title: Improving coverage of postnatal care in rural Ethiopia using a community-based, collaborative quality improvement approach.
abstract: BACKGROUND
  Ethiopia has high maternal and neonatal mortality and low use of skilled maternity care. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), a 3.5-year learning project, used a community collaborative quality improvement approach to improve maternal and newborn health care during the birth-to-48-hour period. This study examines how the promotion of community maternal and newborn health (CMNH) family meetings and labor and birth notification contributed to increased postnatal care within 48 hours by skilled providers or health extension workers.
  
  
  METHODS
  Baseline and endline surveys, monthly quality improvement data, and MaNHEP's CMNH change package, a compendium of the most effective changes developed and tested by communities, were reviewed. Logistic regression assessed factors associated with postnatal care receipt. Monthly postnatal care receipt was plotted with control charts.
  
  
  RESULTS
  The baseline (n = 1027) and endline (n = 1019) surveys showed significant increases in postnatal care, from 5% to 51% and from 15% to 47% in the Amhara and Oromiya regions, respectively (both P < .001). Notification of health extension workers for labor and birth within 48 hours was closely linked with receipt of postnatal care. Women with any antenatal care were 1.7 times more likely to have had a postnatal care visit (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.10-2.54; P < .001). Women who had additionally attended 2 or more CMNH meetings with family members and had access to a health extension worker's mobile phone number were 4.9 times more likely to have received postnatal care (OR, 4.86; 95% CI, 2.67-8.86; P < .001).
  
  
  CONCLUSIONS
  The increase in postnatal care far exceeds the 7% postnatal care coverage rate reported in the 2011 Ethiopian Demographic and Health Survey (EDHS). This result was linked to ideas generated by community quality improvement teams for labor and birth notification and cooperation with community-level health workers to promote antenatal care and CMNH family meetings.
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
authors.forename: Danika
authors.initials: D
authors.lastname: Barry
authors.forename: Abebe Gebremariam
authors.initials: AG
authors.lastname: Gobezayehu
authors.forename: Aynalem Hailemichael
authors.initials: AH
authors.lastname: Frew
authors.forename: Kim Ethier
authors.initials: KE
authors.lastname: Stover
authors.forename: Hana
authors.initials: H
authors.lastname: Tessema
authors.forename: Lamesgin
authors.initials: L
authors.lastname: Alamineh
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Sibley
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000592:standards*; D005002:Ethiopia; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D011181:Postnatal Care / Q000592:standards*; D011247:Pregnancy; D058996:Quality Improvement; D012111:Residence Characteristics; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population
keywords: Ethiopia; community intervention; maternal and newborn health; postnatal care; quality improvement