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"Postnatal care Social aspects South Africa."
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Privileges of birth : constellations of care, myth and race in South Africa
\"Focussing ethnographically on private sector maternity care in South Africa, Privileges of Birth attends to the ways healthcare and childbirth are shaped by South Africa's racialised history. Birth is one of the most medicalised aspects of the life-cycle across all sectors of society and is also deeply divided between what the privileged can afford compared with the rest of the population. Examining the ethics of care in midwife-attended birth, the author situates the argument in the context of a growing literature on care in anthropological and feminist scholarship, offering a unique account of birthing care in the context of elite care services\"-- Provided by publisher.
Book
Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature
Background
Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa.
Methods
Articles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings.
Result
The search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff.
Conclusions
A number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness.
Systematic review registration
PROSPERO CRD42017074102
Journal Article
Factors associated with weighing a child at birth: Evidence from 16 sub-Saharan African countries
Several children from sub-Saharan Africa (SSA) are not weighed at birth. The lack of birthweight data is a significant challenge in monitoring the global prevalence of extreme birthweight, either low or high, and newborn health. This data guides resource allocation and the design of targeted health policies to address neonatal complications and mortalities. This paper explores the demand-side predictors of newborn weighing.
Data were obtained from the Demographic and Health Surveys (DHS) of 16 countries in SSA, conducted from 2014 to 2021. Multivariate logistic regression was used to achieve the study's objectives.
Approximately 59% of the study population were weighed at birth. This prevalence rate varied widely across the 16 countries, ranging from 23% in Chad to 94% in Gabon. The study documents a positive association between higher socioeconomic status and the probability of being weighed at birth. Specifically, older women and women with higher education and wealth were more likely to weigh their newborns at birth. Also, women who delivered at healthcare facilities and those who used antenatal care had a higher likelihood of weighing their children at birth. Urban residents were more likely to weigh their children at birth. On the contrary, the likelihood of weighing a child at birth decreases with parity.
The study highlights the need to target pregnant women of lower socioeconomic status for interventions aimed at averting severe morbidity and mortality occasioned by conditions of low birthweight.
Journal Article
Community caregivers’ perceptions: Family-centred postnatal care in KwaZulu-Natal, South Africa
BackgroundThe family-centred postnatal care (FCPC) approach highlights the active participation of family members in supporting the care of the mother and newborn. It acknowledges the vital role of social support, practical assistance and emotional encouragement from family members.AimThe study aimed to explore community caregivers’ (CCGs) experiences and perceptions of the FCPC approach.SettingThe study took place in uMgungundlovu municipality, KwaZulu-Natal Province.MethodsA qualitative study design using a grounded theory approach was used. Participants were selected using purposive sampling. Four focus group discussions were held with 23 CCGs from the seven sub-districts. Data were analysed manually following the grounded theory steps.ResultsFive themes emerged from the data analysis. These include perceptions of CCGs about the strength of antenatal care in enhancing postnatal care (PNC), experiences of CCGs in FCPC, non-attendance of postnatal visits by mothers and newborns, attitudes of CCGs towards healthcare professionals, and recommended activities for the CCGs in FCPC.ConclusionThe data analysis highlights the vital contributions of CCGs in improving maternal health and neonatal outcomes. These findings underscore the critical areas for improving support and outcomes for mothers and newborns.ContributionThe experiences and perceptions of CCGs on FCPC provide valuable insights into the importance of involving family members in supporting mothers and newborns. Their perspectives highlight practical challenges, opportunities for improved care, and family engagement’s critical role in enhancing postnatal outcomes.
Journal Article
Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
Poor engagement in postpartum maternal HIV care is a challenge worldwide and contributes to adverse maternal outcomes and vertical transmission. Our objective was to project the clinical and economic impact of integrated postpartum maternal antiretroviral therapy (ART) and pediatric care in South Africa.
