MATERNAL AND INFANT HEALTH-PROBLEMS AFTER NORMAL CHILDBIRTH - A RANDOMIZED CONTROLLED-STUDY IN ZAMBIA

Study objectives-The main aim of the study was to discover if a midwif e home visiting programme has a significant effect on the prevalence o f health problems and breast feeding behaviour of mothers who delivere d normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', th e midwife's, and the doctor's findings of prevalence of health problem s at the end of the puerperium period. Design-A randomised controlled trial was carried out. One group of mothers and their infants were ran domly allocated to a home visiting group (Group A); the other group (G roup 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 delive ry and gave birth to a healthy fullterm infant, as assessed by the att ending midwife, were randomised to two groups. Group A consisted of 20 8 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 moth er/infant dyads who were only visited at day 42. Main results-At day 4 2 an equal proportion (30%) of mothers in both groups perceived that t hey had health problems. The prevalence of infant health problems in G roup B was significantly higher (p<0.01) as perceived by mothers. Ther e were more mothers in Group B (p<0.01) perceiving insufficient milk p roduction and giving supplementary feeding. At day 42, mothers in Grou p A (56%) took more actions than mothers in Group B (41%) to solve inf ant health problems (p<0.03). In both groups the mothers' perceived ow n health problems, were significantly higher (p<0.01) than those obser ved 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 th e paediatrician's findings (p<0.01). Conclusions-There was a significa nt difference between the mothers' reported health problems and the he alth problems identified by the midwife and the doctors. The study sho ws that a midwife home visit and individual health education to mother s, reduce the prevalence of infant health problems, and enables the mo ther to more often take action when an infant health problem is identi fied. There is a need to re-evaluate the midwifery training curriculum s with the intention to include more infant management care.