Safeguarding maternal and newborn health: improving the quality of postnatal care in Kenya.

OBJECTIVE: To assess changes in the quality of care following the introduction of a new postnatal package.
DESIGN: Using a pre-test, post test design to observe client-provider interactions with women 0-6 weeks postpartum.
SETTING: Four health facilities in a rural district, eastern Kenya. PARTICIPANTS: Health providers and postpartum women. INTERVENTION: Introduction of comprehensive postnatal package of care, with three targeted assessments within 48 h of birth, 1-2 weeks and 6 weeks, to providers working in maternity and maternal and child health clinics. Main outcome measure Improved quality of postnatal counselling.
RESULTS: Increased mean scores for counselling on danger signs in the newborn (0.24-1.39) and infant feeding (1.33-2.19) were noted. The total quality of care index for the newborn increased overall but remained lower than desired (from 3.37 to 6.45 out of 11). Essential maternal care index improved (3.4-8.72 out of 23). More women accepted a family planning method at 6 weeks (35-63%).
CONCLUSIONS: The introduction of new comprehensive postnatal care package improved performance of providers in counselling in maternal and newborn complications, infant feeding and family planning. Additional studies looking at the postpartum family planning needs for women living with HIV would also be useful. However, providers would benefit from additional clinical skills for managing maternal and newborn complications during the critical period following childbirth.