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Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania: a mixed method evaluation
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).
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).
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2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, 1295697Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings.

OBJECTIVE:

To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania.

METHODS:

A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support.

RESULTS:

The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers' knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers' positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care.

CONCLUSIONS:

The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers' knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance.

Place, publisher, year, edition, pages
2017. Vol. 10, no 1, 1295697
Keyword [en]
Healthcare providers, Tanzania, facilitation, postpartum care, quality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-322208DOI: 10.1080/16549716.2017.1295697ISI: 000401284900001PubMedID: 28498737OAI: oai:DiVA.org:uu-322208DiVA: diva2:1096195
Available from: 2017-05-17 Created: 2017-05-17 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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