Background
Tanzania
is among ten countries that account for a majority of the world’s newborn
deaths. However, data on time-to-discharge after facility delivery, receipt of
postpartum messaging by time to discharge and women’s experiences in the time
preceding discharge from a facility after childbirth are limited.
Methods
Household
survey of 1267 women who delivered in the preceding 2–14 months; in-depth
interviews with 24 women, 12 husbands, and 5 community elders.
Results
Two-thirds
of women with vaginal, uncomplicated births departed within 12 h;
90 % within 24 h, and 95 % within 48 h. Median departure
times varied significantly across facilities (hospital: 23 h, health
center: 10 h, dispensary: 7 h, p < 0.001).
Quantitative
and qualitative data highlight the importance of type of facility and facility
amenities in determining time-to-discharge. In multiple logistic regression,
level of facility (hospital, health center, dispensary) was the only
significant predictor of early discharge (p = 0.001). However across all types of
facilities a majority of women depart before 24 h ranging from hospitals
(54 %) to health centers (64 %) to dispensaries (74 %). Most
women who experienced a delivery complication (56 %), gave birth by
caesarean section (90 %), or gave birth to a pre-term baby (70 %)
stayed longer than 24 h. Reasons for early discharge include: facility
practices including discharge routines and working hours and facility-based
discomforts for women and those who accompany them to facilities. Provision of
postpartum counseling was inadequate regardless of time to discharge and
regardless of type of facility where delivery occurred.
Conclusion
Our
quantitative and qualitative findings indicate that the level of facility care
and comforts existing or lacking in a facility have the greatest effect on time
to discharge. This suggests that individual or interpersonal characteristics
play a limited role in deciding whether a woman would stay for shorter or
longer periods. Implementation of a policy of longer stay must incorporate
enhanced postpartum counseling and should be sensitive to women’s perceptions
that it is safe and beneficial to leave hospitals soon after birth.
Full article at:
By:
1Department of International Health, Johns
Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore
21205-2179, MD, USA
2School of Public Health and Social
Sciences, Department of Behavioural Sciences, Muhimbili University of Health
and Allied Sciences, Dar-Es-Salaam, Tanzania
3School of Public Health and Social
Sciences, Department of Epidemiology and Biostatistics, Muhimbili University of
Health and Allied Sciences, Dar-Es-Salaam, Tanzania
4International Center for Maternal and
Newborn Health, Department of International Health, Johns Hopkins Bloomberg
School of Public Health, 615 N. Wolfe Street, Baltimore 21205-2179, MD, USA
5Institute of Public Health,
Ruprecht-Karls-Universität, Heidelberg, Germany
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment