Impact of family-centred postnatal training on maternal and neonatal health and care practices in district hospitals in two states in India: a pre–post study

• Published in: BMJ open quality 2022-05, Vol.11 (Suppl 1), p.e001462
• Main Authors: Kashyap, Sehj, Spielman, Amanda F, Ramnarayan, Nikhil, SD, Sahana, Pant, Rashmi, Kaur, Baljit, N, Rajkumar, Premkumar, Ramaswamy, Singh, Tanmay, Pratap, Bhanu, Kumar, Anand, Alam, Shahed, Murthy, Seema
• Format: Article
• Language: English
• Subjects: Aftercare; Behavior; Breastfeeding & lactation; Caregivers; Curricula; Education; Families & family life; Female; health behavior; Hospitals; Hospitals, District; Humans; India; Infant Health; Infant, Newborn; maternal health services; Mortality; Newborn babies; Nurses; Original Research; Patient Discharge; patient education; Patient-centered care; patient-centred care; Sample size; Teaching; Training
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2021-001462

Background and objectivesThe Care Companion Program (CCP) is an in-hospital multitopic skill-based training programme provided to families to improve postdischarge maternal and neonatal health. The states of Punjab and Karnataka in India piloted the programme in 12 district hospitals in July 2017, and no study to date has evaluated its impact.MethodsWe compared telephonically self-reported maternal and neonatal care practices and health outcomes before and after the launch of the CCP programme in 11 facilities. Families in the preintervention group delivered between May to June 2017 (N=1474) while those in the intervention group delivered between August and October 2017 (N=3510). Programme effects were expressed as adjusted risk ratios obtained from logistic regression models.ResultsAt 2-week postdelivery, the practice of dry cord care improved by 4% (RR=1.04, 95% CI 1.02 to 1.06) and skin-to-skin care by 78% (RR=1.78, 95% CI 1.37 to 2.27) in the postintervention group as compared with preintervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91), mother complications by 12% (RR=0.88, 95% CI 0.79 to 0.97) and newborn readmissions by 56% (RR=0.44, 95% CI 0.31 to 0.61). Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46). However, the practice of exclusive breastfeeding, unrestricted maternal diet, hand-hygiene and being instructed on warning signs were not statistically different.ConclusionPostnatal care should incorporate predischarge training of families. Our findings demonstrate that it is possible to improve maternal and neonatal care practices and outcomes through a family-centered programme integrated into public health facilities in low and middle-income countries.