Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Jun;52(6):385–391. doi: 10.1136/jech.52.6.385

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

A B Ransjo-Arvidson, K Chintu, N Ng'andu, B Eriksson, B Susu, K Christensson, V K Diwan
PMCID: PMC1756723  PMID: 9764260

Abstract

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.

 

Full Text

The Full Text of this article is available as a PDF (125.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashraf R. N., Jalil F., Khan S. R., Zaman S., Karlberg J., Lindblad B. S., Hanson L. A. Early child health in Lahore, Pakistan: V. Feeding patterns. Acta Paediatr Suppl. 1993 Aug;82 (Suppl 390):47–61. doi: 10.1111/j.1651-2227.1993.tb12906.x. [DOI] [PubMed] [Google Scholar]
  2. Christensson K., Ransjö-Arvidson A. B., Kakoma C., Lungu F., Darkwah G., Chikamata D., Sterky G. Midwifery care routines and prevention of heat loss in the newborn: a study in Zambia. J Trop Pediatr. 1988 Oct;34(5):208–212. doi: 10.1093/tropej/34.5.208-a. [DOI] [PubMed] [Google Scholar]
  3. Christensson K., Siles C., Moreno L., Belaustequi A., De La Fuente P., Lagercrantz H., Puyol P., Winberg J. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr. 1992 Jun-Jul;81(6-7):488–493. doi: 10.1111/j.1651-2227.1992.tb12280.x. [DOI] [PubMed] [Google Scholar]
  4. Dahlquist G., Sterky G., Ivarsson J. I., Tengvald K., Wall S. Health problems and care in young families--load of illness and patterns of illness behaviour. Scand J Prim Health Care. 1987 May;5(2):79–86. doi: 10.3109/02813438709013981. [DOI] [PubMed] [Google Scholar]
  5. Eisenberg L. Disease and illness. Distinctions between professional and popular ideas of sickness. Cult Med Psychiatry. 1977 Apr;1(1):9–23. doi: 10.1007/BF00114808. [DOI] [PubMed] [Google Scholar]
  6. Fauveau V., Stewart K., Khan S. A., Chakraborty J. Effect on mortality of community-based maternity-care programme in rural Bangladesh. Lancet. 1991 Nov 9;338(8776):1183–1186. doi: 10.1016/0140-6736(91)92041-y. [DOI] [PubMed] [Google Scholar]
  7. Faxelid E., Tembo G., Ndulo J., Krantz I. Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting? Sex Transm Dis. 1996 Jul-Aug;23(4):289–292. [PubMed] [Google Scholar]
  8. Filippi V., Marshall T., Bulut A., Graham W., Yolsal N. Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul. Trop Med Int Health. 1997 Jan;2(1):47–56. doi: 10.1046/j.1365-3156.1997.d01-126.x. [DOI] [PubMed] [Google Scholar]
  9. Garcia J., Renfrew M., Marchant S. Postnatal home visiting by midwives. Midwifery. 1994 Mar;10(1):40–43. doi: 10.1016/0266-6138(94)90007-8. [DOI] [PubMed] [Google Scholar]
  10. Ghilarducci E., McCool W. The influence of postpartum home visits on clinic attendance. J Nurse Midwifery. 1993 May-Jun;38(3):152–158. doi: 10.1016/0091-2182(93)90039-j. [DOI] [PubMed] [Google Scholar]
  11. Gjerdingen D. K., Froberg D. Predictors of health in new mothers. Soc Sci Med. 1991;33(12):1399–1407. doi: 10.1016/0277-9536(91)90285-k. [DOI] [PubMed] [Google Scholar]
  12. Jaffre Y., Prual A. Midwives in Niger: an uncomfortable position between social behaviours and health care constraints. Soc Sci Med. 1994 Apr;38(8):1069–1073. doi: 10.1016/0277-9536(94)90224-0. [DOI] [PubMed] [Google Scholar]
  13. Lugina H. I., Sommerfeld D. M. Postpartum concerns: a study of Tanzanian mothers. Health Care Women Int. 1994 May-Jun;15(3):225–233. doi: 10.1080/07399339409516114. [DOI] [PubMed] [Google Scholar]
  14. Moutquin J. M., Gagnon R., Rainville C., Giroux L., Amyot G., Bilodeau R., Raynauld P. Maternal and neonatal outcome in pregnancies with no risk factors. CMAJ. 1987 Oct 15;137(8):728–732. [PMC free article] [PubMed] [Google Scholar]
  15. Ng'andu N. H., Watts T. E. Child growth and duration of breast feeding in urban Zambia. J Epidemiol Community Health. 1990 Dec;44(4):281–285. doi: 10.1136/jech.44.4.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Olds D. L., Kitzman H. Can home visitation improve the health of women and children at environmental risk? Pediatrics. 1990 Jul;86(1):108–116. [PubMed] [Google Scholar]
  17. Quigley P., Ebrahim G. J. Women and community health workers promoting community health and development. J Trop Pediatr. 1994 Apr;40(2):66–71. doi: 10.1093/tropej/40.2.66. [DOI] [PubMed] [Google Scholar]
  18. Ransjö-Arvidson A. B., Christensson K., Darkwah G., Lungu F., Kakoma C., Chikamata D., Diwan V. K., Sterky G. Maternity care routines in a teaching hospital in Zambia. East Afr Med J. 1989 Jul;66(7):427–436. [PubMed] [Google Scholar]
  19. Röckner G., Henningsson A., Wahlberg V., Olund A. Evaluation of episiotomy and spontaneous tears of perineum during childbirth. Scand J Caring Sci. 1988;2(1):19–24. doi: 10.1111/j.1471-6712.1988.tb00026.x. [DOI] [PubMed] [Google Scholar]
  20. Sai F. T., Nassim J. The need for a reproductive health approach. Suppl Int J Gynecol Obstet. 1989;3:103–113. doi: 10.1016/0020-7292(89)90109-4. [DOI] [PubMed] [Google Scholar]
  21. Urassa Earnest, Lindmark Gunilla, Nystrom Lennarth. Maternal mortality in Dar es Salaam, Tanzania: Socio-economic, obstetric history and accessibility of health care factors. . Afr J Health Sci. 1995 Feb;2(1):242–249. [PubMed] [Google Scholar]
  22. Victora C. G., Smith P. G., Vaughan J. P., Nobre L. C., Lombardi C., Teixeira A. M., Fuchs S. C., Moreira L. B., Gigante L. P., Barros F. C. Infant feeding and deaths due to diarrhea. A case-control study. Am J Epidemiol. 1989 May;129(5):1032–1041. doi: 10.1093/oxfordjournals.aje.a115207. [DOI] [PubMed] [Google Scholar]
  23. Widström A. M., Ransjö-Arvidson A. B., Christensson K., Matthiesen A. S., Winberg J., Uvnäs-Moberg K. Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour. Acta Paediatr Scand. 1987 Jul;76(4):566–572. doi: 10.1111/j.1651-2227.1987.tb10522.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES