Horizons Projects | Repositioning Postnatal Care in a High HIV Prevalence Environment: Operations Research in Swaziland

HORIZONS PROJECT
Repositioning Postnatal Care in a High HIV Prevalence Environment: Operations Research in Swaziland

Since June 2004, comprehensive prevention of mother-to-child transmission (PMTCT) services have been integrated into a maternal and child health (MCH) care package at selected sites in Swaziland. While antenatal attendance is high, which allows many women to access PMTCT services during the antenatal period, one of the main challenges identified for PMTCT programs is follow-up of mothers and infants after delivery. The postnatal period from birth to six weeks is critical for ensuring the health of the mother and infant, and more comprehensive follow-up will assist in ensuring that mothers and their infants are healthy and thriving. The Ministry of Health and Social Welfare wanted to explore changing the policy of when postnatal visit(s) should occur. Horizons, the Elizabeth Glaser Pediatric AIDS Foundation, Basic Support for Institutionalizing Child Survival, and Central Statistical Office assisted the ministry in conducting operations research to collect the pertinent data needed to re-orient the postnatal visit, document the implementation of a revitalized postnatal service, assess the impact of these changes, and inform reproductive health programming with regard to HIV and AIDS. The study objectives were to:

Determine why postnatal care is underutilized within MCH services.
Document the types of service delivery modifications required to improve care, follow-up, and referrals.
Measure the effect of changing the postnatal care policy guidelines on the quality of postnatal care and the utilization of postnatal services by all women.
Increase the use of HIV care and support services by HIV-positive women and their infants.

The research comprised a pre-/post-test design to evaluate the effectiveness of the new postnatal service guidelines in four facilities providing delivery and/or MCH services.

Key findings include:

Facilities are prepared to provide a new postnatal care package.
Health provider knowledge increased in several areas.
More information was given to pregnant women during late pregnancy about the postnatal period.
Women and their babies received better postnatal care.
A higher proportion of postpartum women were breastfeeding post-intervention.
The strong PMTCT program maintained a high proportion of women testing for HIV and receiving antiretroviral therapy.
More women’s partners were testing for HIV and sharing their results.
There was an increased use of care and support services by HIV-positive postpartum women and their infants.
More women were asked about family planning by health care providers.
The new postnatal package was well received by clients.
Providers were receptive to new postnatal package.
Sustaining new PNC package requires addressing barriers.

Location

Swaziland

Duration

January 2006–July 2007

Horizons and Population Council researchers

Charlotte Warren, Carolyn Baek

Non-Council collaborators

Peggy Chibuye, Joven Ongole (Elizabeth Glaser Pediatric AIDS Foundation)

Rachel Shongwe (Swaziland Central Statistical Office)

Linda Kanya (Swaziland Ministry of Health and Social Welfare)

Academy for Educational Development (AED)/ LINKAGES Project

Basic Support for Institutionalizing Child Survival (BASICS)

US Agency for International Development's Southern Africa Regional HIV/AIDS Program

Donors

US Agency for International Development

Elizabeth Glaser Pediatric AIDS Foundation

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2008
Warren, Charlotte, Rachel Shongwe, Allen Waligo, Mohammed Mahdi, Goldy Mazia, and Indira Narayanan. "Repositioning postnatal care in a high HIV environment: Swaziland," Horizons Final Report. Washington, DC: Population Council. (PDF)

2007
Khan, Hena. "Repositioning postnatal care: Baseline results from Swaziland, a high HIV prevalence environment," Horizons Report, June. Washington, DC: Population Council. (full text)