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

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Abstract
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.
Keywords
Postpartum, Maternal and infant health, Integration of services, Burkina Faso, MIDDLE-INCOME COUNTRIES, INTERVENTIONS, STRATEGIES

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MLA
Yugbare Belemsaga, Danielle et al. “Integration of Postpartum Care into Child Health and Immunization Services in Burkina Faso : Findings from a Cross-sectional Study.” REPRODUCTIVE HEALTH 15.1 (2018): n. pag. Print.
APA
Yugbare Belemsaga, D., Goujon, A., Bado, A., Kouanda, S., Duysburgh, E., Temmerman, M., & Degomme, O. (2018). Integration of postpartum care into child health and immunization services in Burkina Faso : findings from a cross-sectional study. REPRODUCTIVE HEALTH, 15(1).
Chicago author-date
Yugbare Belemsaga, Danielle, Anne Goujon, Aristide Bado, Seni Kouanda, Els Duysburgh, Marleen Temmerman, and Olivier Degomme. 2018. “Integration of Postpartum Care into Child Health and Immunization Services in Burkina Faso : Findings from a Cross-sectional Study.” Reproductive Health 15 (1).
Chicago author-date (all authors)
Yugbare Belemsaga, Danielle, Anne Goujon, Aristide Bado, Seni Kouanda, Els Duysburgh, Marleen Temmerman, and Olivier Degomme. 2018. “Integration of Postpartum Care into Child Health and Immunization Services in Burkina Faso : Findings from a Cross-sectional Study.” Reproductive Health 15 (1).
Vancouver
1.
Yugbare Belemsaga D, Goujon A, Bado A, Kouanda S, Duysburgh E, Temmerman M, et al. Integration of postpartum care into child health and immunization services in Burkina Faso : findings from a cross-sectional study. REPRODUCTIVE HEALTH. 2018;15(1).
IEEE
[1]
D. Yugbare Belemsaga et al., “Integration of postpartum care into child health and immunization services in Burkina Faso : findings from a cross-sectional study,” REPRODUCTIVE HEALTH, vol. 15, no. 1, 2018.
@article{8577038,
  abstract     = {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.},
  articleno    = {171},
  author       = {Yugbare Belemsaga, Danielle and Goujon, Anne and Bado, Aristide and Kouanda, Seni and Duysburgh, Els and Temmerman, Marleen and Degomme, Olivier},
  issn         = {1742-4755},
  journal      = {REPRODUCTIVE HEALTH},
  keywords     = {Postpartum,Maternal and infant health,Integration of services,Burkina Faso,MIDDLE-INCOME COUNTRIES,INTERVENTIONS,STRATEGIES},
  language     = {eng},
  number       = {1},
  pages        = {17},
  title        = {Integration of postpartum care into child health and immunization services in Burkina Faso : findings from a cross-sectional study},
  url          = {http://dx.doi.org/10.1186/s12978-018-0602-8},
  volume       = {15},
  year         = {2018},
}

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