Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: A cross-sectional study using Demographic and Health Survey data from 33 countries

English version

Autoři: Lenka Benova ^aff001; Onikepe Owolabi ^aff003; Emma Radovich ^aff001; Kerry L. M. Wong ^aff001; David Macleod ^aff001; Etienne V. Langlois ^aff004; Oona M. R. Campbell ^aff001
Působiště autorů: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom ^aff001; Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium ^aff002; Guttmacher Institute, New York City, New York, United States of America ^aff003; Alliance for Health Policy and Systems Research, Science Division, World Health Organization, Geneva, Switzerland ^aff004
Vyšlo v časopise: Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: A cross-sectional study using Demographic and Health Survey data from 33 countries. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002943
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1002943

Souhrn

Background

Postpartum care has the potential to avert a substantial proportion of maternal and perinatal mortality and morbidity. There is a crucial gap in understanding the quality of postpartum care for women giving birth in health facilities in low- and middle-income settings. This is particularly the case in sub-Saharan Africa (SSA), where the levels of maternal and neonatal mortality are highest globally despite rapid increases in facility-based childbirth. This study estimated the percentage of women receiving a postpartum health check following childbirth in a health facility in SSA and examined the determinants of receiving such check.

Methods and findings

We used the most recent Demographic and Health Survey (DHS) conducted in 33 SSA countries between 2000–2016. We estimated the percentage of women receiving a postpartum check by a health professional while in the childbirth facility and the associated 95% confidence interval (CI) for each country. We analyzed determinants of receiving such checks using logistic regression of the pooled data. The analysis sample included 137,218 women whose most recent live birth in the 5- year period before the survey took place in a health facility. Of this pooled sample, 65.7% of women were under 30 years of age, 85.9% were currently married, and 57% resided in rural areas. Across countries, the median percentage of women who reported receiving a check was 71.7%, ranging from 26.6% in Eswatini (Swaziland) to 94.4% in Burkina Faso. The most fully adjusted model showed that factors from all four conceptual categories (obstetric/neonatal risk factors, care environment, and women’s sociodemographic and child-related characteristics) were significant determinants of receiving a check. Women with a cesarean section had a significantly higher adjusted odds ratio (aOR) of 1.88 (95% CI 1.72–2.05, p < 0.001) of receiving a check. Women giving birth in lower-level public facilities had lower odds of receiving a check (aOR 0.94, 95% CI 0.90–0.98, p = 0.002) compared to those in public hospitals, as did women attended by a nurse/midwife (compared to doctor/nonphysician clinician) (aOR 0.74, 95% CI 0.69–0.78, p < 0.001). This study was limited by the accuracy of the respondent’s recall of the provider, timing, and receipt of postpartum checks. The outcome of interest was measured using three slightly different question sets across the 33 included countries.

Conclusions

The suboptimal levels of postpartum checks in health facilities in many of the included SSA countries partially reflect the lack of importance given to postpartum care in the global discourse on essential interventions and quality improvement in maternal health. Addressing disparities in access to both facility-based childbirth and good-quality postpartum care in SSA is critical to addressing stalling declines in maternal mortality and morbidity.

Klíčová slova:

Neonates – Birth – Labor and delivery – Pregnancy – Medical risk factors – Antenatal care – Postpartum care – Postnatal care

Zdroje

1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462–74. Epub 2015 Nov 21. doi: 10.1016/S0140-6736(15)00838-7 26584737.

2. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality: Report 2017 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York, NY: United Nations Children’s Fund; 2017.

3. Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, et al. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388(10056):2164–75. doi: 10.1016/S0140-6736(16)31533-1 27642022.

4. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71. Epub 2014 Dec 23. doi: 10.1016/S0140-6736(14)61682-2 25530442.

5. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet. 2018;391(10129):1538–48. doi: 10.1016/S0140-6736(18)30104-1 29395268.

6. Souza JP, Gulmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381(9879):1747–55. doi: 10.1016/S0140-6736(13)60686-8 23683641.

