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Assessment of Quality of Postnatal Care Services Offered to Mothers in

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 Research & Reviews: Journal of Medical Science and Technology
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
Volume 6, Issue 1
www.stmjournals.com

Assessment of Quality of Postnatal Care Services Offered

to Mothers in Hospitals, of Tigray Ethiopia 2016
Almaz Berhe1,*, Tsige Araya1, Kidisty Tesfay1, Alemayehu Bayray2, Natnael Etsay3,
Gebreamlak Gidey4, Solomon Weldemariam1, Kidanemariam Berhe5
1
Department of Midwifery, College of Health Sciences, Mekelle University, Ethiopia
2
School of Public Health, Mekelle University, Ethiopia
3
Department of Midwifery, College of Health Sciences, Adigrat University, Ethiopia
4
Department of Midwifery, College of Health Sciences, AXUM University, Ethiopia
5
Department of Public Health, College of Health Sciences, Adigrat University, Ethiopia
Abstract
Each year, 287,000 women die from complications related to pregnancy and childbirth, and
about 99% of these deaths occur in developing countries. The first hours, days and weeks
after childbirth are a dangerous time for both the mother and newborn infant. Postnatal care
prevents the great majority of maternal and child morbidity and mortality. This study
therefore, aims to assess quality of postnatal care services offered to mothers in Tigray health
facilities, Ethiopia in 2015/16. 123 Midwives who are providing postnatal care during the
time of study were observed while giving postnatal care. Human and material resources were
assessed for provision of comprehensive and quality postnatal care in all the hospitals. All the
facilities scored below 80% showing that the quality of postnatal care offered to clients in the
hospitals of Tigray was poor and below standard. The mid-wives were responsible for
managing the entire maternity care involving the antenatal, labor and delivery and postnatal
wards thus no priority is given for postnatal care. The midwives in all hospitals did not take
any training on postnatal care. Human and material resources were inadequate for provision
of comprehensive and quality postnatal care in all the hospitals. The process of service
provision which entails client monitoring and examination was not in line with the Postnatal
WHO recommendation due to lack of essential equipment and workload. Therefore, to provide
quality postnatal services to improve the maternal and neonatal health the government has to
provide basic infrastructure for the hospitals. In addition, refresher training courses for
midwives in maternal and neonatal health with emphasis on postnatal care are recommended.

Keywords: Maternal and Neonatal Health, Quality of Postnatal Care, Structure, Process,
Outcome

*Author for Correspondence E-mail: almazbw1@gmail.com

INTRODUCTION and during the postpartum period annually.

Background
The postnatal period is the time from delivery
of baby till the first 42 days. Risks of maternal
and newborn deaths are greatest during the
first 24 to 48 h after birth. Postnatal period is a
susceptible time because most maternal and
new born deaths occur during this period
Therefore, Providing Postnatal Care (PNC)
using the WHO standards contact time within
one hour of birth to 24 h, 2–3 days, 6–7 days,
at 6 weeks and extra contacts two or three
visits for LBW or mothers life with HIV
should have [1, 2].
Globally, more than half a million women die
of complications due to pregnancy, child birth
Despite the calls for improved access to
maternal health care services universally and
the reduction of maternal mortality, maternal
and neonatal mortality have remained a great
challenge in developing countries, and
subsaharan Africa in particular. In Africa,
about 125,000 women and 870,000 newborns
die annually in the first week after delivery,
and the lifetime risk of maternal mortality is 1
in 26 [3].
In some African countries such as South
Africa, maternal mortality rate is estimated at
237 per 100,000 live births, while in the
subsahara African countries the rates are over
400 per 100,000 live births and in Malawi, the

RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 11
Quality of Postnatal Care Offered to Mothers in Hospitals
maternal mortality is estimated at 675 per
100,000 live births, 60% of the maternal
deaths occur during the postpartum period, of
which 70% occur during the first week and
30% within 2 weeks after delivery [4]. PNC
coverage is low in Ethiopia; only 5% of
mothers received PNC within the critical first
2 days after delivery [5]. Nationwide, 34.3%
of mothers in Ethiopia receive PNC within the
first 6 weeks after delivery.
Postnatal care (PNC) is the most neglected
area in the health care delivery system despite
being very important time for the provision of
interventions that are vital to the health of both
the mother and the new born [6]. As a result,
serious complications which account for two
thirds of all maternal and neonatal deaths
occur during the postnatal period [7].
Postnatal care is one of the most important
maternal health-care interventions not only for
prevention of impairment and disabilities but
also for reduction of maternal mortality [8].
Adequate utilization of postnatal care can help
to reduce maternal mortality and morbidity
among mothers and their babies. To improve
maternal, newborn and infant health status
through increasing the proportion of women
receiving essential postpartum services is
strategies of many countries [5].
Resources pose a challenge to provide
appropriate care to clients despite the fact that
it is the basic right of every woman and
neonate to have the best available care that
enables them go through pregnancy and
childbirth in good health. There is therefore, a
need for adequate resources to be available in
the postnatal wards because availability of
supplies and essential medicines in maternal
and neonatal health is an indicator of
successful service implementation towards
achieving MDGs 4 and 5 [9].
The BEmONC facilities are staffed with
midwives that are trained to offer essential
postpartum care services to clients. Despite the
availability of minimal resources and, rate of
complications and deaths in the postpartum
period in the district is high even among
women that are delivering in the health
facilities.
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
Berhe et al.
This study therefore, aimed at assessing the
quality of care that is offered to postpartum
women at the BEmONC facilities in the
district. Specifically the study assessed the
three elements of quality of PNC care services,
which are structure, process and outcome.
Justification
Quality of postnatal care given by the
midwives is low. Postpartum maternal and
newborn health care is the most neglected area
in the health care delivery system despite
being very important time for the provision of
interventions that are vital to the health of both
the mother and the new born therefore,
research on quality of postnatal care may help
to inform the findings and the
recommendation on quality of postnatal care
for policy makers, service providers, education
planners and other respective stakeholders in
Ethiopia.
Furthermore, it will be initial data or
preliminary study for further studies related to
postnatal care and maternal health services in
Tigray region, Ethiopia since there is no
tangible research that has been conducted in
this area.
OBJECTIVES
General Objective
Assessment of quality of postnatal care
services offered to mothers in Tigray health
facilities, Ethiopia in 2015/16.
Specific Objective
To assess the quality of postnatal care services
that midwives provide to mothers seeking
postnatal service. To assess the structure,
process and outcome of the components of
postnatal care services.
METHODOLOGY
Description of Study Area
The studies were conducted in Tigray regional
state of hospitals, Ethiopia. Tigray regional
state, the focus of this study located in
Northern part of Ethiopia, which is 783 km far
from Addis Ababa, capital city of Ethiopia to
the capital city of Tigray region which is
called Mekelle. The total area of the region is
about 54,569.25 km. It is bordered in the
North by Eritrea, in the South by Amhara
regional, state, in the East by Afar regional
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Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
state and in the West by Sudan. The region is
administratively divided into seven zones,
including one especial zone, and it has 47
Weredas; out of which 35 are rural and 12 are
urban. According to the projected census of
2007, the region has a total population of
4,806,843 (3,787,667 rural and 1,019,176
urban). The majority of the population is
Christian. According to the data from Tigray
Health Bureau, it has five zonal hospitals,
seven district general/hospitals, one referral
university hospital, and 211 health centers and
604 health posts which are run by
Government.
According to the EDHS report, the total
fertility rate of this region was 4.6%;
prevalence of pregnancy was 7.2%; ANC
coverage from a skilled provider was 50.1%.
During this period, 11.6% of births were
attended by a skilled birth attendant; and 37
neonatal deaths/1000 live births [10].
The facilities that were targeted for this study
was those that provide BEmONC (Axum Sent
Marry Hospital, Adwa Hospital, Adigrat
Hospital, Maichew Hospital, Wukro Hospital,
Abyi Adi Hospital, Shire Hospital, Quiha and
Mekelle Hospital) were included in the study.
This study was conducted from Sep-Oct 2016.
Study Design: Institutional based descriptive
cross sectional study design was employed.
Source population and study subjects:
Source population: The source population was
all midwives that provide BEmONC in Tigray
Region Health Facilities, Ethiopia.
Study population: All midwives that provide
BEmONC in the selected study area.
Study unit: Individual midwives who are
participating in this study.
Eligibility Criteria
Inclusion Criteria
The study embattled all consenting midwives
that were working in the postnatal care of the
BEmONC facilities in Tigray Region Health
Facilities.
Exclusion Criteria
The study excluded facilities that were not
designated as BEmONC sites and midwives
who were working in facilities that are not
designated as BEmONC. In addition midwives
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
who are working in other sections of the
facility other than postnatal wards, students
and who are working on special programs
were excluded from the study.
Sample Size Calculation and Sampling
Procedure
Sample Size Determination
All midwives in the randomly selected
hospitals.
Sampling Technique and Procedure
Nine general hospitals in Tigray BEmONC
facilities were selected by simple random
sampling technique and study subjects were
observed when they were on practicing
postnatal care.
Data Collection Technique and Quality
Control Methods
Data were collected by the senior midwives.
The midwives were observed as they were
provided postnatal care to the clients. At each
facility, observations on the quality of
postnatal care were done every day and the
service delivery practices are recorded to
determine the outcomes of postpartum care. A
structured questionnaire that was formulated
based WHO postnatal guidelines and
Reproductive Health (RH) standards of care
was used to observe the midwives.
A checklist was used to collect data on the
assessment of structure in terms of availability
of human and material resources,
infrastructure and midwives’ knowledge on
postnatal health assessment, health education
and counseling on postnatal care concepts.
Regarding the process of care, a checklist were
used to mark whether the midwives offered
care in accordance with the procedures as
recommended in the RH standard of care. The
components of care observed included client
monitoring, physical examination, client
education and counseling. The outcome
component was determined with the use of
checklist derived from RH standards and
WHO guidelines which is used to measure
availability of basic infrastructure, materials
and resources for providing postnatal care, and
the education content that is providing to
women during postpartum care and at
discharge. A facility is supposed to score at
least 80% on the standard of care to be
Page 13
Quality of Postnatal Care Offered to Mothers in Hospitals Berhe et al.

