Implementing quality-of-care during labour, childbirth, and early postnatal care, northeast Namibia: a quasi-experimental study

Abstract

Attention to quality-of-care is increasing in low- and-middle-income countries. Nevertheless, few studies exist on the impact of these approaches to caregiving. This paper presents results on the quality-of-care mothers and neonates receive during labour, childbirth, and early postnatal care, pre-and-post-implementation of the World Health Organization/United Nations Children’s Fund/United Population Fund (WHO/UNICEF/UNFPA) quality improvement interventions. A quasi-experimental study design was used to assess the quality-of-care measures/interventions around childbirth and the immediate postnatal care period; we purposively sampled a high-volume hospital, northeast Namibia. Using the Every Mother Every Newborn (EMEN) childbirth quantitative survey questionnaire, we interviewed (pre=100; post=102) women who delivered prior to their discharge home and observed (pre=53; post=60) different women at admission, of which 19 of 53 and 50 of 60, respectively, progressed to deliver on the same day of data collection. Twenty (pre) and 24 (post) staff, and one facility manager (pre-and-post) were also interviewed. Descriptive statistics were used to present results. Postintervention, we found improvements in most assessed quality-of-care measures/interventions, e.g., thorough drying (94.7-100%), babies placed skin-to-skin with their mothers (89.5-98%) and assessed for resuscitation (69.8-98%) needs. Monitoring labour using partograph remained low (11.3-19.3%). During admission, women’s history taking (75.5-95%), blood pressure (98.1%-100%), urine testing (77.4-93.3%), foetal heart rate (94.3-100%), abdominal (86.8-100%) and vaginal examinations (96.2-100%) all improved. Yet, quality-of-care gaps were identified for labour monitoring, and routine postnatal care. Less 50% of women received counselling on family planning (5.3-42%), postnatal care (5.3-40%), maternal (0-38%) and newborn (0-40%) danger signs. Women’s satisfaction with information on breastfeeding and post-partum care and hygiene was 48-56.9% and 41-43.0% respectively. This is the first study in Namibia to assess pre-and-post implementation of quality-of-care practices around childbirth, and postnatal period. Inconsistency and noteworthy quality-of-care gaps exist in the early postnatal care period. Postnatal care management and interpersonal communication skills trainings are likely to improve and sustain high evidence-based care beyond labour and delivery. The poor quality-of-care practices for labour and postnatal care requires further investigation.