7. Doctor H, Radovich E, Benova L. Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016. Journal of Global Health. 2019;9(2):020406. doi: 10.7189/jogh.09.020406 31360446

8. World Health Organization. WHO recommendations on postnatal care of the mother and newborn. Geneva, Switzerland: World Health Organization; 2013.

9. World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva, Switzerland: World Health Organization; 2018.

10. National Institute of Statistics, Directorate General for Health, ICF International. Cambodia Demographic and Health Survey 2014. Phnom Penh, Cambodia, and Rockville, MD, USA: National Institute of Statistics, Directorate General for Health, and ICF International; 2015.

11. Belemsaga DY, Kouanda S, Goujon A, Kiendrebeogo JA, Duysburgh E, Degomme O, et al. A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa. Afrika Focus. 2015;28(2):83–105.

12. Duysburgh E, Kerstens B, Kouanda S, Kabore CP, Belemsaga Yugbare D, 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 Childbirth. 2015;15:131. doi: 10.1186/s12884-015-0562-8 26038100.

13. de Graft-Johnson J, Vesel L, Rosen HE, Rawlins B, Abwao S, Mazia G, et al. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries. BMJ open. 2017;7(3):e014680. doi: 10.1136/bmjopen-2016-014680 28348194.

14. Fort AL, Kothari MT. Postpartum Care: Levels and Determinants in Developing Countries. DHS Comparative Reports No. 15. Calverton, MD, USA: Macro International; 2006.

15. Ganle JK, Parker M, Fitzpatrick R, Otupiri E. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy Childbirth. 2014;14:425. doi: 10.1186/s12884-014-0425-8 25527872.

16. Langlois EV, Miszkurka M, Zunzunegui MV, Ghaffar A, Ziegler D, Karp I. Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2015;93(4):259–270G. doi: 10.2471/BLT.14.140996 26229190.

17. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196–e252. doi: 10.1016/S2214-109X(18)30386-3 30196093

18. Campbell OM, Cegolon L, Macleod D, Benova L. Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys. PLoS Med. 2016;13(3):e1001972. Epub 2016/03/10. doi: 10.1371/journal.pmed.1001972 26954561.

19. World Health Organization. Global Nutrition Targets 2025 Low Birth Weight Policy Brief. Geneva, Switzerland: World Health Organization; 2014 [cited 2019 Jan 8]. http://apps.who.int/iris/bitstream/handle/10665/149020/WHO_NMH_NHD_14.5_eng.pdf?ua=1.

20. Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OM. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Tropical medicine & international health: TM & IH. 2015;20(12):1657–73. doi: 10.1111/tmi.12598 26412496.

21. Wang W, Alva S, Wang S, Fort A. Levels and Trends in the Use of Maternal Health Services in Developing Countries. DHS Comparative Reports No. 26. Calverton, MD, USA: ICF MAcro; 2011.

22. Owili PO, Muga MA, Chou YJ, Hsu YE, Huang N, Chien LY. Relationship between women’s characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling. Women & health. 2017;57(8):942–61. Epub 2016 Aug 11. doi: 10.1080/03630242.2016.1222327 27613111.

23. Bishanga DR, Massenga J, Mwanamsangu AH, Kim YM, George J, Kapologwe NA, et al. Women’s Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania. Int J Environ Res Public Health. 2019;16(3):E481. doi: 10.3390/ijerph16030481 30736396.

24. Ntambue AM, Malonga FK, Dramaix-Wilmet M, Ilunga TM, Musau AN, Matungulu CM, et al. Commercialization of obstetric and neonatal care in the Democratic Republic of the Congo: A study of the variability in user fees in Lubumbashi, 2014. PLoS ONE. 2018;13(10):e0205082. doi: 10.1371/journal.pone.0205082 30304060.

25. Blanc AK, Diaz C, McCarthy KJ, Berdichevsky K. Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care. BMC pregnancy and childbirth. 2016;16:255. doi: 10.1186/s12884-016-1047-0 27577266.

