Assessment of knowledge, attitude and practice of primary health care workers in postpartum care in the North Bank East Division of the Gambia

Only a small proportion of women in developing countries –less than 30% -receive adequate postpartum care (WHO 1998). In very poor countries and regions, as few as 5% of women receive such care. A large proportion of maternal deaths occur during the first 6 weeks after delivery, and postpartum care might help to prevent many of these deaths. In developed countries, 90% of new mothers receive postpartum care.(WHO 1997). The health policy for The Gambia affirms the integration of Maternal and Child Health (MCH) and Family Planning services, postpartum care being a major component of this integrated approach. However the attention for ‘a healthy start’ for the Gambian child (nearly 94% of women report their child receiving a vaccination at the first MCH visit) seems to go at the cost of the Mothers in the MCH services – there is not enough attention for the mother, especially in the postpartum period. (Walraven et.al 1999) Care during the postpartum period should provide opportunities to check that both mother and baby are doing well, provide support to breast feeding, family planning and enable the health workers to detect and manage health problems early. MAIN OBJECTIVES:-The overall objectives of the study was to assess knowledge, attitudes and practices of primary health care workers in primary postnatal care in the North Bank East Division of the Gambia. SPECIFIC OBJECTIVES (i) To obtain Nurses’ and Traditional Birth Attendants' (TBAs) understanding of postpartum health problems. (ii) To describe the knowledge, attitude, and practice of Nurses and TBAs in postpartum care (with emphasis on breast-feeding, postpartum sepsis control, postpartum family planning and postpartum anaemia). (iii) To obtain information from postnatal mothers regarding birth related illnesses, health seeking behaviour during the postnatal period, and perceptions of postnatal care and needs and demands (iv) To obtain Nurses’ opinion concerning problems they have in providing postnatal care as well as potential strategies for improving postpartum care. (v) To compare knowledge, attitude and practice of the professional health workers -nurse- midwives and the non -midwives in postnatal care(specifically on anaemia, breastfeeding, postpartum sepsis and postpartum family planning) to determine if training contributes to a significantly better knowledge, andpractice. DESIGN:- a cross-sectional descriptive study. METHODS: semi-structured questionnaires were used to collect data from (a) 31 nurses from the 5 health facilities and 9 Primary Health Care Villages (b)53 TBAs from 43 Primary Health Care (PHC) villages (c) 119 women attending an MCH clinic who fulfilled the inclusion criteria . 3 focus group of nurses were convened during 5th October to 12th October 2000. The group discussions were held with the view of soliciting more important and in-depth information from the participants in the groups that might not have been fully addressed in the questionnaires. RESULTS: - There is a need to improve knowledge and practice of the TBAs in the four components the survey examined. The study revealed that there is room for improvement demonstrated by the positive attitudes of the TBAs on all the four themes. The level of knowledge and practice in all the four components studied among the health professionals was reasonable but there is still room for improvement. Most women attend clinics after delivery for child health reasons, but less for their own health. Although not surprising, a relatively high proportion of mothers reported symptoms during the postpartum period, a large proportion received help from facilities and/or home based care. A number of specific operational barriers that hinder postnatal care services have been outlined. Shortage of staff, lack of supervision, gaps in technical competence, poor supplies, poor staff attitude and cultural barriers among others. Each of these is an important barrier. Potential strategies to improve the situation outlined include continuing education of health staff, logistical support, and community education, integrating of services and monitoring and evaluation of progress. CONCLUSION: The prevention, recognition and management of complications depends on experience and training, and regular training of health workers in all forms plays a major role in safe motherhood. What is needed is the development of locally appropriate comprehensive simple intervention plans needed before and during pregnancy, during delivery and after delivery for mothers and newborn linking and maximizing the skills of health workers. RECOMMENDATIONS - the issue of postnatal care should now be addressed fully in an integrated approach making use of the health system and its collaborating partners. A “Primary Postnatal Care Package” could be developed and tested for its effectiveness in North Bank East Health Division