Integrating quality postnatal care into PMTCT in Swaziland.
Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies.
The United States Agency for International Development, Basic Support for Institutionalising Child Survival Project (USAID/BASICS), Arlington, VA, USA. gmazia@basics.org
G
G
Mazia
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I
Narayanan
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C
Warren
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M
Mahdi
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P
Chibuye
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A
Walligo
P
P
Mabuza
R
R
Shongwe
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M
Hainsworth
D000293:Adolescent; D000328:Adult; D003376:Counseling; D013541:Eswatini; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D009035:Mothers; D019370:Observation; D011181:Postnatal Care / Q000379:methods / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D055815:Young Adult