Professional Documents
Culture Documents
Quality of Postnatal Care Services
Quality of Postnatal Care Services
net/publication/317388700
CITATIONS READS
0 1,935
1 author:
Alemayehu Bayray
Mekelle University
55 PUBLICATIONS 176 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
All content following this page was uploaded by Alemayehu Bayray on 23 July 2017.
Keywords: Maternal and Neonatal Health, Quality of Postnatal Care, Structure, Process,
Outcome
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 11
Quality of Postnatal Care Offered to Mothers in Hospitals Berhe et al.
maternal mortality is estimated at 675 per This study therefore, aimed at assessing the
100,000 live births, 60% of the maternal quality of care that is offered to postpartum
deaths occur during the postpartum period, of women at the BEmONC facilities in the
which 70% occur during the first week and district. Specifically the study assessed the
30% within 2 weeks after delivery [4]. PNC three elements of quality of PNC care services,
coverage is low in Ethiopia; only 5% of which are structure, process and outcome.
mothers received PNC within the critical first
2 days after delivery [5]. Nationwide, 34.3% Justification
of mothers in Ethiopia receive PNC within the Quality of postnatal care given by the
first 6 weeks after delivery. midwives is low. Postpartum maternal and
newborn health care is the most neglected area
Postnatal care (PNC) is the most neglected in the health care delivery system despite
area in the health care delivery system despite being very important time for the provision of
being very important time for the provision of interventions that are vital to the health of both
interventions that are vital to the health of both the mother and the new born therefore,
the mother and the new born [6]. As a result, research on quality of postnatal care may help
serious complications which account for two to inform the findings and the
thirds of all maternal and neonatal deaths recommendation on quality of postnatal care
occur during the postnatal period [7]. for policy makers, service providers, education
planners and other respective stakeholders in
Postnatal care is one of the most important Ethiopia.
maternal health-care interventions not only for
prevention of impairment and disabilities but Furthermore, it will be initial data or
also for reduction of maternal mortality [8]. preliminary study for further studies related to
Adequate utilization of postnatal care can help postnatal care and maternal health services in
to reduce maternal mortality and morbidity Tigray region, Ethiopia since there is no
among mothers and their babies. To improve tangible research that has been conducted in
maternal, newborn and infant health status this area.
through increasing the proportion of women
receiving essential postpartum services is OBJECTIVES
strategies of many countries [5]. General Objective
Assessment of quality of postnatal care
Resources pose a challenge to provide services offered to mothers in Tigray health
appropriate care to clients despite the fact that facilities, Ethiopia in 2015/16.
it is the basic right of every woman and
neonate to have the best available care that Specific Objective
enables them go through pregnancy and To assess the quality of postnatal care services
childbirth in good health. There is therefore, a that midwives provide to mothers seeking
need for adequate resources to be available in postnatal service. To assess the structure,
the postnatal wards because availability of process and outcome of the components of
supplies and essential medicines in maternal postnatal care services.
and neonatal health is an indicator of
successful service implementation towards METHODOLOGY
achieving MDGs 4 and 5 [9]. Description of Study Area
The studies were conducted in Tigray regional
The BEmONC facilities are staffed with state of hospitals, Ethiopia. Tigray regional
midwives that are trained to offer essential state, the focus of this study located in
postpartum care services to clients. Despite the Northern part of Ethiopia, which is 783 km far
availability of minimal resources and, rate of from Addis Ababa, capital city of Ethiopia to
complications and deaths in the postpartum the capital city of Tigray region which is
period in the district is high even among called Mekelle. The total area of the region is
women that are delivering in the health about 54,569.25 km. It is bordered in the
facilities. North by Eritrea, in the South by Amhara
regional, state, in the East by Afar regional
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 12
Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
state and in the West by Sudan. The region is who are working in other sections of the
administratively divided into seven zones, facility other than postnatal wards, students
including one especial zone, and it has 47 and who are working on special programs
Weredas; out of which 35 are rural and 12 are were excluded from the study.
urban. According to the projected census of
2007, the region has a total population of Sample Size Calculation and Sampling
4,806,843 (3,787,667 rural and 1,019,176 Procedure
urban). The majority of the population is Sample Size Determination
Christian. According to the data from Tigray All midwives in the randomly selected
Health Bureau, it has five zonal hospitals, hospitals.
seven district general/hospitals, one referral Sampling Technique and Procedure
university hospital, and 211 health centers and Nine general hospitals in Tigray BEmONC
604 health posts which are run by facilities were selected by simple random
Government. sampling technique and study subjects were
observed when they were on practicing
According to the EDHS report, the total postnatal care.
