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BMC Pregnancy and Childbirth Apr 2021Postnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention... (Comparative Study)
Comparative Study
BACKGROUND
Postnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention than antenatal care. This study determines the level of PNC coverage and its determinants in Srilanka.
METHODS
This is a secondary analysis of the 2016 Demographic and Health Survey. Receiving full postnatal care (FPNC) was defined with a set of indicators to detect adequate care for mother and newborn. Demographic and socio-economic associated factors for receiving FPNC were identified using binary and multiple logistic regression. Variables that had marginal relationship with receiving FPNC which p-value less than or equal to 0.2 at binary analysis were selected and included in the multiple logistic regression models. We used manual backward stepwise regression to identify variables which had independent association with receiving FPNC on the basis of adjusted odds ratios (AOR), with 95% confidence interval (CI) and p-value less than 0.05. All analyses were performed in SPSS 25.
RESULTS
Of the 8313 women with a live birth in the last 5 years, more than 98% had received postnatal care at facility at least 24 h. More than three-fourth of mothers (n = 5104) received the FPNC according to WHO guideline. Four factors were positively associated with receiving FPNC: mothers received antenatal home visits by Public health midwife (AOR = 1.98, 95% CI 1.65-2.39), mothers who got information about antenatal complications and places to go at antenatal clinics (AOR = 1.56, 95% CI 1.27-1.92), been Sinhala (AOR = 1.89, 95% CI 1.35-2.66) and having own mobile phone (AOR = 1.19, 95% CI 1.02-1.38). Mothers who are residing in rural area (AOR = 0.697 95% CI = 0.52-0.93] compared to those who reside in urban areas and maternal age between 20 and 34 years [AOR = 0.72, 95% CI 0.54-0.97] compared to maternal age less than 20 years were detected as negatively associated.
CONCLUSION
Receiving FPNC in Srilanka is high. However, inequity remains to be a challenge. Socio-demographic factors are associated with FPNC coverage. Strategies that aim to improve postnatal care should target improvement of non-health factors as well.
Topics: Adult; Age Factors; Child; Child, Preschool; Fathers; Female; Health Services Accessibility; Health Surveys; Healthcare Disparities; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mothers; Patient Acceptance of Health Care; Postnatal Care; Pregnancy; Rural Population; Socioeconomic Factors; Sri Lanka; Urban Population; Young Adult
PubMed: 33849462
DOI: 10.1186/s12884-021-03770-0 -
Bulletin of the World Health... Apr 2015To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries.
METHODS
We searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting.
FINDINGS
A total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96-1.34), 1.32 (95% CI: 1.12-1.55), 1.60 (95% CI: 1.30-1.98) and 2.27 (95% CI: 1.75-2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01-1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education.
CONCLUSION
In low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents.
Topics: Developing Countries; Female; Health Services Accessibility; Healthcare Disparities; Humans; Postnatal Care; Poverty; Pregnancy; Pregnancy Complications; Socioeconomic Factors
PubMed: 26229190
DOI: 10.2471/BLT.14.140996 -
Ethiopian Journal of Health Sciences Nov 2022Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in...
BACKGROUND
Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district.
METHODS
A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02-30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization.
RESULTS
Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization.
CONCLUSION
Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it.
Topics: Pregnancy; Child; Infant, Newborn; Female; Humans; Cross-Sectional Studies; Postnatal Care; Mothers; Ethiopia
PubMed: 36475253
DOI: 10.4314/ejhs.v32i6.9 -
Tropical Medicine & International... Jan 2023High-quality postnatal care is vital for improving maternal health. This study examined the relationship between household socioeconomic status and both coverage and...
OBJECTIVE
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.
METHOD
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.
RESULTS
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.
CONCLUSION
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.
Topics: Pregnancy; Female; Humans; Maternal Health Services; Postnatal Care; Ethiopia; Cross-Sectional Studies; Socioeconomic Factors; Prenatal Care
PubMed: 36398859
DOI: 10.1111/tmi.13829 -
Journal of Global Health Jun 2020Postnatal care (PNC) for mothers and newborns is essential to monitor risks of morbidity and adverse conditions following delivery. Current estimates of the coverage of...
