Integrating quality postnatal care into PMTCT in Swaziland

Area of Science:

• Public Health
• Maternal and Child Health
• HIV/AIDS Prevention

Background:

• Swaziland's prevention of mother-to-child transmission (PMTCT) program integrates with maternal and newborn health (MNH) services, primarily focusing on HIV/AIDS.
• Existing MNH services, particularly postnatal care (PNC), are insufficient, leading to delayed postnatal visits.
• Only 57% of staff in seven Swazi facilities were trained in early PNC promotion and provision.

Purpose of the Study:

• To evaluate the impact of trained health workers on early postnatal care (PNC) uptake and quality in Swaziland.
• To assess improvements in breastfeeding initiation and cotrimoxazole prophylaxis for HIV-exposed infants.
• To determine the feasibility and acceptability of integrated PMTCT and MNH postnatal services.

Main Methods:

• Training of 57% of staff in seven health facilities on early PNC promotion and provision.
• Evaluation of early postnatal visit rates (within 3 days postpartum).
• Direct observation of client-provider interactions to assess health worker competence in postnatal examinations and care.

Main Results:

• A 20-fold increase in early postnatal visits was observed.
• Significant improvements in health worker competence for postnatal examinations and care (p<0.05- < 0.01).
• Increased breastfeeding rates (41% HIV-positive, 52% HIV-negative mothers) and cotrimoxazole prophylaxis (24% increase for HIV-exposed infants).

Conclusions:

• Integrated PMTCT and MNH postnatal services are feasible and acceptable in Swaziland.
• The intervention significantly promoted early postnatal visits and improved care for mothers and newborns, regardless of HIV status.
• Despite improved service delivery, maternal recall of health messages was poor, indicating a need for enhanced health behavior promotion strategies.