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. 2018 Jul 4;18(1):282.
doi: 10.1186/s12884-018-1906-y.

Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

Amnesty LeFevre  1   2 , Rose Mpembeni  3 , Charles Kilewo  4   5 , Ann Yang  1 , Selena An  1 , Diwakar Mohan  1 , Idda Mosha  4 , Giulia Besana  6 , Chrisostom Lipingu  6 , Jennifer Callaghan-Koru  1 , Marissa Silverman  1 , Peter J Winch  1 , Asha S George  1   7
Affiliations

Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

Amnesty LeFevre et al. BMC Pregnancy Childbirth. .

Abstract

Background: The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania.

Methods: Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10).

Results: While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment.

Conclusions: Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged.

Keywords: Counselling; Postnatal care; Postpartum care; Primary health care; Tanzania.

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Conflict of interest statement

Ethics approval and consent to participate

The study received ethical approval from the Muhimbili University of Health and Allied Sciences and Johns Hopkins School of Public Health Institutional Review Boards.

Consent for publication

Not applicable.

Competing interests

The authors of this manuscript do not have competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Concepual Framework for assessing the context and Quality of PPC counseling in health centres in Morogoro Tanzania. Legend: *Not measured in the current analysis. References: 1. Donabedian A. The quality of care. How can it be assessed?1988, ARCH Pathol Lab Med 1997, 121 (11):Pg 1145-50. 2. Atherton F. G. Mbekem and I. Nyalusi. Improving service quality from thre Tanzania Family Health Project. Int J Qual Health Care. 3. WHO. Quality of care. A process for making strategic choices in health systems:2006, Worls Health Organization: France 4:p3
Fig. 2
Fig. 2
Availability of essential PPC infrastructure, drugs, equipment, supplies and testings services in 18 health centres in Morogoro region, Tanzania in 2012: Mean composite scores. Legend: Physical Infrastructure (On call staff housing, electricity, water source, client toilet, waiting area, wash basin with running water in the PPC area). Drugs and Commodities: (Iron/folic acid, vitamin A, tetracycline, polio vaccine, BCG vaccine, DPT vaccine, Condoms, Oral Contraceptive pills, depo provera, intra uterine devices, implants, cotrimoxazole, NVP for mother, NVP for child, AZT, 3TC, ARVs.) Equipment /supplies: (Tape measure, sterile clamps, thermometer, baby weighing scale, sterile gloves, syringes, vaccine thermometer, ice box, ice packs and fridge). Diagnostic tests: (CD4 count, HIV testing, DBS HIV for newborns)
Fig. 3
Fig. 3
Composite scores of provider knowledge (N = 62), observed message delivery (N = 45), and client knowledge (N = 41) of PPC messages in 18 health centers in 4 districts of Morogoro region, Tanzania in 2012
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References

    1. WHO . Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.
    1. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;388(10063):3027–3035. doi: 10.1016/S0140-6736(16)31593-8. - DOI - PMC - PubMed
    1. WHO, UNICEF, Bank W, Division UNP . Trends in maternal mortality: 1990 to 2015. Geneva: Estimates by WHO, UNICEF, World Bank, and the United Nations Population Division; 2015.
    1. Ministry of Health, Community Development, Gender, Elderely and Chilrden (MOHCDGEC) [Tanzania Mainland], Ministry of Health Zanzibar (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International 2016. Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS- MIS) 2015-16. Dar es Salaam, Tanzania and Rockville, Maryland, (MOHCDGEC), USA: MoHSW, MoH, NBS, OCGS, and ICF International.
    1. WHO. Oportunities for African Newborns: Practical Data, Policy and Programmatic Support for newborn care in Africa. In. Edited by Lawn J, Kerber K; 2006.

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