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

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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.