Academic journal article Bulletin of the World Health Organization

Inequities in Postnatal Care in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis/Inegalites Des Soins Postnatals Dans Les Pays a Revenu Faible et a Revenu Intermediaire: Revue Systematique et Meta- analyse/Las Desigualdades En la Atencion Posnatal En Los Paises De Ingresos Bajos Y Medianos: Una Revision Sistematica Y Metaanalisis

Academic journal article Bulletin of the World Health Organization

Inequities in Postnatal Care in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis/Inegalites Des Soins Postnatals Dans Les Pays a Revenu Faible et a Revenu Intermediaire: Revue Systematique et Meta- analyse/Las Desigualdades En la Atencion Posnatal En Los Paises De Ingresos Bajos Y Medianos: Una Revision Sistematica Y Metaanalisis

Article excerpt

Introduction

Each year an estimated 289 000 women die worldwide from complications related to pregnancy, childbirth or the postnatal period' and up to two thirds of such maternal deaths occur after delivery. (2,3) Poor outcomes of maternal and neonatal care also include 2.9 million neonatal deaths per year. (4) Of the maternal and neonatal deaths that occur globally, 99% occur in low- and middle-income countries. (1,5)

According to the World Health Organization (WHO), the postnatal period begins immediately after childbirth and lasts six weeks. (6) In low-income countries, almost 40% of women experience complications after delivery and an estimated 15% develop potentially life-threatening problems/ Postnatal care services are a fundamental element of the continuum of essential obstetric care--which also includes antenatal care and skilled birth attendance--that decreases maternal and neonatal morbidity and mortality in low- and middle-income countries. (8,9) Compared with other maternal and infant health services, (10) coverage for postnatal care tends to be relatively poor. Increasing such coverage has been highlighted as a priority. (11) In the Democratic Republic of the Congo, for example, at least 93% of pregnant women receive antenatal care and skilled birth attendance but only 35% of birthing women receive postnatal care. (12) In Kenya, fewer than 20% of women use postnatal care services. (13) In 2014, WHO recommended that a mother and her newborn child should receive postnatal care within 24 hours of the birth and then at least three more times--i.e. at least on day three after the birth, in the second week after the birth and six weeks after the birth. (14) Postnatal care services can be defined as preventive care practices and assessments that are designed to identify and manage or refer complications for both the mother and the neonate. Typically, such services include an integrated package of routine maternal and neonatal care as well as extra care for neonates that are considered particularly vulnerable because, for example, they are preterm, have a low birth weight, are small for gestational age or have mothers infected with human immunodeficiency virus (HIV). (15) Possible postnatal interventions for the mother include: (i) iron and folic acid supplementation for at least three months; (ii) screening for--and treatment of--infection, haemorrhage, thromboembolism, postnatal depression and other conditions; (iii) prophylactic antibiotics given to women who have a third- or fourth-degree perineal tear; and (iv) counselling on early and exclusive breastfeeding, nutrition, birth spacing and family planning options--including any available contraception. (14,16,17) Possible interventions for the neonate include: (i) care of the umbilical cord (ii) special care for preterm, low-birth-weight and HIV-infected neonates; (14,15,18) (iii) screening and treatment of infections and postnatal growth restriction; (iv) assessment of factors predisposing to infant anaemia; (19) and (v) teaching the mother to seek additional care for her neonate if she notices danger signs such as convulsions or problems with feeding. (14)

Low use of postnatal care services is associated with lack of education, poverty and limited access to health-care facilities. (2) However, these associations have not been assessed systematically. We therefore conducted a systematic review of the relevant evidence from low- and middle-income countries, to inform policy-making, help strengthen health systems and increase access to--and use of--postnatal care services.

Methods

We followed guidelines for systematic reviews from the Cochrane Collaboration (20) and a standardized methodology described in an explicit protocol. (21) The review was registered with the Prospero database (registration number: CRD42013004661) and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. …

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