Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia.

STUDY OBJECTIVES: The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period. DESIGN: A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42. SETTING: The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia. PARTICIPANTS: A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42. MAIN RESULTS: At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01). CONCLUSIONS: There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care.

Family planning practices before and after childbirth in Lusaka, Zambia.

A total of 408 randomly selected normally delivered women who had given birth to healthy infants were recruited from a postnatal ward at the University Teaching Hospital (UTH) in Lusaka, Zambia. Family planning practices before and after pregnancy and delivery were investigated among 376 of these women. The interviews were conducted in their homes or at the postpartum clinic at the UTH at the end of puerperium. The remaining 32 women, mainly primiparae, were lost to follow-up. Thirty four percent of the women had used a family planning method before the present childbirth. Most of those (90%) had used modern methods. Women with eight and more years of education used modern contraceptive methods more often than those with less education. One year after delivery, 64% of the women were using modern or traditional family planning methods. Of those who used traditional methods, 15% relied on lactational amenorrhoea. Of those who did not use any method, 39% indicated that their husbands did not allow them. Fifty-six per cent of the teenagers stated that they had no knowledge of family planning, whereas 84% of the single teenagers had not used contraceptives before. In view of this, teenagers and single mothers need a special focus in the development of family planning programmes. We also recommend that more research should focus on views of both men and women on contraceptive use.

PIP: This article presents an analysis of contraceptive usage before and after childbirth among 376 women (out of a total of 408 randomly selected women) delivering at the University Teaching Hospital in Lusaka, Zambia, during 1989-90. 90% of the original 408 women were married and living with their husbands. 75% lived in the high-density districts of Lusaka. 60% were housewives, and 22% had regular wage employment. 80% of husbands had regular paid employment. 66% reported knowledge of at least one contraceptive method; 34% had no contraceptive knowledge. 97% of those with some knowledge knew about modern methods. 56% of adolescents were unaware of any contraceptive method. 67% did not use any contraceptives. Of the 33% who used a method, 90% used a modern one. 84.4% of unmarried teenagers had not used contraceptives before the study. 58.4% stopped contraceptive use in order to conceive. After 1 year, 64% of 309 women were using contraceptives, of which 55% used a modern method. The most commonly used method was the pill. 17% of the 89 women who used traditional methods relied on lactational amenorrhea. 92% were still breast feeding (2-11 feeds in a 24-hour period) at the end of a year. 47% were menstruating. 68% had resumed sexual relations. 39% of the women at the end of the year who did not use contraception reported that husbands did not allow this practice. 22 women reported that their infant died within the year. Women with 8 or more years of education were more likely to use modern contraception. Contraceptive knowledge and use was influenced by parity, education, marital status, and age. Women mainly asked about what contraceptive methods were available, when to start use, and where to obtain contraception.