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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

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Abstract
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.
Keywords
HEALTH-SERVICES, NEWBORN HEALTH, Sub-Saharan Africa, Health system research, Maternal mortality, Newborn, Infant, Maternal health, Postpartum, WOMENS GROUPS, CHILD HEALTH, ALMA-ATA, MORTALITY, MALAWI, PERCEPTIONS, INTEGRATION, STRATEGIES

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Please use this url to cite or link to this publication:

Chicago
Duysburgh, Els, Birgit Kerstens, Seni Kouanda, Charles Paulin Kabore, Danielle Belemsaga Yugbare, Peter Gichangi, Gibson Masache, et al. 2015. “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.” Bmc Pregnancy and Childbirth 15.
APA
Duysburgh, E., Kerstens, B., Kouanda, S., Kabore, C. P., Yugbare, D. B., Gichangi, P., Masache, G., et al. (2015). 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. BMC PREGNANCY AND CHILDBIRTH, 15.
Vancouver
1.
Duysburgh E, Kerstens B, Kouanda S, Kabore CP, Yugbare DB, Gichangi P, et al. 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. BMC PREGNANCY AND CHILDBIRTH. 2015;15.
MLA
Duysburgh, Els, Birgit Kerstens, Seni Kouanda, et al. “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.” BMC PREGNANCY AND CHILDBIRTH 15 (2015): n. pag. Print.
@article{7019637,
  abstract     = {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.},
  articleno    = {131},
  author       = {Duysburgh, Els and Kerstens, Birgit and Kouanda, Seni and Kabore, Charles Paulin and Yugbare, Danielle Belemsaga and Gichangi, Peter and Masache, Gibson and Crahay, Beatrice and Sitefane, Gilda Gondola and Osman, Nafissa Bique and Foia, Severiano and Barros, Henrique and Lopes, Sofia Castro and Mann, Susan and Nambiar, Bejoy and Colbourn, Tim and Temmerman, Marleen},
  issn         = {1471-2393},
  journal      = {BMC PREGNANCY AND CHILDBIRTH},
  keyword      = {HEALTH-SERVICES,NEWBORN HEALTH,Sub-Saharan Africa,Health system research,Maternal mortality,Newborn,Infant,Maternal health,Postpartum,WOMENS GROUPS,CHILD HEALTH,ALMA-ATA,MORTALITY,MALAWI,PERCEPTIONS,INTEGRATION,STRATEGIES},
  language     = {eng},
  pages        = {11},
  title        = {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},
  url          = {http://dx.doi.org/10.1186/s12884-015-0562-8},
  volume       = {15},
  year         = {2015},
}

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