The Delivery of Post Natal Care and its Association with Newborn Survival and Feeding: A focus on Africa Public Deposited

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  • March 19, 2019
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  • Khan, Shane
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
Abstract
  • The overall goal of this dissertation is to understand how postnatal care (PNC), a relatively new intervention, functions in the context of sub-Saharan Africa with respect to improving neonatal survival and newborn feeding. Further, this dissertation also evaluates if a quality improvement intervention is able to improve PNC. Paper one examines the distribution of PNC and if it is associated with neonatal mortality in 17 countries in sub-Saharan Africa. Findings from descriptive analysis show that PNC coverage is low, often lower than skilled delivery, and that newborns from wealthier households are more likely to receive PNC. Using multi-level modelling to examine if PNC is associated with neonatal mortality, findings show that PNC is associated with saving newborn lives. PNC provided at home and facilities show about the same level of neonatal mortality reductions. Finally, the association of PNC with neonatal mortality is different in East and Southern Africa compared with the West and Central African countries we studied. These findings show the potential of PNC as a mechanism to improve newborn survival. In paper two, we examine if PNC is associated with improved newborn feeding practices. Using multi-level models, we examine if PNC is associated with breastfeeding within one day of birth and with prelacteal feeds (PLFs), which refer to liquids other than breastmilk that are given to newborns before breastfeeding is established. The results indicate that PNC is associated with early breastfeeding though not with PLFs. These findings may indicate that the implementation of PNC must better be tailored to promote the reduction of PLFs. The third paper examines if a quality improvement (QI) intervention in Ghana can improve PNC for the mother and newborn. Using three waves of household survey data, the analysis shows that PNC is associated with improvements in PNC for the mother though not for the newborn. The intervention was associated with significant reductions in PNC within one week for either the newborn or mother. These findings suggest that the program may have emphasized maternal health but not newborn health improvements. Additionally, intervention and comparison areas used overlapping approaching for programming though the intervention area had a strong community component to implementation. The results suggest that community implementation of the QI intervention may have indeed assisted in improvements in PNC. Overall, these results show promise that firstly, national implementation of PNC can save lives and improve newborn feeding though additional work is needed to supplement existing approaches to newborn feeding. Then, QI interventions may be a useful mechanism to improve PNC coverage. These findings are useful to monitor national outcomes as well as examine small-scale studies which contribute to the overall knowledge base on PNC implementation.
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  • In Copyright
Advisor
  • Singh, Kavita
  • Twum-Danso, Nana
  • Barker, Pierre
  • Angeles, Gustavo
  • Speizer, Ilene
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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