considered as providing quality of RH care in
which postnatal care is a component.
RESULT
Structure as assessed by Availability of
Human Resources and Physical
Infrastructure
Human Resources
The study enrolled nine hospitals owned by
the government which have a total of 123
midwives. Majority of midwives in the all
hospitals were female in gender. With regard
to level of education, 66.7, 78.6 and 58.3% of
the midwives in Wukro, Abiadi and Maichew,
respectively were diploma holders whereas
76.5, 68.8 and 70.6% of the midwives in
Mekelle, Adigrat and Shire, respectively were
BSc. degree holders. The lowest midwife-
client ratio (1:100) was recorded at Quiha
Hospital while the highest (1:270) was
recorded at Mekelle Hospital. Similarly, the
mean year of work experience the midwives
had was 8.4 with 6.9 SD. the midwives were
responsible for managing the whole maternity
care comprising the antenatal, labor and
delivery and postnatal wards. The level of
education and midwife-client ratio and the
estimated number of deliveries per year is
shown in Table 1.
Physical Infrastructure
All hospitals had not a special examination
rooms for postnatal care. When the
impoverished rooms were engaged with other
activities, the postnatal women were
discharged with compromised examination.
Essential Equipment, Drugs and Guidelines
All the facilities did have postnatal care
monitoring equipment like
sphygmomanometer and thermometers in their
maternity departments. In addition, guidelines
and teaching aids for postnatal care were not
available in all the facilities. However, all the
facilities had essential drugs such as
gentamycin IV and Amoxicillin tablets. Cord
clamps and neonatal resuscitation equipment’s
were also available in all the facilities.
Provider Knowledge and Training
The midwives in all hospitals did not take any
training on postnatal care. But the midwives
have good knowledge regarding postnatal care
(on maternal danger signs, basic preventive
newborn care and newborn danger signs).
Process Attributes of Quality Postnatal
Care
Provider Technical Skills
The midwives in all hospitals had skills on
history taking, physical examination, on
maternal danger sign advice, infant danger
sign and documenting what they did but the
midwives in all facilities miss STI/HIV risk
assessment, and STI management.
 Services Provided for the Mother
Client monitoring and examination
Out of 123 midwives who were observed
while giving postnatal care for postpartum
mother 72(58.5%) and 80(65%) of them took
blood pressure and temperature of their clients,
respectively whereas, only 45(36.5%)
observed participants check for pallor. With
regard to providing vitamin A, 70(56.9%) of
the midwives provide Vitamin A to the clients.
10(8%) out of the total midwives observed
offer TB screening. Ninety one (74%),
56(45.5%) and 33(26.8%) of the providers
examined lochia loss (perineum), involution of
the uterus and breast for engorgement/cracked
nipples.

