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.
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.
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DOI：
10.1186/s12884-015-0562-8
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发表时间：
2015-06-03
影响因子：
3.1
通讯作者：
Temmerman M
中科院分区：
文献类型：
--
作者：
Duysburgh E;Kerstens B;Kouanda S;Kaboré CP;Belemsaga Yugbare D;Gichangi P;Masache G;Crahay B;Gondola Sitefane G;Bique Osman N;Foia S;Barros H;Castro Lopes S;Mann S;Nambiar B;Colbourn T;Temmerman M
撒哈拉以南非洲的产后孕产妇和婴儿死亡率很高，作为加强孕产妇和婴儿健康的一项战略，改善产后护理一直被忽视。我们描述了有可能改善产后护理的适当的、针对具体情况的干预措施的设计和选择。这项研究在布基纳法索、肯尼亚、马拉维和莫桑比克的农村地区实施。我们使用“系统思维”的四个步骤来设计和选择干预措施：1)我们进行了利益相关者分析，以确定和召集利益相关者；2)我们组织了利益相关者原因分析研讨会，在研讨会上讨论了当地的产后情况、挑战和可能的干预措施；3)根据全面的需求评估结果、利益相关者的意见和关于良好产后护理的现有知识，设计了一份潜在干预措施的清单；4)利益相关者选择并商定了最终的针对具体情况实施的干预方案，以改善产后护理。需求评估结果显示，在所有研究国家中，产妇、新生儿和儿童健康是国家优先事项，但产后护理的具体政策薄弱，几乎没有证据表明有效实施了产后护理。在研究地区，很少有妇女在分娩后的第一周接受产后护理(布基纳法索为25%，肯尼亚为33%，马拉维为41%，莫桑比克为40%)。根据这些调查结果，利益攸关方选择的干预措施主要侧重于增加产后服务的提供和提供，并通过加强设施和社区一级的产后服务和护理来提高产后护理的质量。这包括引入产后家访、加强产后外展服务、将母亲的产后服务整合到儿童免疫接种诊所、向保健工作者分发产后护理指南，以及通过培训提高产后护理知识和技能。在母亲和婴儿的可获得性和提供产后护理方面存在很大差距。认识到这些差距并让相关利益攸关方参与进来，对于设计和选择可持续的、针对具体情况的一揽子干预措施以改善产后护理非常重要。
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. 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. 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. 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.
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影响因子：
168.9
作者：
Bhutta, Zulfiqar A.;Soofi, Sajid;Martines, Jose
通讯作者：
Martines, Jose
影响因子：
7.2
作者：
Baker, Ulrika;Tomson, Goeran;Eriksen, Jaran
通讯作者：
Eriksen, Jaran
影响因子：
3.1
作者：
Chersich, Matthew F.;Kley, Nicole;Temmerman, Marleen
通讯作者：
Temmerman, Marleen
影响因子：
168.9
作者：
Bhutta, Zulfiqar A.;Ali, Samana;Black, Robert E.
通讯作者：
Black, Robert E.