Monographs Els Duysburg 'Quality of Maternal and Infant Care in sub-Saharan Africa: Challenges and Oppurtunities


Maternal and infant mortality remain unacceptably high in sub-Saharan Africa, despite the fact that evidence-based interventions and strategies have been devised and are being implemented.
Implementation of and access to these evidence-based interventions alone does not guarantee improved health outcomes. This will only be possible if the quality of the existing antenatal, childbirth, and postpartum care is sufficiently high to provide adequate management and treatment and to encourage utilisation of the provided care.
Our research focused on this need to improve quality of maternal and infant care. The research compromised a study on quality of antenatal and childbirth care conducted in rural primary health care facilities in Burkina Faso, Ghana, and Tanzania and a study on improving postpartum care conducted in rural districts in Burkina Faso, Kenya, Malawi,
and Mozambique.
The antenatal and childbirth quality assessment study identified critical gaps in the quality of care that are remarkably similar between the study sites. Counselling and health education practices are poor, laboratory investigations are often not performed, examination and monitoring of mother and newborn during childbirth are inadequate, partographs are
poorly used, and none of the surveyed health facilities performed assisted vaginal delivery.
Detection, prevention and, if applicable, management of obstetric complications was substandard at all study sites. The same study couldn’t show that the implementation of a computer assistant electronic clinical decision support system and performance-based incentives improved the quality of antenatal and childbirth care provided at the health facilities
during the study period. However the use of new technology seems acceptable and feasible in rural primary health care facilities in resource-constrained settings creating the possibility to use this technology to address identified quality and knowledge gaps.
The study on improving postpartum care for mothers and infants 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. 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 included the introduction of postpartum home visits, 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.

Authors & affiliation: 
Els Duysburgh, ICRH
Published In: 
ICRH Monographs
Publication date: 
Friday, March 11, 2016