Targeted Postnatal Care Implementation for Mothers in Selected Health Facilities in Western Kenya

Abstract

Context: Postnatal care (PNC) is essential in improving maternal health and reducing maternal mortality, especially in low-resource settings. Targeted Postnatal Care (TPNC) is an approach to postnatal care for mothers and newborns that involves a set of assessments and interventions given in four scheduled visits from birth to 6 months postpartum. The goal is to improve outcomes for these mothers and babies.

Aim: This study aimed to assess the implementation of targeted postnatal care interventions for mothers and their variation across four scheduled visits at selected health facilities in Kakamega County, Western Kenya.

Methods: This was a cross-sectional study conducted in the Maternal and Child Health (MCH) units of selected public health facilities in Kakamega County, a county in the Western region of Kenya. It employed quantitative methods in data collection using a combined tool containing a questionnaire and observation schedule. Data collected from 160 mothers was descriptively analyzed, where the mean, median, and standard deviation were computed and compared across the visits. Analysis of variance (ANOVA) was used to measure the significance of the variations in implementation across the various visits.

Results: The study highlighted significant variations in the provision of maternal care between different visits, with the implementation of TPNC interventions highest within the first 48 hours after delivery (66.62%) and declining at subsequent visits 47.38% at 2-4 weeks, reaching 51.98, at 4-6 weeks, and 50% at 4-6 months. Despite the World Health Organization's recommendations for comprehensive postnatal assessments, the findings reveal gaps in care delivery, such as low rates of health education about maternal HIV testing (20%) within 48 hours and 21.25% at 2-4 weeks, physical examinations (46.88%) at 2-4 weeks and 27.5% at 4-6 months visits, mental health assessments (6.88%) at 2-4 weeks and STI screening at 4-6weeks was 16.10%. There were inconsistent reports on the implementation of key interventions such as early breastfeeding initiation, vital sign checks, and postpartum family planning.

Conclusion: These results demonstrate suboptimal implementation of TPNC for mothers, which can frustrate efforts in achieving sustainable development goals. There was a significant decrease in implementation between the first and second visits and a significant increase from the second to third visits. Considerations should be made to make the second visits convenient for the mothers through community midwifery to ensure that mothers do not miss out on these important interventions. The third visit could be more comprehensive if a room and staff could be allocated to postnatal care and not assumed as a family planning room.