BACKGROUND
Postnatal care (PNC) for mothers and newborns is essential to monitor risks of morbidity and adverse conditions following delivery. Current estimates of the coverage of PNC show substantial discordance between mothers and newborns. We investigate the sources of this discordance in Demographic and Health Surveys (DHS).
METHODS
We used DHS data from 48 countries collected since 2011, spanning phases 6 and 7 of the survey program with 32 and 16 surveys, respectively, analyzed. We assessed the distribution of the reported timing of PNC and conducted a sensitivity analysis that excludes/includes PNC reported within 0-1 hour or PNC in the day 2. Agreement in PNC reporting considered four groups: (1) Concordance, neither mother nor newborn received PNC; (2) Concordance, mother and newborn pair received PNC; (3) Discordance, mother received PNC and newborn did not; of (4) Discordance, mother did not receive PNC but the newborn did. We carried out logistic regressions to understand correlates of PNC discordance. All analyses distinguished phase 6 surveys from phase 7.
RESULTS
We found substantial differences in the PNC coverage estimated between phase 6 and phase 7 surveys. The phase 7 PNC questions for newborns were improved to increase the understanding of the questions by respondent which probably led to reducing the large PNC gap between mothers and newborns observed in phase 6 surveys. With phase 6 surveys, PNC coverage for mother was estimated on average at 62% compared to only 31% for newborns. No such gap was observed for phase 7 surveys, where for both mothers and newborns, the PNC coverage estimate was similar, at 56%. For both phases, over half of the reported PNC for mothers and newborns occurred during 0-1 hour following delivery, leading to substantial overestimation of PNC coverage, due to confusion between intrapartum care and PNC. There were 37% discordant cases between mother and newborn, largely in favor of the mother in phase 6 surveys, compared to 16% in phase 7 surveys. In phase 6 surveys, discordant PNC cases were observed largely among facility deliveries vs non-facility deliveries (44% compared to 19%).
CONCLUSIONS
Current estimates of coverage of PNC from DHS phase 6 surveys appears to include substantial level of measurement noises that could explain substantial part of the mother-newborn discordance in PNC. The PNC estimates appear to capture a substantial number of intrapartum care. Current measurement approaches warrant further validation to ensure accurate monitoring of the PNC programs.
Topics: Adult; Artifacts; Child Health Services; Demography; Female; Health Care Surveys; Humans; Infant, Newborn; Maternal Health Services; Mothers; Postnatal Care; Pregnancy; Prenatal Care
PubMed: 32257159
DOI: 10.7189/jogh.10.010505 -
BMC Pregnancy and Childbirth Mar 2022Little is known about the physical therapists' practice and perceptions toward management of pregnancy/postpartum-related disorders in Taiwan. The aim of this study was...
BACKGROUND
Little is known about the physical therapists' practice and perceptions toward management of pregnancy/postpartum-related disorders in Taiwan. The aim of this study was to document current practice of physical therapy in antepartum and postpartum care in Taiwan.
METHODS
An exploratory, cross-sectional study was conducted in registered physical therapists living in Taiwan. An anonymized online survey was designed, piloted, and advertised widely from March 2020 to March 2021. Data were analyzed using descriptive statistics, Chi square analysis and multivariate logistic regression.
RESULTS
Of the 364 respondents, 37.6% had experience of treating pregnant or postpartum women in clinical practice. The most commonly treated pregnancy/postpartum-related disorder in practice was low back pain (61.3%). All respondents reported little to moderate level of confidence in their ability to manage pregnancy/postpartum-related disorder. Being female (p < 0.01); working at a regional hospital (p = 0.01), district hospital or district teaching hospital (p < 0.01), clinic (p = 0.01) or physiotherapy clinic (p = 0.01); and having prior experience of treating antepartum or postpartum women (p < 0.01) were significantly associated with willingness to provide customer-oriented service or health education to patients/clients with pregnancy/postpartum-related disorder after controlling for other confounding variables. The most commonly reported barrier was "lack of available training" (81.3%).
