Improving quality of home-based postnatal care by microteaching of multipurpose workers in rural and urban slum areas of Chandigarh, India: a pilot study

Figures & data

Table 1 Characteristics of the postnatal mothers and the newborn who were paid a postnatal visit

Characteristics	Round 1 N (%)	Round 2 N (%)	Round 3 N* (%)
Total	N=14	N=14	N=12
Place of residence
Urban	4 (29)	4 (29)	2 (17)
Rural/slum	10 (71)	10 (71)	10 (83)
Term/preterm delivery
Term	12 (86)	14 (100)	12 (100)
Preterm	2 (14)	0 (0)	0 (0)
Type of delivery
Normal vaginal	8 (57)	13 (93)	9 (75)
Caesarean	6 (43)	1 (7)	3 (25)
Place of delivery
Institutional	14 (100)	13 (93)	12 (100)
Home	0 (0)	1 (7)	0 (0)
Low birth weight
Yes	2 (14)	3 (21)	1 (8)
No	12 (86)	11 (79)	11 (92)
Comorbidity of the mother
Yes	1 (7)	1 (7)	5 (42)
No	13 (93)	13 (93)	7 (58)
Comorbidity of the baby
Yes	2 (14)	4 (29)	6 (50)
No	12 (86)	10 (71)	6 (50)
Which postnatal visit?
First	0 (0)	0 (0.0)	0 (0)
Second	6 (43)	3 (21)	1 (8)
Third and above	8 (57)	11 (79)	11 (92)

Note:

* Two health workers got transferred after the second round.

Table 2 Scores of different domains of postnatal care in three rounds of microteaching

Domains of postnatal care	Round 1	Round 2	Round 3	P-value
Maternal examination
Dietary intake	0.67	1.38	1.92	0.005
Bleeding PV	1.11	1.46	1.83	0.17
Keeping baby warm	0.64	1.54	1.92	0.02
Breastfeeding	1.93	2.0	1.92	0.41
Urination	0.93	1.61	1.83	0.005
Fever	0.07	0.69	1.50	<0.001
Discharge PV	0.07	0.38	1.58	<0.001
Speaking abnormally/fits	0.07	0.62	1.92	<0.001
Breast milk	0.21	0.92	1.67	0.02
Breast abnormality	0.21	0.61	1.42	0.004
Abdominal examination	0.29	0.46	1.25	0.004
Examination of the perineum	0.79	1.23	1.75	0.01
Leg examination	0.07	0.85	1.67	<0.001
Average maternal examination skill score	0.54	1.06	1.71	<0.001
Newborn examination
Eyes	0.07	1.08	1.75	0.001
Weight	1.86	2.0	2.00	0.15
Temperature by using thermometer	1.0	1.92	2.00	0.003
Examination of skin for pustules	0.36	1.69	2.00	0.005
Skinfold examination for cracks or redness	0.36	1.46	2.00	<0.001
Jaundice	0.64	2.0	2.00	0.001
Check umbilicus	1.5	2.0	2.00	0.22
Limping of legs	0.0	0.15	1.42	<0.001
Feeding	0.14	1.23	1.67	0.005
Cry of the baby	0.36	1.15	1.67	<0.001
Abdomen examination	0.0	0.77	1.50	0.002
Chest indrawing	0.0	0.0	1.50	0.005
Average neonatal examination skill score	0.52	1.29	1.74	<0.001
Maternal counseling
Nutrition	1.07	1.77	1.92	0.05
Danger signs	0.43	1.38	1.92	<0.001
Family planning	1.29	1.61	1.83	0.06
Immunization	1.14	1.54	1.67	0.14
Hand hygiene	0.14	1.46	1.67	<0.001
Apply on cord	1.5	1.92	1.92	0.10
Referral	1.5	1.92	2.0	0.10
Average maternal counseling skill score	1.01	1.66	1.85	<0.001
Overall skill assessment score	0.64	1.27	1.76	<0.001

Note: P<0.05 denotes significant difference.

Abbreviation: PV, per vaginum.

Figure 1 Comparison of postnatal skill score across three rounds of microteaching.

Figure 2 Comparison of PNC across three rounds of microteaching.

Abbreviations: HWs, health workers; PNC, postnatal care.

Table S1 Details of the examination done by the health workers under home-based care

Domain of examination	Description of the examination
Maternal examination
Dietary intake	Ask about mother’s dietary intake: number of times mother takes full meals in 24 hours, if >4 whether advised on adequate diet
Bleeding PV	How many pads are changed each day, if more than five pads whether referred to hospital
Keeping baby warm	Whether baby is kept warm in winter season (near mother, clothed and wrapped properly)
Breastfeeding	Is baby being fed properly (at least eight times in 24 hours)
Cry of the baby	Is the baby crying incessantly
Urination	Is the baby passing urine less than six times a day
Temperature	Measure and record, if more than 100 whether referred to hospital
Discharge PV	Foul smelling discharge
Speaking abnormally/fits	Is mother speaking abnormally/having fits
Breast milk	Is mother having no milk since delivery or if she perceives breast milk to be less than adequate
Breast abnormality	Cracked nipples/painful/engorged breast
Abdominal examination	Involution of uterus
Examination of the perineum	Condition of the stitches
Leg examination	Swelling, signs of deep vein thrombosis
Newborn examination
Eyes	Are eyes swollen or with pus
Weight	Measurement of weight
Temperature by using thermometer	Measure and record temperature
Examination of skin for pustules	Look for skin filled pustules
Skinfold examination for cracks or redness	Cracks or redness on the skin folds (thigh/neck/axilla/buttocks)
Jaundice	Yellowish discoloration of the eyes/skin
Check umbilicus	Check the umbilicus
Limping of legs	Weak/floppy/limping of legs
Feeding	Decreased/stopped feeding
Cry	Weak/stopped
Abdomen examination	Distended/mother say baby vomits often
Temperature by hand	Cold to touch/temperature >99°
Chest	Chest indrawing
Umbilicus	Pus on umbilicus
Maternal counseling
Nutrition	Diet of a lactating mother; breastfeeding frequency; burping
Danger signs	Child vomits everything; lethargy/unconscious; convulsions; not feeding well
Family planning	Copper-T, condoms; permanent sterilization
Immunization	Child immunization schedule and next date of immunization
Hand hygiene	Importance and steps of hand hygiene
Apply on cord	Not to apply anything on cord
Referral	Referred those who required referral

Abbreviation: PV, per vaginum.