Adapting and Implementing Group-Based Postpartum/Well-Child Care at Clinics In Blantyre District, Malawi

项目总结 产后护理，定义为从出生到第一年，为长期健康和 母亲和孩子的福祉；此外，这是降低母婴发病率的关键时期 和死亡率。世界卫生组织(WHO)建议，每个母亲和婴儿都应该在 在分娩后的前六周内，至少四次产后探视。出生后的第一年是 不仅是身体恢复，而且是确定和管理健康和社会挑战的重要时期 包括心理社会适应和向父母角色的转变，这使妇女和儿童变得脆弱 因为健康状况不佳。在全球范围内，没有标准化的产后第一年护理套餐。 此外，产后护理出勤率很低，显示出妇女在这一关键时期未得到满足的需求 在它们的生命过程中。撒哈拉以南非洲，特别是马拉维，有一些最高的 孕产妇和婴儿死亡率(每100,000名活产中有634名产妇死亡，每1000名婴儿中有42名婴儿死亡 活产)。孕产妇和婴儿发病率和死亡率以及可预防疾病和 疾病需要在产后分娩和良好的儿童护理方面进行转变，在这个关键时刻 母婴生命历程。以人为本育儿是一种创新的团体医疗模式，可以弥补差距 在产后和儿童保健方面，证据越来越多，产生了积极的结果。这个团体护理中心 该模式旨在通过解决孕产妇并存问题改善孕产妇和儿童健康结果，确保 避孕计划，促进适当的生育间隔，鼓励纯母乳喂养，婴儿营养， 父母教养自我效能感、儿童发展和护理质量。有必要通过创新发展 对低资源母婴敏感的产后/健康儿童团体护理模式的策略 在孕产妇和婴儿发病率和死亡率很高的情况下。因此，这样做的目的是 混合方法研究是适应和实施以父母为中心的模式，这是一种有望 关于优质产后和良好儿童护理的先期指南，并评估其可行性和可接受性 马拉维的背景。这项研究将建立在正在进行的NINR的研究基础设施和势头上- 资助(R01 NR018115)马拉维布兰太尔区基于群体的产前护理有效性试验。这个 建议的研究将使用五步设计思维方法来适应以中心为中心的父母教养方式：1)移情； 2)定义；3)构思；4)原型；5)测试。这将通过快速的人种学评估和 与妇女、健康监测工作者和提供者举行孵化器会议，以创建关怀圈原型。 将对关怀圈原型进行测试，以确定在马拉维情况下的可行性和可接受性。这个 调查结果将为申请人的研究计划的下一步提供信息，以确定 中心马拉维和其他低资源环境的育儿计划模式，包括美国和其他国家。

PROJECT SUMMARY Postpartum care, defined from the time of birth through the first year, sets the stage for long-term health and well-being for both the mother and her child; further it is a critical time to reduce maternal and infant morbidity and mortality. The World Health Organization (WHO) recommends that every mother and baby should have at least four postpartum visits within the first six weeks of giving birth. The first year after childbirth is a period of not only physical recovery but is an important time to identify and manage health and social challenges including psychosocial adaptations and transitions to a parental role, that make women and children vulnerable for poor health outcomes. Globally there is no standardized package of care for the first year postpartum. Further, there are low rates of postpartum care attendance, revealing women's unmet needs during this critical period in their life course. Sub-Saharan Africa and specifically Malawi have some of the highest rates of maternal and infant mortality (MMR 634 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births) globally. High rates of maternal and infant morbidity and mortality and preventable illness and disease necessitate transformation in the delivery of postpartum and well-child care in this critical time in the maternal/infant life course. CenteringParenting is an innovative group healthcare model that can address gaps in both postpartum and well-child care with a growing evidence base yielding positive results. This group-care model aims to improve maternal and child health outcomes by addressing maternal co-morbidities, ensuring contraceptive plans to promote adequate birth-spacing, encouraging exclusive breastfeeding, infant nutrition, parenting self-efficacy, child development and quality of care. There is a need to develop through innovative strategies a postpartum/well-child group care model that is sensitive to maternal-infant dyads in low resource contexts where rates of maternal and infant morbidity and mortality are high. Therefore, the purpose of this mixed methods study is to adapt and implement CenteringParenting, a model of care that holds promise to advance guidelines for quality postpartum and well-child care, and evaluate its feasibility and acceptability in the Malawian context. This study will build on the research infrastructure and momentum of the ongoing NINR- funded (R01 NR018115) effectiveness trial for group based antenatal care in Blantyre district, Malawi. The proposed study will use the five-steps of design thinking approach to adapt CenteringParenting: 1) empathize; 2) define; 3) ideate; 4) prototype; and 5) test. This will be done through a rapid ethnographic assessment and incubator sessions with women, health surveillance workers and providers to create the Care Circles prototype. The Care Circles prototype will be tested to determine feasibility and acceptability in the Malawian context. The findings will inform the next step in the applicant's program of research, to determine the effectiveness of the CenteringParenting program model in Malawi and other low-resource settings, including in the US and beyond.