Repositioning Postnatal Care in a High HIV Prevalence Environment: Operations Research in Swaziland
Council operations research tested whether a change in the Swaziland National Guidelines for postnatal care strengthened postnatal care attendance and follow-up of mothers and infants.
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.
Banner photo: © Tebogo Letsie/IRIN
The key findings of this study showed that facilities are prepared to provide a new postnatal care package. Health provider knowledge increased in several areas and consequently more information was provided to pregnant women during late pregnancy about the postnatal period. As a result, women and their babies received better postnatal care; one indicator of this was a higher proportion of postpartum women were breastfeeding during the post-intervention period.
The strong PMTCT program maintained a high proportion of women testing for HIV and receiving antiretroviral therapy. In addition, there was an increase in testing for HIV among women’s partners and subsequent sharing of test results, as well as increased use of care and support services by HIV-positive postpartum women and their infants.
Overall, the new postnatal package was well received by both clients and providers. To address the barriers to sustaining the new care package, these findings suggest strengthening policy guidelines; developing and implementing a plan to strengthen health systems; emphasizing capacity building through community-based interventions; further developing effective communication techniques; and using monitoring and evaluation tools to document all activities.
Banner photo: © Tebogo Letsie/IRIN
Integrating quality postnatal care into PMTCT in Swaziland (abstract)
Mazia,Goldy; Narayan,I.; Warren,Charlotte; Mahdi,Mohammed; Chibuye,P.; Walligo,A.; Mabuza,P.; Shongwe,Rachel; Hainsworth,M.
Global Public Health 4(3): 253-270
Publication date: 2009
Repositioning postnatal care in a high HIV environment: Swaziland (PDF)
Warren,Charlotte; Shongwe,Rachel; Waligo,Allen; Mahdi,Mohammed; Mazia,Goldy; Narayanan,Indira
Horizons Final Report
Publication date: 2008
Project Stats
Location: Swaziland
Program(s):
HIV and AIDS
Topic(s):
Newborn/infant health
PMTCT and pediatric HIV
Postpartum maternal care
Duration: 1/2006 - 7/2007
Population Council researchers:
Charlotte Warren
Non-Council collaborators:
Joven Ongole (Elizabeth Glaser Pediatric AIDS Foundation)
Linda Kanya (Kenya Ministry of Health and Social Welfare)
Peggy Chibuye (Elizabeth Glaser Pediatric AIDS Foundation)
Rachel Shongwe (Swaziland Central Statistical Office)
Donors:
Elizabeth Glaser Pediatric AIDS Foundation
US Agency for International Development
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