Table 1: Level of Education and Mid-wife-client Ratio and the Estimated Number of
Deliveries per Year.
Facility Sex, frequency and % Level of education Total Annual Midwife/Client
frequency and % deliveries ratio

Female Male Diploma Degree Number

Mekelle 15(88.2) 2(11.8) 4(23.5) 13(76.5) 17 4596 1:270
Quiha 5(83.3) 1(16.7) 3(50) 3(50) 6 600 1:100
Wukro 10(83.3) 2(16.7) 8(66.7) 4(33.3) 12 1930 1:161
Adigrat 9(56.2) 7(43.8) 5(31.2) 11(68.8) 16 2554 1:160
Adwa 10(71.4) 4(28.6) 7(50) 7(50) 14 2404 1:172
Axum 10(66.7) 5(33.3) 7(46.7) 8(53.3) 15 2739 1:183
Shire 11(64.7) 6(35.3) 5(29.4) 12(70.6) 17 2998 1:177
AbiAdi 13(92.9) 1(7.1) 11(78.6) 3(21.4) 14 1410 1:101

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Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)

Maichew 8(66.7) 4(33.3) 7(58.3) 5(41.7) 12 1243 1:104

Client examination was not done according to care and personal
the RH standards. The standards stipulate that hygiene
women are supposed to stay in the hospital for  Services Offered to the Baby
observation at least 48 h after delivery. Monitoring and examination of babies
However, actual practice in the health facilities Midwives who were enrolled to the study were
showed that women were observed for 6 h also observed while they give care for the
after delivery. newborn. Out of the 123 midwives
111(90.2%) midwives check baby air way
Health Education and Counseling (observed respiration). Eighty three (67.5%) of
One hundred twenty three midwives were the participants assisted mothers with early
observed while they were providing postnatal exclusive breastfeeding. Majority of the
care for postpartum mothers guided by a midwives 100(81.4%) did not took babies
checklist. One hundred ten (89.4%) and temperature. 49(39.8) of the participants
56(45.5%) of the midwives counsel their examined the babies undressed. Regarding
clients on the danger of excessive bleeding, detecting and managing danger signs, majority
and headaches, swollen hands and feet, 96(78%) of the midwives detect and mange
respectively. 35(28.5%) of the midwives danger signs. Almost all of the midwives
counseled their client on leaking of participated in the study provided HIV test for
urine/faece. The danger of increased pain and the infant if the mother of the baby is HIV
infection in the area of the wound (redness, positive (PCR) and Provide HIV prophylaxis
swelling, pain, or pus in wound site) were if indicated (Table 3).
counseled by 24(19.5%) and 31(5.2%) of
midwives. Concerning family planning, Table 3: Distribution of Monitoring and
57(46.3%) of the observed providers has given Examination of Babies by the Midwives in
counseling on pregnancy spacing and family Selected Hospitals, Tigray, Ethiopia, 2016.
planning. Maternal Nutrition was also Yes No
Service provided Frequency Frequency
counseled by 24(19.5%) of the participated (%) (%)
midwives. Thirty six (29.3%) of the observed Check baby airway, 111(90.2) 12(9.8)
midwives advised their clients on breast care observe respiration
and personal hygiene (Table 2). Assist mother with 83(67.5) 40(32.3)
early exclusive
breastfeeding
Table 2: Distribution of Danger Sign
Counseling Offered by Midwives in the Take the babies 23(18.6) 100(81.4)
temperature
Selected Nine Hospitals, Tigray, Ethiopia,
2016. Examine 49(39.8) 74(60.2)
Yes No baby(undressed)
Service provided Frequency Frequency Detect and manage 96(78) 26(21.1)
(%) (%) danger signs
Excessive bleeding 110(89.4) 13(10.6)
HIV test for infant if 122(99.2) 1(0.8)
Headaches, swollen 56(45.5) 67(54.6) mother HIV
hands and feet positive(PCR)
Smelly Vaginal 29(23.5) 94(76.5)
discharge Provide HIV 121(98.4) 2(1.6)
Leaking of 35(28.5) 88(71.5) prophylaxis if
urine/faece indicated
Increased pain 24(19.5) 99(80.5)
Infection 31(5.2) 92(94.8) Counseling given to the care giver on infant
Swollen breast 21(17) 102(83) health
Council on spacing 92(74.8) 31(25.2) Counseling on essential new born care to the
Council on FP 57(46.3) 66(53.7) care giver of the infants were given by
Council on maternal 24(19.5%) 99(80.5)
58(47.2%) of the observed midwives. Nine out
nutrition of ten, 74(60.2%) midwives counsel the care
Council on breast 36(29.3%) 87(61.8) giver of the babies on danger signs and when

RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved Page 15
Quality of Postnatal Care Offered to Mothers in Hospitals
to seek care. One hundred three (83.7%)
midwives offered counseling for the care
givers on keeping the baby warm (temperature
control). Immunization and vitamin A at 6
month was counseled to the care givers by
108(87.8%) of the midwives. Majority of the
midwives, 104(84.6%) did not counseled care
givers on growth monitoring. All of the
midwives counseled the care givers on Infant
HIV test and Prophylaxis (if indicated).
Regarding counseling on exclusive breast
feeding for 6 months and complementary
feeding 107(87%) and only 22(17.9%) of the
midwives counseled their clients, respectively.
Provider Interpersonal Skills
All hospitals miss the very important
components of rapport (greeting clients, used
client’s name, and introduces her /his self and
encouraging client to ask questions).
Outcome Attributes of Quality of
Postpartum Care
All the facilities scored below 80% showing
that the quality of postnatal care offered to
clients in the BEmONC health facilities in
Tigray was poor and below standard. Highest
scores of 70 and 65% were obtained from two
hospitals, Mekelle and Axum (Table 4).
Table 4: Health Facility Scores according to
the Standard of Postnatal Care in Tigray,
Ethiopia 2016.
Hospital Name Score (%)
Mekelle 70
Quiha 56.9
Wukro 58.2
Adigrat 48.3
Adwa 57.7
Axum 65.3
Shire 54.6
Abiadi 41.7
Maichew 51.7
DISCUSSION
In this study a total of nine government
hospitals enrolled and all midwives (123)
working in the selected health facilities were
participated.
The postnatal care that was provided in the
selected BEmONC hospitals in Tigray was
below standard this is in tune with a study
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
Berhe et al.
conducted in Dedza district results show that
quality of maternal and neonatal health care
was low in all facilities [10].
The midwives in this study were responsible
for managing the entire maternity care
involving the antenatal, labor and delivery and
postnatal wards thus no priority was given for
postnatal care. Similar study show that
prioritizing of other areas over postnatal care
[11, 12].
The midwives/patient ratios in the in the MCH
area were poor; the study agrees with previous
studies by Riley et al. and Rayner A [11–13].
The study found that heavy workload in all
hospitals of Tigray hindered the delivery of
quality postnatal care according to the
recommended WHO standard. Analogous
results were reported in Australia, where a
review of postnatal care revealed that the
services were provided in very busy
environments thus unable to meet the aims of
postnatal care [11].
All hospitals had no special examination
rooms for postnatal care, similar with a study
done by Rawlins et al. Midwives agreed that
postnatal care and units were indeed neglected
areas due to priorities given to other units such
as the labor and delivery wards [14].
This study also showed that the facilities did
not have suitable infrastructure for the
provision of quality postnatal care. A study by
Mgawadere also reported that lack of proper
structures for providing maternal and neonatal
health services contributed to poor or partial
service provision to clients and hence
compromised the quality of care [10, 15, 16].
Human and material resources were
inadequate for provision of comprehensive and
quality postnatal care in all hospitals of
Tigray. The finding is in line with a study in
Dar es Salaam perinatal needs assessment for
quality of care infrastructure, equipment and
supplies for perinatal care in Dar es Salaam
public health institutions were inadequate [17].
Midwives in this study did not follow the
required guidelines and teaching aids for
postnatal care. To increase the availability and
effectiveness of ANC and PNC services, staff
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Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
shortages and skills gaps, lack of equipment
and supplies, and the absence of proper PNC
guidelines must be remedied. Suggestions
from most respondents focused on increasing
the number of staff at all levels of health
facilities. The importance of strengthening
human resources in healthcare is also
increasingly acknowledged [18–20].
Majority of the midwives are providing
postnatal care 72(58.5%) and 80(65%) of them
took blood pressure and temperature of their
clients, respectively whereas, only 45(36.5%)
observed participants check for pallor. This is
similar with. A study conducted in Northern
Botswana found that despite critical shortage
of health professionals, midwives checked
vital signs and fully examined women prior to
discharge [21].
Midwives who were participated in the study
were observed while they were monitoring
their clients immediately after they gave
delivery. Majority 72(58.5%) of them were
observed taking blood pressure and
temperature 80(65%) of mothers. Similarly,
sixty six point seven percent of midwives were
also observed while checking for pallor. This
is similar with a study done in Mali where
majority of the midwives didn’t monitor the
mother after they gave delivery [10].
Majority of the midwives counseled on
exclusive breast feeding for 6 months and
complementary feeding 107(87%), similarly in
Mali, study on quality of postnatal care
revealed that 98% of the midwives counseled
women on exclusive breast feeding and its
benefits [10].
BEmONC facilities designed to ensure quality
maternal and neonatal care, however, the
situation is that the quality of care was below
standard in these selected BEmONC facilities.
These results are in tune with those reported
by Leight et al. [21]. That almost twice the
minimum number of recommended EmONC
facilities existed in Malawi but only 2% of the
facilities met the basic requirements for the
provision of quality maternal and neonatal
care.
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
Regarding the supply side, staff, in-service
training were reported inadequate in the study,
Previous studies found that understaffing and
inadequate funding at township and village
level health facilities are the main barriers
from the supply side [22,23]. Shortages of
staff, equipment and supplies were common
complaints in the community [24, 25].
CONCLUSION AND
RECOMMENDATIONS
The postnatal care that was provided in the
selected BEmONC hospitals in Tigray was
below standard. Human and material resources
were inadequate for provision of
comprehensive and quality postnatal care in all
the hospitals. The midwives combined their
postnatal care with services of other
departments within the facilities and the
essential equipment’s and supplies were in
adequate. The process of service provision
which entails client monitoring and
examination was not in line with the Postnatal
WHO recommendation due to lack of essential
equipment and workload. Therefore, to
provide quality postnatal services to improve
the maternal and neonatal health the
government has to provide basic infrastructure
for the hospitals. In addition, refresher training
courses for midwives in maternal and neonatal
health with emphasis on postnatal care are
recommended.
ACKNOWLEDGMENT
We would like to pass our heart-felt gratitude
to Mekelle University, Institute of
Environment, Gender and Development
Study, and Tewelde gebre (head department
of Institute of Environment, Gender and
Development Study) for their valuable
support throughout the research project
development. Next I would like to thank
Professor Foten for her will to help female
instructors for funding this research project.
COMPETING INTERESTS
We, the author(s) declare that we have no
competing interests'.
ABBREVIATIONS
ANC: Antenatal Care
BEmONC: Basic Emergency Obstetric Care
EDHS: Ethiopian Demographic and Health
Page 17
Quality of Postnatal Care Offered to Mothers in Hospitals
survey
FMOH: Federal Ministry of Health
HIV/AIDS: Human Immune Virus/Acquired
immunodeficiency Syndrome
IRB: Institutional Review Board
PNC: Postnatal Care
RH: Reproductive health;
SPSS: Statistical Package for Social Scientists;
WHO: World Health Organization
REFERENCES
1. Fraser D, Cooper M, Nolte A. Myles text-
book for midwives: African edition.
Churchill Living- stone, Edinburgh, 2006.
2. Dhaher E, Mikolajezyk R, Maxwell A, et
al. Factor associated with lack of potential
care among Palestine women: A cross
sectional study of three clinics in the West
Bank. BMC Preg Children. 2008; 8: 26p.
3. World Health Organization. WHO
technical consultation on postpartum and
postnatal care, Department of making
pregnancy safer. WHO, Geneva,
Switzerland, 2010.
4. WHO. WHO technical consultation on
postpartum, Guidelines on postnatal care.
WHO, Geneva, Switzerland, 2003.
5. National Statistical Office (NSO) and ICF