Using the CEPAC computer simulation models, parameterized with data from the Maternal and Child Health-Antiretroviral Therapy (MCH-ART) randomized controlled trial, we evaluated the cost-effectiveness of integrated postpartum care for women initiating ART in pregnancy and their children. We compared two strategies: 1) standard of care (SOC) referral to local clinics after delivery for separate standard ART services for women and pediatric care for infants, and 2) the MCH-ART intervention (MCH-ART) of co-located maternal/pediatric care integrated in Maternal and Child Health (MCH) services throughout breastfeeding. Trial-derived inputs included: 12-month maternal retention in care and virologic suppression (SOC: 49%, MCH-ART: 67%), breastfeeding duration (SOC: 6 months, MCH-ART: 8 months), and postpartum healthcare costs for mother-infant pairs (SOC: $50, MCH-ART: $69). Outcomes included pediatric HIV infections, maternal and infant life expectancy (LE), lifetime HIV-related per-person costs, and incremental cost-effectiveness ratios (ICERs; ICER
Journal Article
Equity in newborn care, evidence from national surveys in low- and middle-income countries
Background
High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia.
Methods
We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health.
Results
Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births.
Conclusion
This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.
Journal Article
Experiences of postnatal mothers regarding the implementation of maternal and neonatal referral system guidelines in Mopani District in the Limpopo Province, South Africa
South Africa experiences challenges of maternal mortality, caused by pregnancy related conditions. Limpopo Province as one of the provinces in South Africa, is also affected. There are challenges facing obstetric emergency referrals, despite the availability of maternal/neonatal referral system guidelines. Therefore, this study explored the experiences of postnatal mothers aiming at facilitation of prompt referral of obstetric emergencies. Descriptive phenomenological research methods were used. The study was conducted in two selected sites, a maternity unit of a district hospital and a primary healthcare facility (fixed clinic), which is a feeder clinic to the district hospital in a selected sub-district of the Mopani district. Population were eleven (11) postnatal mothers. Purposive sampling was used. Data were collected using in-depth individual face –to-face interviews. Data was analysed using Colaizzi’s seven procedural steps. Four essential meanings and their constituents were revealed: postnatal mothers’ positive experiences, challenging experiences, consequences of challenges and post-natal mothers' recommendations. Health care facilities to be equipped with adequate, functional, safe, reliable, well equipped obstetrical equipment, material and human resources to facilitate prompt referral of obstetric emergencies.
Journal Article
Community-based adherence clubs for postpartum women on antiretroviral therapy (ART) in Cape Town, South Africa: a pilot study
Background
With an increasing number of countries implementing Option B+ guidelines of lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women, there is urgent need to identify effective approaches for retaining this growing and highly vulnerable population in ART care.
Methods
Newly postpartum, breastfeeding women who initiated ART in pregnancy and met eligibility criteria were enrolled, and offered the choice of two options for postpartum ART care: (i) referral to existing network of community-based adherence clubs or (ii) referral to local primary health care clinic (PHC). Women were followed at study measurement visits conducted separately from either service. Primary outcome was a composite endpoint of retention in ART services and viral suppression [VS < 50 copies/mL based on viral load (VL) testing at measurement visits] at 12 months postpartum. Outcomes were compared across postpartum services using chi-square, Fisher’s exact tests and Poisson regression models. The primary outcome was compared across services where women were receiving care at 12 months postpartum in exploratory analyses.
Results
Between February and September 2015, 129 women (median age: 28.9 years; median time postpartum: 10 days) were enrolled with 65% opting to receive postpartum HIV care through an adherence club. Among 110 women retained at study measurement visits, 91 (83%) achieved the composite endpoint, with no difference between those who originally chose clubs versus those who chose PHC services. Movement from an adherence club to PHC services was common: 31% of women who originally chose clubs and were engaged in care at 12 months postpartum were attending a PHC service. Further, levels of VS differed significantly by where women were accessing ART care at 12 months postpartum, regardless of initial choice: 98% of women receiving care in an adherence club and 76% receiving care at PHC had VS < 50 copies/mL at 12 months postpartum (
p
= 0.001).
Conclusion
This study found comparable outcomes related to retention and VS at 12 months postpartum between women choosing adherence clubs and those choosing PHC. However, movement between postpartum services among those who originally chose adherence clubs was common, with poorer VS outcomes among women leaving clubs and returning to PHC services.
Trial registration
ClinicalTrials.gov
NCT02417675
, April 16, 2015 (retrospectively registered).
Journal Article
“I am scared, I do not want to lie”: exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa
Background
COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement.
Methods
A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (
N
= 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants;
n
= 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis.
Results
Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed.
Conclusions
About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.
Journal Article
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
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.
Journal Article