Presenter: Bernadette Daelmans, World Health Organization
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Background: Most maternal and infant deaths occur in the days and weeks following childbirth, yet, this is the most neglected period for the provision of quality care. In 2013 WHO updated guidelines that addressed the timing and content of postnatal care (PNC) and contacts for the mother and newborn following normal childbirth in resource-limited settings. In addition WHO and UNICEF issued a joint statement in 2009 on Home visits for the newborn: a strategy to improve survival. It includes evidence-based information on how trained community health workers can be effective in reaching pregnant and lactating women and newborns. These recommendations have been corroborated through systematic reviews published by WHO in 2012. The publication Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting aims to address critical health workforce shortages that slow down progress towards the Millennium Development Goals.
Methodology: WHO recommendations are based on a systematic process of evidence review using an expert consultation, that considered the quality of the evidence using GRADE criteria, benefits and harms, values and preferences of policy makers, health care providers and parents, and whether costs are justifiable relative to benefits in low and middle income countries.
Results: The PNC guidelines include twelve recommendations covering the following areas: timing of health facility discharge; number and timing of PNC contacts; PNC home visits; assessment of baby; exclusive breastfeeding; cord care; other postnatal care for baby; assessment of mother; counselling; iron and folate supplementation; prophylactic antibiotics; and psychosocial support. The joint statement from WHO and UNICEF provides complementary guidance on health cadres to implement the recommendations.
Conclusions: To improve the coverage and quality of PNC it is critical that service providers, policy-makers and program managers are knowledgeable of the recent evidence-based guidelines and service options using their available health work force.