title: Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries.
abstract: BACKGROUND
  Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care.
  
  
  METHODS
  The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps 'systems thinking' approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and possible interventions were discussed; 3) based on comprehensive needs assessment findings, inputs from the stakeholders and existing knowledge regarding good postpartum care, a list of potential interventions was designed, and; 4) the stakeholders selected and agreed upon final context-specific intervention packages to be implemented to improve postpartum care.
  
  
  RESULTS
  Needs assessment findings showed that in all study countries maternal, newborn and child health is a national priority but specific policies for postpartum care are weak and there is very little evidence of effective postpartum care implementation. In the study districts few women received postpartum care during the first week after childbirth (25 % in Burkina Faso, 33 % in Kenya, 41 % in Malawi, 40 % in Mozambique). Based on these findings the interventions selected by stakeholders mainly focused on increasing the availability and provision of postpartum services and improving the quality of postpartum care through strengthening postpartum services and care at facility and community level. This includes the introduction of postpartum home visits, strengthening postpartum outreach services, integration of postpartum services for the mother in child immunisation clinics, distribution of postpartum care guidelines among health workers and upgrading postpartum care knowledge and skills through training.
  
  
  CONCLUSIONS
  There are extensive gaps in availability and provision of postpartum care for mothers and infants. Acknowledging these gaps and involving relevant stakeholders are important to design and select sustainable, context-specific packages of interventions to improve postpartum care.
authors.affiliation: International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. els.duysburgh@ugent.be.
authors.forename: Els
authors.initials: E
authors.lastname: Duysburgh
authors.affiliation: International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. birgit.kerstens@antwerpen.be.
authors.forename: Birgit
authors.initials: B
authors.lastname: Kerstens
authors.affiliation: Institut de Recherche en Sciences et de la Santé, P.O. Box 7192, Ouagadougou, 03, Burkina Faso. skouanda@irss.bf.
authors.forename: Seni
authors.initials: S
authors.lastname: Kouanda
authors.affiliation: Institut de Recherche en Sciences et de la Santé, P.O. Box 7192, Ouagadougou, 03, Burkina Faso. kaborewendyam@yahoo.fr.
authors.forename: Charles Paulin
authors.initials: CP
authors.lastname: Kaboré
authors.affiliation: Institut de Recherche en Sciences et de la Santé, P.O. Box 7192, Ouagadougou, 03, Burkina Faso. belemsagadanielle@yahoo.fr.
authors.forename: Danielle
authors.initials: D
authors.lastname: Belemsaga Yugbare
authors.affiliation: International Centre of Reproductive Health Kenya, Obote Avenue - Tudor Estate, P.O. Box 91109, 80103, Mombasa, Kenya. Peter@icrhk.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Gichangi
authors.affiliation: Parent and Child Health Initiative Trust, P.O. Box 31686, Lilongwe, 3, Malawi. gibsonmasache2012@yahoo.com.
authors.forename: Gibson
authors.initials: G
authors.lastname: Masache
authors.affiliation: International Centre of Reproductive Health Mozambique, Av. Maquiguana, Praceta 1607, Prédio 100, 1 Andar, Maputo, Mozambique. beatrice.crahay@gmail.com.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Crahay
authors.affiliation: International Centre of Reproductive Health Mozambique, Av. Maquiguana, Praceta 1607, Prédio 100, 1 Andar, Maputo, Mozambique. gildagondola@gmail.com.
authors.forename: Gilda
authors.initials: G
authors.lastname: Gondola Sitefane
authors.affiliation: Eduardo Mondlane University, Faculdade de Medicina, Av. Salvador Allende 702, Maputo, Mozambique. nafissa.osman@gmail.com.
authors.forename: Nafissa
authors.initials: N
authors.lastname: Bique Osman
authors.affiliation: Eduardo Mondlane University, Faculdade de Medicina, Av. Salvador Allende 702, Maputo, Mozambique. s_foia@yahoo.com.br.
authors.forename: Severiano
authors.initials: S
authors.lastname: Foia
authors.affiliation: Department of Hygiene and Epidemiology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. hbarros@med.up.pt.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
authors.affiliation: Department of Hygiene and Epidemiology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal. fia.clopes@gmail.com.
authors.forename: Sofia
authors.initials: S
authors.lastname: Castro Lopes
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. suemann@doctors.org.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Mann
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. b.nambiar@ucl.ac.uk.
authors.forename: Bejoy
authors.initials: B
authors.lastname: Nambiar
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. t.colbourn@ucl.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Colbourn
authors.affiliation: International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. marleen.temmerman@ugent.be.|Department of Reproductive Health and Research, World Health Organisation, Avenue Appia 20, 1211, Geneva, 27, Switzerland. marleen.temmerman@ugent.be.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D017954:Africa South of the Sahara; D003153:Community Health Services / Q000379:methods* / Q000592:standards; D003159:Community-Institutional Relations; D005260:Female; D006297:Health Services Accessibility; D006792:House Calls; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000592:standards*; D020380:Needs Assessment; D011181:Postnatal Care / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D012424:Rural Population