fertility rate of this region was 4.6%;
prevalence of pregnancy was 7.2%; ANC Data Collection Technique and Quality
coverage from a skilled provider was 50.1%. Control Methods
During this period, 11.6% of births were Data were collected by the senior midwives.
attended by a skilled birth attendant; and 37 The midwives were observed as they were
neonatal deaths/1000 live births [10]. provided postnatal care to the clients. At each
facility, observations on the quality of
The facilities that were targeted for this study postnatal care were done every day and the
was those that provide BEmONC (Axum Sent service delivery practices are recorded to
Marry Hospital, Adwa Hospital, Adigrat determine the outcomes of postpartum care. A
Hospital, Maichew Hospital, Wukro Hospital, structured questionnaire that was formulated
Abyi Adi Hospital, Shire Hospital, Quiha and based WHO postnatal guidelines and
Mekelle Hospital) were included in the study. Reproductive Health (RH) standards of care
was used to observe the midwives.
This study was conducted from Sep-Oct 2016.
Study Design: Institutional based descriptive A checklist was used to collect data on the
cross sectional study design was employed. assessment of structure in terms of availability
Source population and study subjects: of human and material resources,
Source population: The source population was infrastructure and midwives’ knowledge on
all midwives that provide BEmONC in Tigray postnatal health assessment, health education
Region Health Facilities, Ethiopia. and counseling on postnatal care concepts.
Study population: All midwives that provide Regarding the process of care, a checklist were
BEmONC in the selected study area. used to mark whether the midwives offered
Study unit: Individual midwives who are care in accordance with the procedures as
participating in this study. recommended in the RH standard of care. The
components of care observed included client
Eligibility Criteria monitoring, physical examination, client
Inclusion Criteria education and counseling. The outcome
The study embattled all consenting midwives component was determined with the use of
that were working in the postnatal care of the checklist derived from RH standards and
BEmONC facilities in Tigray Region Health WHO guidelines which is used to measure
Facilities. availability of basic infrastructure, materials
Exclusion Criteria and resources for providing postnatal care, and
The study excluded facilities that were not the education content that is providing to
designated as BEmONC sites and midwives women during postpartum care and at
who were working in facilities that are not discharge. A facility is supposed to score at
designated as BEmONC. In addition midwives least 80% on the standard of care to be
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 13
Quality of Postnatal Care Offered to Mothers in Hospitals Berhe et al.
considered as providing quality of RH care in and teaching aids for postnatal care were not
which postnatal care is a component. available in all the facilities. However, all the
RESULT facilities had essential drugs such as
Structure as assessed by Availability of gentamycin IV and Amoxicillin tablets. Cord
Human Resources and Physical clamps and neonatal resuscitation equipment’s
Infrastructure were also available in all the facilities.
Human Resources Provider Knowledge and Training
The study enrolled nine hospitals owned by The midwives in all hospitals did not take any
the government which have a total of 123 training on postnatal care. But the midwives
midwives. Majority of midwives in the all have good knowledge regarding postnatal care
hospitals were female in gender. With regard (on maternal danger signs, basic preventive
to level of education, 66.7, 78.6 and 58.3% of newborn care and newborn danger signs).
the midwives in Wukro, Abiadi and Maichew,
respectively were diploma holders whereas Process Attributes of Quality Postnatal
76.5, 68.8 and 70.6% of the midwives in Care
Mekelle, Adigrat and Shire, respectively were Provider Technical Skills
BSc. degree holders. The lowest midwife- The midwives in all hospitals had skills on
client ratio (1:100) was recorded at Quiha history taking, physical examination, on
Hospital while the highest (1:270) was maternal danger sign advice, infant danger
recorded at Mekelle Hospital. Similarly, the sign and documenting what they did but the
mean year of work experience the midwives midwives in all facilities miss STI/HIV risk
had was 8.4 with 6.9 SD. the midwives were assessment, and STI management.
responsible for managing the whole maternity
care comprising the antenatal, labor and Services Provided for the Mother
delivery and postnatal wards. The level of Client monitoring and examination
education and midwife-client ratio and the Out of 123 midwives who were observed
estimated number of deliveries per year is while giving postnatal care for postpartum
shown in Table 1. mother 72(58.5%) and 80(65%) of them took
Physical Infrastructure blood pressure and temperature of their clients,
All hospitals had not a special examination respectively whereas, only 45(36.5%)
rooms for postnatal care. When the observed participants check for pallor. With
impoverished rooms were engaged with other regard to providing vitamin A, 70(56.9%) of
activities, the postnatal women were the midwives provide Vitamin A to the clients.
discharged with compromised examination. 10(8%) out of the total midwives observed
Essential Equipment, Drugs and Guidelines offer TB screening. Ninety one (74%),
All the facilities did have postnatal care 56(45.5%) and 33(26.8%) of the providers
monitoring equipment like examined lochia loss (perineum), involution of
sphygmomanometer and thermometers in their the uterus and breast for engorgement/cracked
maternity departments. In addition, guidelines nipples.
