. Additional data were extracted at the individual level which allowed to link infant immunization with maternal PPC from September 2013 to August 2014 in the health facilities’ (HF) PP and immunization registers. We also conducted a review of documents that allowed for a qualitative evaluation of the effects. Results: Show an increasing trend of all monitored indicators during the interventions, particularly at day 6–10 when PPC increased from 61% in 2013 to 81% in 2015 and especially in rural areas (p \u3c 0.05). We found large improvements in the detection and management of PP maternal hemorrhage, sepsis and newborn fever or low temperature. However, the intervention was less successful in raising PPC at week 6–8 and later due to the existence of structural barriers, caused for instance by the lack of collaboration among health workers and high turnover in the staff of HF. Conclusion: The overall package of community and facility interventions contributed to improve integrated PPC at day 6–10, particularly the role of community health workers. While the integration of maternal and child health services seems to be a valid concept, it needs to be rethought within the primary health care syste

Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries

Background: Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care. Methods: The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps ‘systems thinking’ approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and possible interventions were discussed; 3) based on comprehensive needs assessment findings, inputs from the stakeholders and existing knowledge regarding good postpartum care, a list of potential interventions was designed, and; 4) the stakeholders selected and agreed upon final context-specific intervention packages to be implemented to improve postpartum care. Results: Needs assessment findings showed that in all study countries maternal, newborn and child health is a national priority but specific policies for postpartum care are weak and there is very little evidence of effective postpartum care implementation. In the study districts few women received postpartum care during the first week after childbirth (25 % in Burkina Faso, 33 % in Kenya, 41 % in Malawi, 40 % in Mozambique). Based on these findings the interventions selected by stakeholders mainly focused on increasing the availability and provision of postpartum services and improving the quality of postpartum care through strengthening postpartum services and care at facility and community level. This includes the introduction of postpartum home visits, strengthening postpartum outreach services, integration of postpartum services for the mother in child immunisation clinics, distribution of postpartum care guidelines among health workers and upgrading postpartum care knowledge and skills through training. Conclusion: There are extensive gaps in availability and provision of postpartum care for mothers and infants. Acknowledging these gaps and involving relevant stakeholders are important to design and select sustainable, context-specific packages of interventions to improve postpartum care

Utilization and quality of postpartum services for mother and infant in Kaya health district (Burkina Faso)

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The cost of integrating maternal postpartum care to infant immunization service in Kaya health district (Burkina Faso)

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A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa

Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions were those on immediate postpartum maternal care combining several intervention packages such as community mobilization and provision of services, community outreach services and health training. The integration within health facilities of mother and child clinics was shown to contribute significantly to improving the frequency of mothers’ postpartum visits