CONCLUSION
The majority of participating physical therapists indicated a positive attitude to antepartum and postpartum care but were not confident in management of various pregnancy/postpartum-related disorder in practices. The findings of this study highlight the educational needs related to antepartum and postpartum care in clinical practice for physical therapists in Taiwan.
Topics: Adult; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Physical Therapists; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Self Efficacy; Surveys and Questionnaires; Taiwan
PubMed: 35241016
DOI: 10.1186/s12884-022-04484-7 -
PloS One 2021As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and...
As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers.
Topics: Adult; Delivery, Obstetric; Female; Health Services Accessibility; Humans; Infant, Newborn; Maternal Health; Maternal Health Services; Midwifery; Patient Acceptance of Health Care; Postnatal Care; Pregnancy; Prenatal Care; Rural Health Services; Rural Population; Zambia
PubMed: 33481942
DOI: 10.1371/journal.pone.0245893 -
Women's Health (London, England) 2022This study assessed the non-utilization of PNC services, identified factors associated with PNC non-utilization, and explored barriers to PNC utilization in the rural...
OBJECTIVES
This study assessed the non-utilization of PNC services, identified factors associated with PNC non-utilization, and explored barriers to PNC utilization in the rural community.
METHOD
A community-based mixed-cross-sectional study was conducted from 20 March to 20 April 2020 among 521 women who gave birth in the last 12 months prior to this survey. A multistage sampling and face-to-face interview techniques were used for the quantitative data collection, and a purposive sampling technique was used to select the study participants. In-depth interviews were used for the qualitative data collection. The quantitative data were entered into EpiData version 3.1 and then exported to SPSS version 25 for analysis. A binary logistic regression analysis was used to test the association between the independent and outcome variables. A -value of <0.2 was used as the cutoff value to include variables in the multivariate analysis. Finally, a -value of <0.05 was used to declare an independent association. The qualitative data were manually sorted, cleaned up, and labeled as themes. Every major theme was identified and enumerated, and the meaning units were cited together with the relevant participant's socio-demographic details.
RESULT
The non-utilization of postnatal care was found to be 75.4% in the area. Normal delivery, fewer than four antenatal care visits, inaccessibility to transportation, and poor knowledge of postnatal care were all identified as factors enhancing non-utilization of postnatal care. However, being informed about postnatal care positively influences postnatal care utilization. Poor awareness, information gaps, cultural and religious beliefs, service inaccessibility, and the unfriendly approach of healthcare workers were all explored as barriers in the qualitative study.
CONCLUSIONS
The non-utilization of PNC services in this study was higher than the majority, but not all, of the previous comparable local and worldwide findings. Mode of delivery, hearing postnatal care information, the number of antenatal visits, transportation availability, and knowledge of postnatal care services were factors affecting the non-utilization of postnatal care. The clients' poor awareness, information gaps, cultural and religious beliefs, service inaccessibility, and healthcare staff's inauspicious approach were barriers explored. Therefore, counseling and transportation access need to be reinforced in the setting.
Topics: Cross-Sectional Studies; Ethiopia; Female; Health Knowledge, Attitudes, Practice; Humans; Postnatal Care; Pregnancy; Rural Population
PubMed: 36113137
DOI: 10.1177/17455057221125091 -
BMC Pregnancy and Childbirth Apr 2019Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the... (Review)
Review
BACKGROUND
Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans.
METHODS
This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O'Malley approach employing five stages.
RESULTS
The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four overarching themes: 'Positioning of post-birth care planning in policy; 'Content and approach'; 'Personalised care and relational continuity'; Feasibility and acceptability in practice'.
CONCLUSIONS
Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested.
Topics: Female; Health Policy; Humans; Midwifery; Parturition; Postnatal Care; Practice Guidelines as Topic; Pregnancy; Surveys and Questionnaires
PubMed: 31023255
DOI: 10.1186/s12884-019-2274-y -
The Canadian Journal of Nursing... Dec 2022The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women.
BACKGROUND
The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women.
PURPOSE
To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers.
METHODS
Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses.
RESULTS
A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4 or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery.
CONCLUSION
There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Male; Postnatal Care; Cross-Sectional Studies; Canada; Mothers; Surveys and Questionnaires
PubMed: 34704508
DOI: 10.1177/08445621211052141