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A baseline mixed methods study on postpartum care among health professionals in Tanzania
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Aga Khan University. (Midwifery)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Midwfery)
2017 (English)In: African Journal of Midwifery and Women's Health, ISSN 1759-7374, Vol. 11, no 3, p. 115-122Article in journal (Refereed) Published
Abstract [en]

Background: Globally, postpartum care (PPC) is a neglected part of maternal and neonatal health, despite 50% of maternal deaths occuring in the first weeks after childbirth.

Aim: The study aimed to assess knowledge, attitudes and practices among providers of PPC in government institutions in two low-resource suburbs of Dar es Salaam: Ilala and Temeke.

Methods: Health professionals ( n =149) at all levels of care completed a knowledge and attitudes questionnaire. A checklist was used to observe 25 health professionals at reproductive and child health units, and 38 mothers were interviewed on exit. χ 2 - and logistic regression tests were used to analyse the outcomes. Field notes were analysed qualitatively.

Findings: Overall, 64% of health professionals had high knowledge and most had positive attitudes towards PPC. Level of education was found to be positively associated with positive attitudes towards PPC (OR=2.5 CI 95% 1.03–6.13). PPC consultations with mothers and newborns during the first week after childbirth were found to be few or nonexistent. Mothers who came with newborns for BCG immunisation were mostly satisfied with the services.

Conclusion: Quality improvement is required at the structure and process levels of the health system in order to provide holistic PPC consultations.

Place, publisher, year, edition, pages
2017. Vol. 11, no 3, p. 115-122
Keywords [en]
Postpartum care, knowledge, Practice, Tanzania
National Category
Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-327324OAI: oai:DiVA.org:uu-327324DiVA, id: diva2:1130386
Available from: 2017-08-09 Created: 2017-08-09 Last updated: 2017-08-11Bibliographically approved
In thesis
1. "If really we are committed things can change starting from us providers" Improving postpartum care: A facilitation intervention at government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania
Open this publication in new window or tab >>"If really we are committed things can change starting from us providers" Improving postpartum care: A facilitation intervention at government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Globally, postpartum care is a neglected area in the continuum of maternal and newborn services. Facilitation interventions focusing on addressing local problems report positive results in improving the health of mothers and newborns in low-resource settings. 

The aim of this thesis was to investigate a facilitation intervention to improve postpartum care at government-owned health institutions in a low-resource suburb of Dar es Salaam, Tanzania. A before-and-after study design was used to describe and evaluate the intervention in this thesis. Data were collected using mixed methods in the intervention group and the control group, before and after the intervention and were used for making comparisons.  

The baseline studies showed that postpartum care practices were next to non-existent at the institutions, that most healthcare providers had high levels of knowledge, positive attitudes towards postpartum care and declared themselves ready to engage in its improvement. Mothers coming with their newborns for immunisation were satisfied with the services. 

The intervention to improve postpartum care involved healthcare providers in six geographical clusters, each including 3–6 institutions, with one facilitator for each cluster. Using a participatory approach, they facilitated colleagues in identifying and addressing the provision of postpartum care at institutions. Data were collected among healthcare providers, facilitators and mothers using: focus group discussions; questionnaires; observations; and interviews, and by making field notes, written at each institution. 

In the intervention, facilitators and healthcare providers used four strategies to improve postpartum care:increasing awareness and knowledge on postpartum care of healthcare providers and mothers; mobilising professional and material resources; improving care routines, communication and documentation; and promoting an empowering and collaborative work style. 

The endline evaluation showed that postpartum care was conducted in the intervention group with some care items performed for 80% of observed mothers. The quality grading, which involved nine experts and was based on national guidelines, showed that none of the healthcare providers reached the level of good quality of care. In the comparison group, postpartum care continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but to a higher extent in the intervention group. The t-test indicated a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference in differences for knowledge was 1.3. The attitudes showed no major difference between baseline and endline in the intervention and comparison groups. 

This facilitation intervention was an acceptable and applicable approach and indicates promising results in improving the quality of postpartum care and in increasing mothers’ attendance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1351
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-327432 (URN)978-91-513-0027-6 (ISBN)
Public defence
2017-09-28, Rosénsalen, Akademiska sjukhuset, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2017-09-07 Created: 2017-08-11 Last updated: 2017-09-08

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Pallangyo, Eunice N.Källestål, CarinaOlsson, Pia

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