Table 1: Level of Education and Mid-wife-client Ratio and the Estimated Number of
Deliveries per Year.
Facility Sex, frequency and % Level of education Total Annual Midwife/Client
frequency and % deliveries ratio
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 14
Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 15
Quality of Postnatal Care Offered to Mothers in Hospitals Berhe et al.
to seek care. One hundred three (83.7%) conducted in Dedza district results show that
midwives offered counseling for the care quality of maternal and neonatal health care
givers on keeping the baby warm (temperature was low in all facilities [10].
control). Immunization and vitamin A at 6 The midwives in this study were responsible
month was counseled to the care givers by for managing the entire maternity care
108(87.8%) of the midwives. Majority of the involving the antenatal, labor and delivery and
midwives, 104(84.6%) did not counseled care postnatal wards thus no priority was given for
givers on growth monitoring. All of the postnatal care. Similar study show that
midwives counseled the care givers on Infant prioritizing of other areas over postnatal care
HIV test and Prophylaxis (if indicated). [11, 12].
Regarding counseling on exclusive breast
feeding for 6 months and complementary The midwives/patient ratios in the in the MCH
feeding 107(87%) and only 22(17.9%) of the area were poor; the study agrees with previous
midwives counseled their clients, respectively. studies by Riley et al. and Rayner A [11–13].
Provider Interpersonal Skills
All hospitals miss the very important The study found that heavy workload in all
components of rapport (greeting clients, used hospitals of Tigray hindered the delivery of
client’s name, and introduces her /his self and quality postnatal care according to the
encouraging client to ask questions). recommended WHO standard. Analogous
results were reported in Australia, where a
Outcome Attributes of Quality of review of postnatal care revealed that the
Postpartum Care services were provided in very busy
All the facilities scored below 80% showing environments thus unable to meet the aims of
that the quality of postnatal care offered to postnatal care [11].
clients in the BEmONC health facilities in
Tigray was poor and below standard. Highest All hospitals had no special examination
scores of 70 and 65% were obtained from two rooms for postnatal care, similar with a study
hospitals, Mekelle and Axum (Table 4). done by Rawlins et al. Midwives agreed that
postnatal care and units were indeed neglected
Table 4: Health Facility Scores according to areas due to priorities given to other units such
the Standard of Postnatal Care in Tigray, as the labor and delivery wards [14].
Ethiopia 2016.
Hospital Name Score (%) This study also showed that the facilities did
Mekelle 70 not have suitable infrastructure for the
Quiha 56.9 provision of quality postnatal care. A study by
Mgawadere also reported that lack of proper
Wukro 58.2
structures for providing maternal and neonatal
Adigrat 48.3
health services contributed to poor or partial
Adwa 57.7 service provision to clients and hence
Axum 65.3 compromised the quality of care [10, 15, 16].
Shire 54.6
Abiadi 41.7 Human and material resources were
inadequate for provision of comprehensive and
Maichew 51.7
quality postnatal care in all hospitals of
Tigray. The finding is in line with a study in
DISCUSSION Dar es Salaam perinatal needs assessment for
In this study a total of nine government quality of care infrastructure, equipment and
hospitals enrolled and all midwives (123) supplies for perinatal care in Dar es Salaam
working in the selected health facilities were public health institutions were inadequate [17].
participated.
Midwives in this study did not follow the
The postnatal care that was provided in the required guidelines and teaching aids for
selected BEmONC hospitals in Tigray was postnatal care. To increase the availability and
below standard this is in tune with a study effectiveness of ANC and PNC services, staff
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 16
Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
shortages and skills gaps, lack of equipment Regarding the supply side, staff, in-service
and supplies, and the absence of proper PNC training were reported inadequate in the study,
guidelines must be remedied. Suggestions Previous studies found that understaffing and
from most respondents focused on increasing inadequate funding at township and village
the number of staff at all levels of health level health facilities are the main barriers
facilities. The importance of strengthening from the supply side [22,23]. Shortages of
human resources in healthcare is also staff, equipment and supplies were common
increasingly acknowledged [18–20]. complaints in the community [24, 25].
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 17
Quality of Postnatal Care Offered to Mothers in Hospitals Berhe et al.
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 18
Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 19