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Use of Job Aids to Improve Facility-Based Postnatal Counseling and Care in Rural Benin

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Abstract

This study examined the effect of a job aids-focused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre–post randomized design, data were drawn from direct observations and interviews with 411 mother–newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention’s relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [∆i − ∆c] +30.9, 95 % confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour (∆i − ∆c +33.7, 95 % CI 19.0, 48.4) and delayed for bathing (∆i − ∆c +23.9, 95 % CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding (∆i − ∆c +6.8, 95 % CI −2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant (∆i − ∆c +8.5, 95 % CI −2.8, 19.9). The proportion of mothers with correct knowledge of maternal (∆i − ∆c +27.8, 95 % CI 11.0, 44.6) and newborn (∆i − ∆c +40.3, 95 % CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices (∆i − ∆c +26.0, 95 % CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with community-based initiatives.

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Acknowledgments

The authors wish to thank all of the health personnel and recently-delivered women who participated in the study, in addition to the data collectors, supervisors, and technical and administrative staff of the Integrated Family Health Project (PISAF, Projet Intégré de Santé Familiale) and the Benin Ministry of Health who enabled the conduct of the study. Special thanks as well to the research and maternal health advisors for their technical support and guidance. This study was co-funded with resources received from the United States Agency for International Development (USAID) through the USAID Health Care Improvement Project (Contract No. GHN-I-01-07-00003-00) and the Integrated Family Health Project Health Project (Contract No. 680-A-00-06-00013-00), both managed by University Research Co., LLC (URC). All conclusions are the authors and do not necessarily reflect the views of the funding organizations.

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Authors and Affiliations

  1. USAID Health Care Improvement Project, University Research Co. LLC, Bethesda, MD, USA

    L. Jennings

  2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    L. Jennings

  3. Integrated Family Health Project, University Research Co. LLC, Bohicon, Benin

    A. Yebadokpo, J. Affo & M. Agbogbe

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  1. L. Jennings
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  2. A. Yebadokpo
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  3. J. Affo
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  4. M. Agbogbe
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Correspondence to L. Jennings.

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Jennings, L., Yebadokpo, A., Affo, J. et al. Use of Job Aids to Improve Facility-Based Postnatal Counseling and Care in Rural Benin. Matern Child Health J 19, 557–565 (2015). https://doi.org/10.1007/s10995-014-1537-5

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  • DOI: https://doi.org/10.1007/s10995-014-1537-5

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