Macro. Malawi demographic and health
survey, 2010. NSO and ICF Marco,
Zomba, Malawi, and Calverton, Maryland,
2011.
6. Matisavich A, Santos M. Inequalities in
maternal postnatal visits among public and
private patients. BMC Pub Health. 2009;
9: 335p.
7. Li X, Fortney J, Kotelchuck M, et al. The
postpartum period; The key to maternal
mortality. Science Direct Online
publication, Elsevier, 1999.
8. Ministry of Health. Road map for
accelerating the reduction of maternal and
neonatal mortality and morbidity in
Malawi. Ministry of Health, Lilongwe,
2007.
9. Lockwood J, Madsen E, Bernstein J.
Maternal health supplies in Bangladesh.
Population action International,
Bangladesh, 2009.
10. Chimtembo LK, Maluwa A, Chimwaza A,
et al. Assessment of quality of postnatal
care services offered to mothers in Dedza
district, Malawi. Open J Nurs. 2013; 3(4).
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
Berhe et al.
11. Rayner JA, McLachlan HL, Forster DA, et
al. A statewide review of postnatal care in
private hospitals in Victoria, Australia.
BMC Preg Childbirth. 2010; 10(1).
12. Riley M, Davey MA, King J. Births in
Victoria 2003–2004, Victorian Perinatal
Data Collection Unit. Melbourne:
Victorian Government Department of
Human Services, 2005.
13. Forster DA, McLachlan HL, Yelland J, et
al. Staffing in postnatal units: is it
adequate for the provision of quality care?
Staff perspectives from a state-wide
review of postnatal care in Victoria,
Australia. BMC Health Services Res.
2006; 6(1): 83p.
14. Rawlins Barbara J, Young-Mi Kim,
Aleisha M. Rozario, et al. Reproductive
health services in Malawi: An evaluation
of a quality improvement intervention—
Reply to paper YMIDW-D-11-00257.
Midwifery. 2012; 28(6): e872–e873.
15. Mgawadere FM. Assessing the Quality of
Antenatal Care at Lungwena Health
Centre in Rural Malawi. [Unpublished
Master's thesis], University of Malawi,
College of Medicine, 2009.
16. Banda H, Dzilankulani A. Malawi family
planning and reproductive health project.
Dedza District Assessment Report on
Health Centre and Community Baseline
Needs Assessment, Malawi, 2001.
17. Nyamtema Angelo S, David P. Urassa,
Siriel Massawe, et al. Dar es Salaam
perinatal care study: needs assessment for
quality of care. East Afr J Pub
Health. 2008 Apr; 5(1): 17–21p,
[Bergeson-Lockwood Jennifer, Elizabeth
Leahy Madsen, Jessica Bernstein.
Maternal health supplies in Bangladesh.
Population Action International, 2010].
18. Conteh L, Stevens W, Wiseman V. The
role of communication between clients
and health care providers: implications for
adherence to malaria treatment in rural
Gambia. Trop Med Int Health. 2007;
12(3): 382–391p.
19. Chen, Lincoln, Timothy Evans, Sudhir
Anand, et al. Human resources for health:
overcoming the crisis. The Lancet. 2004;
364(9449): 1984–1990p.
20. Kurowski, Christoph, Kaspar Wyss, Salim
Abdulla, et al. Scaling up priority health
Page 18
 Research & Reviews: Journal of Medical Science and Technology
Volume 6, Issue 1
ISSN: 2319-3417 (Online), ISSN: 2349-1272 (Print)
interventions in Tanzania: the human
resources challenge. Health Policy Plan.
2007; 22(3): 113–127p.
21. Kebalepile T, Sundby J. An evaluation of
the quality of care midwives provide
during the postpartum period in Northern
Botswana. [Ph.D. Thesis], University of
Oslo, Oslo, 2006.
22. Tao F, Huang K, Long X, et al. Low
postnatal care rates in two rural counties in
Anhui Province, China: perceptions of key
stakeholders. Midwifery. 2011; 27(5):
707–715p.
23. Oyediran MA. The importance of training
and supervision in quality of care. Adv
Contraception. 1993; 9(2): 175–180p.
24. Mrisho M, Obrist B, Schellenberg JA, et
al. The use of antenatal and postnatal care:
perspectives and experiences of women
and health care providers in rural southern
RRJoMST (2017) 11-19 © STM Journals 2017. All Rights Reserved
View publication stats
Tanzania. BMC Preg Childbirth. 2009;
9(1): 10p.
25. Chen Li, Wu Qiong, Michelle Helena Van
Velthoven, et al. Coverage, quality of and
barriers to postnatal care in rural Hebei,
China: a mixed method study. BMC Preg
Childbirth. 2014; 14(1): 31p.
Cite this Article
Almaz Berhe, Tsige Araya, Kidisty
Tesfay et al. Assessment of Quality of
Postnatal Care Services Offered to
Mothers in Hospitals, of Tigray
Ethiopia 2016. Research & Reviews:
Journal of Medical Science &
Technology. 2017; 6(1): 11–19p.
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