26. Tuncalp O, Stanton C, Castro A, Adanu R, Heymann M, Adu-Bonsaffoh K, et al. Measuring coverage in MNCH: validating women’s self-report of emergency cesarean sections in Ghana and the Dominican Republic. PLoS ONE. 2013;8(5):e60761. doi: 10.1371/journal.pone.0060761 23667428.

27. Liu L, Li M, Yang L, Ju L, Tan B, Walker N, et al. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China. PLoS ONE. 2013;8(5):e60762. doi: 10.1371/journal.pone.0060762 23667429.

28. Stanton CK, Rawlins B, Drake M, Dos Anjos M, Cantor D, Chongo L, et al. Measuring coverage in MNCH: testing the validity of women’s self-report of key maternal and newborn health interventions during the peripartum period in Mozambique. PLoS ONE. 2013;8(5):e60694. doi: 10.1371/journal.pone.0060694 23667427.

29. Radovich E, Benova L, Penn-Kekana L, Wong K, Campbell OMR. 'Who assisted with the delivery of (NAME)?' Issues in estimating skilled birth attendant coverage through population-based surveys and implications for improving global tracking. BMJ global health. 2019;4(2):e001367. doi: 10.1136/bmjgh-2018-001367 31139455.

30. Owili PO, Muga MA, Chou YJ, Hsu YH, Huang N, Chien LY. Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. BMC public health. 2016;16:414. doi: 10.1186/s12889-016-3075-0 27188624.

31. McCarthy KJ, Blanc AK, Warren CE, Mdawida B. Women’s recall of maternal and newborn interventions received in the postnatal period: a validity study in Kenya and Swaziland. Journal of Global Health. 2018;8(1):010605. doi: 10.7189/jogh.08.010605 29904605

32. Amouzou A, Mehra V, Carvajal-Aguirre L, Khan SM, Sitrin D, Vaz LM. Measuring postnatal care contacts for mothers and newborns: An analysis of data from the MICS and DHS surveys. J Glob Health. 2017;7(2):020502. Epub 2018 Feb 10. doi: 10.7189/jogh.07.020502 29423179.

33. Sacks E, Langlois EV. Postnatal care: increasing coverage, equity, and quality. The Lancet Global health. 2016;4(7):e442–3. doi: 10.1016/S2214-109X(16)30092-4 27185467.

34. Moran AC, Kerber K, Sitrin D, Guenther T, Morrissey CS, Newby H, et al. Measuring Coverage in MNCH: Indicators for Global Tracking of Newborn Care. PLoS Med. 2013;10(5):e1001415. doi: 10.1371/journal.pmed.1001415 23667335

35. Moran AC, Jolivet RR, Chou D, Dalglish SL, Hill K, Ramsey K, et al. A common monitoring framework for ending preventable maternal mortality, 2015–2030: phase I of a multi-step process. BMC pregnancy and childbirth. 2016;16(1):250. doi: 10.1186/s12884-016-1035-4 27565428

36. Suplee PD, Bingham D, Kleppel L. Nurses’ Knowledge and Teaching of Possible Postpartum Complications. MCN The American journal of maternal child nursing. 2017;42(6):338–344. 28816712.

37. Prata N, Passano P, Rowen T, Bell S, Walsh J, Potts M. Where there are (few) skilled birth attendants. J Health Popul Nutr. 2011;29(2):81–91. doi: 10.3329/jhpn.v29i2.7812 21608417.

38. Thorsen VC, Tharp AL, Meguid T. High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study. BMC nursing. 2011;10:9. doi: 10.1186/1472-6955-10-9 21605379.

39. Campbell OM, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, et al. The scale, scope, coverage, and capability of childbirth care. Lancet (London, England). 2016;388(10056):2193–208. doi: 10.1016/s0140-6736(16)31528-8 27642023.

40. Gabrysch S, Nesbitt RC, Schoeps A, Hurt L, Soremekun S, Edmond K, et al. Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials. The Lancet Global health. 2019;7(8):e1074–e87. doi: 10.1016/S2214-109X(19)30165-2 31303295.