Integrating quality postnatal care into PMTCT in Swaziland

Abstract

Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4–6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client–provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05– < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies.

Keywords:

• integrated PMTCT and MNH care
• postnatal
• Swaziland

Acknowledgements

Gratitude goes to the Central Statistics Office, specifically Rachel Shongwe and Nelisiwe Dlamini for the coordination of the training of data collectors and the field work, and to Phumuzile Mabuza and Bonsile Nhlabatsi of the Sexual and Reproductive Unit in the Ministry of Health and Social Welfare for facilitating the study. In addition we would like to thank Peggy Chibuye (Country Director for EGPAF 2004–2007) for her energy and support in getting the project off the ground. We would also like to recognise the financial and technical support from United States Agency for International Development (USAID) and the Regional HIV and AIDS Programme (RHAP), notably Lily Kak and Karen Heckert. Special recognition goes to the USAID/BASICS regional trainers, Dr Bongi Nzama and Ms Nokuzola Mzolo from South Africa and to the USAID/BASICS local coordinator and trainer, Ms Prisca Khumalo, whose hard work and commitment contributed enormously to make this work possible.

This manuscript was made possible through support provided by the Bureau for Global Health, U.S. Agency for International Development, under the terms of Contract No. GHA-I-00-04-00002-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development.