Pregnancy, Childbirth, Postpartum And Newborn Care
Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice (3rd edition) (PCPNC), has been updated to include recommendations from recently approved WHO guidelines relevant to maternal and perinatal health. These include pre-eclampsia & eclampsia; postpartum haemorrhage; postnatal care for the mother and baby; newborn resuscitation; prevention of mother-to- child transmission of HIV; HIV and infant feeding; malaria in pregnancy, interventions to improve preterm birth outcomes, tobacco use and second-hand exposure in pregnancy, post-partum depression, post-partum family planning and post abortion care.
Pregnancy, Childbirth, Postpartum and Newborn Care
The aim of PCPNC is to provide evidence-based recommendations to guide health care professionals in the management of women during pregnancy, childbirth and postpartum, and newborns, and post abortion, including management of endemic diseases like malaria, HIV/AIDS, TB and anaemia.
The PCPNC is a guide for clinical decision-making. All recommendations are for skilled attendants working at the primary level of health care, either at the facility or in the community. They apply to all women attending antenatal care, in delivery, postpartum or post abortion care, or who come for emergency care, and to all newborns at birth for routine and emergency care.
Data from national health information systems are essential for routinely tracking progress, programmatic decision-making and to improve quality of services. Understanding the data elements captured in patient registers which are building blocks of national HMIS indicators, enables us to standardize data collection and measurement of key indicators for tracking progress towards achieving maternal and newborn health goals. This analysis was done through a review of antenatal care (ANC), childbirth and postnatal care (PNC) registers from 21 countries across five geographic regions. Between July and October 2020, country-based maternal and newborn experts, implementing agencies, program managers, and ministry of health personnel were asked to share the registers in use. Both paper-based and electronic registers were obtained. Twenty ANC registers, eighteen childbirth and thirteen PNC were available and analyzed. Both longitudinal and cross-sectional ANC and PNC registers were obtained, while the childbirth registers included in the analysis were all cross-sectional. Fifty-five percent (11/20) ANC registers and 54% (7/13) PNC registers were longitudinal. In four countries, the registers were electronic, while the rest were paper-based (17 countries). Sub-analysis of registers from four countries (Ghana, Kenya, Nigeria, and Zambia) where the 2017/2018 and 2019/2020 registers were available showed that the latest versions included 21/27 (78%) of data elements that are critical in the computation of key maternal and newborn care indicators. This analysis highlights some areas in where there are data gaps in data on pregnancy and childbirth. Program managers and health workers should use data gathered routinely to monitor the performance of their national health system and to guide the continuous improvement of health care services for women and newborns. The findings can help to inform the standardization of pregnancy and childbirth registers, and provide information for other countries seeking to introduce indicators in their health systems.
The global burden of maternal deaths is estimated at 810 women dying each day from preventable conditions related to pregnancy and childbirth [1,2]. Although there was 38% reduction in the maternal mortality ratio (MMR) between 2000 and 2017, the current MMR of 211 deaths per 100,000 live births remains unacceptably high especially, with two-thirds of the deaths occurring in low-to middle- income countries (LMICs) . At the same time, the number of stillbirths is rising especially in Sub-Saharan Africa, increasing from 0.77 million in 2000 to 0.82 million in 2019. In some high-income countries more stillbirths than neonatal deaths occur, and in some cases, even surpass the number of infant deaths [2,3]. Most maternal and newborn deaths are preventable if proper preventive measures are in place. In many settings poor quality of care is a greater contributor to poor health outcomes than care coverage and it is estimated that about half of the maternal deaths and 58% of the newborn deaths could be averted with quality health care . Maternal and newborn mortality is considered to be proxy indicator of limited access to quality healthcare service delivery in a population. Avoidable maternal and newborn health inequalities arise because of the socio-cultural and socio-eco- political circumstances in which a woman and her newborn grow, live, work, and age, and the systems put in place to deal with illness .
The approach used in this review was informed by previous similar work that focused on maternal, newborn and child survival [13,29]. Selection of the countries included in the review was guided by the findings of a literature review conducted prior to embarking on the analysis of the registers as well as the availability of the records. Countries included in this review had some literature published related to ANC, childbirth, or PNC registers. A few countries, especially those from regions where published literature was not available, were added to the list to present a more global perspective, taking into account the geographical distribution as well as the access to the registers at the time of the review. In the end, twenty-one countries drawn from five geographical regions (Africa, Europe, South-East Asia, Eastern Mediterranean, and the Americas), were included in the review (Table 1).
Between July and October 2020, maternal and newborn experts, implementing agencies, program managers, and ministry of health personnel were contacted and requested to share the current versions of the ANC, childbirth, and PNC registers in use in the selected countries. We received 20 ANC, 18 childbirth, and 13 PNC registers from 21 countries in various formats such Microsoft Excel and Word, portable document format, images, and links to websites. Both paper-based and electronic registers were obtained. Unavailability of some registers for analysis from any of the 21 countries did not mean that the registers do not exist in the country, but that they were not able to be easily shared, especially in countries using electronic registers. For the paper-based registers, the years of their production ranged from between 2015 to 2020. For some of the electronic registries, no specific dates could be assigned to when they were produced. However, majority had some time-periods documented in various ways; for example, the medical birth register of Sweden reviewed spans the period 1967 to 2018 [24,25]. This review was limited to the three types of registers and did not include other records such as the partograph and data summary forms.
Results of analysis of registers from four countries (Ghana, Kenya, Nigeria, and Zambia) where the 2017/2018 and 2019/2020 versions of the registers were available showed that there is an apparent change towards inclusion of data elements that are critical in the computation of key maternal and newborn care indicators. Overall, 21/27(78%) key data elements for tracking maternal and newborn care are present in the latest versions of the registers reviewed (Table 9 and S1 File of key priority indicators). The ones that are present in to varying degrees are: ANC visits
For childbirth, the majority of countries capture data on obstetric complications, but few do preventative or management interventions for postpartum hemorrhage or pre-eclampsia. Although there is evidence of documentation of key data on childbirth, it is possible that some other materials such as the partograph, which is recommended by WHO for capturing data during active labor to inform care, should supplement the information captured through registers . Additionally, few countries tracked whether the partograph was used or fetal heart monitoring during childbirth. Furthermore, data on breastfeeding within one hour of birth, newborn resuscitation and BCG immunization were also not routinely captured in most countries.
The ANC, childbirth and PNC registers are a major source of essential maternal and newborn data, but standardization in recording of data elements varies across countries. Managers and frontline health workers use these data to monitor the performance of their national health system and to guide the continuous improvement of health care services for women and newborns. The results of this analysis will complement additional work and help to inform the standardization of global indicators and provide information for other countries seeking to introduce indicators in their health systems. There is need for further analysis of the HMIS indicators reported from data captured in the registers to understand what data elements/indicators help more to suggest policy changes and inform programme decisions.
The aim of Pregnancy, childbirth, postpartum and newborn care guide for essential practice (PCPNC) is to provide evidence-based recommendations to guide health care professionals in the management of women during pregnancy, childbirth and postpartum, and post abortion, and newborns during their first week of life.
All recommendations are for skilled attendants working at the primary level of health care, either at the facility or in the community. They apply to all women attending antenatal care, in delivery, postpartum or post abortion care, or who come for emergency care, and to all newborns at birth and during the first week of life (or later) for routine and emergency care.
This issue brief provides an overview of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections in the U.S. compared to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 We use the most recently available data from the Centers for Disease Control and Prevention (CDC), the Organisation for Economic Co-operation and Development (OECD), and earlier Commonwealth Fund studies.3 041b061a72