Length-of-stay after a health facility birth and associated factors: analysis of data from three Sub-Saharan African countries

Objectives: We estimated the length-of-stay (LOS) in the health facility after childbirth and identified associated factors in three sub-Saharan African countries.Design: Secondary analysis using data from the most recent Multiple Indicator Cluster Surveys.Setting: Multiple Indicator Cluster Surveys from Ghana, Malawi and Eswatini were selected.Participants: Women aged 15-49 years who had a facility delivery in the two years preceding the survey were in-cluded.Main outcome measures: Length-of-stay recorded in days and weeks were converted to hours and analysed as a continuous variable.Results: Length-of-stay was estimated for 9147 women, wherein 6610 women (median LOS and IQR: 36 36,60 hours), 1698 women (median LOS and IQR 36 10,60 hours) and 839 women (median-length-stay 36 36,60 hours) were from Malawi, Ghana and Eswatini respectively. Being from Ghana [RC, -20.6 (95%CI:-25.2 - -16.0)] and then Eswatini [RC: -13.0 (95%CI: -19.9 - -9.8)] and delivery in a government hospital [RC: -4.9 (95%CI -9.9- -0.3)] were independently associated with having a shorter LOS. Having a caesarean section, assistance by Nurses/Mid-wives or Auxiliaries/CHOs, single birth, heavier birth weight, and death of newborn before discharge increased the duration of stay.Conclusions: Necessitating and facility factors are important determinants of length of stay. Socio-demographic characteristics, however, have a restricted role in influencing the duration of postpartum stay in sub-Saharan Africa. Further prospective research is required to identify more determinants and provide evidence for policy formulation and clinical guidelines regarding the safest time for discharge after delivery.

[1]  Lorraine Hicking-Woodison.  Planning Health Promotion Programs: An Intervention Mapping Approach , 2017 .

[2]  K. Roelens,et al.  A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium. , 2017, Midwifery.

[3]  E. Zemp,et al.  Does Coordinated Postpartum Care Influence Costs? , 2017, International journal of integrated care.

[4]  K. Strandberg-Larsen,et al.  Early discharge following birth - What characterises mothers and newborns? , 2017, Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives.

[5]  R. Goldenberg,et al.  Cesarean section in sub-Saharan Africa , 2016, Maternal Health, Neonatology and Perinatology.

[6]  L. Beňová,et al.  Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys , 2016, PLoS medicine.

[7]  Rachel P. Chase,et al.  “You should go so that others can come”; the role of facilities in determining an early departure after childbirth in Morogoro Region, Tanzania , 2015, BMC Pregnancy and Childbirth.

[8]  A. Melese,et al.  Risk factors for low birth weight in Bale zone hospitals, South-East Ethiopia : a case–control study , 2015, BMC Pregnancy and Childbirth.

[9]  S. Fawcus,et al.  Maternal death and caesarean section in South Africa: Results from the 2011-2013 Saving Mothers Report of the National Committee for Confidential Enquiries into Maternal Deaths. , 2015, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[10]  C. Goodman,et al.  Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys , 2015, Tropical medicine & international health : TM & IH.

[11]  Simon Dalton.  The current crisis in human resources for health in Africa: the time to adjust our focus is now. , 2014, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[12]  T. Ayele,et al.  Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia , 2014, BMC Pregnancy and Childbirth.

[13]  B. Branger,et al.  [Pregnancy and delivery satisfaction of 424 patients in Perinatal Health Network « Sécurité Naissance » of Pays-de-la-Loire area]. , 2014, Journal de gynecologie, obstetrique et biologie de la reproduction.

[14]  Kristin L Sainani,et al.  Understanding Linear Regression , 2013, PM & R : the journal of injury, function, and rehabilitation.

[15]  L. Wright,et al.  Perinatal Outcomes of Multiple-Gestation Pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: A Global Network Study , 2013, American Journal of Perinatology.

[16]  M. Abrahamowicz,et al.  Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey , 2012, PloS one.

[17]  C. Roberts,et al.  Decreasing length of maternal hospital stay is not associated with increased readmission rates , 2012, Australian and New Zealand journal of public health.

[18]  N. Ford,et al.  Cesarean Section Rates and Indications in Sub-Saharan Africa: A Multi-Country Study from Medecins sans Frontieres , 2012, PloS one.

[19]  Paulina Bravo,et al.  Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns. , 2011, Revista da Escola de Enfermagem da U S P.

[20]  D. Urassa,et al.  Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change , 2011, BMC pregnancy and childbirth.

[21]  J. Plange-Rhule,et al.  Shortage of healthcare workers in sub-Saharan Africa: a nephrological perspective. , 2011, Clinical nephrology.

[22]  S. Cousens,et al.  3.6 million neonatal deaths--what is progressing and what is not? , 2010, Seminars in perinatology.

[23]  J. Lawn,et al.  Reducing intrapartum‐related deaths and disability: Can the health system deliver? , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[24]  A. Donner,et al.  Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study , 2007, BMJ : British Medical Journal.

[25]  O. Campbell,et al.  Strategies for reducing maternal mortality: getting on with what works , 2006, The Lancet.

[26]  C. Ronsmans,et al.  Maternal mortality: who, when, where, and why , 2006, The Lancet.

[27]  Maria E. Fernandez,et al.  Planning Health Promotion Programs: An Intervention Mapping Approach , 2006 .

[28]  D. Kılıç,et al.  Health problems related to early discharge of Turkish women. , 2005, Midwifery.

[29]  Carmen Victoria Almeida Gonzalez,et al.  Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up. , 2005, American journal of obstetrics and gynecology.

[30]  J. Spencer-Jones,et al.  Make every mother and child count. , 2005, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[31]  S. Oddie,et al.  Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study , 2005, Archives of Disease in Childhood.

[32]  P. Ryan,et al.  Length of stay after vaginal birth: sociodemographic and readiness-for-discharge factors. , 2004, Birth.

[33]  B. Lichtenstein,et al.  Giving Birth, Going Home: Influences on when Low-Income Women Leave Hospital , 2004, Health.

[34]  K. Schoendorf,et al.  Does postpartum length of stay affect breastfeeding duration? A population-based study. , 2003, Birth.

[35]  E. Keeler,et al.  Postpartum length of stay and newborn health: a cost-effectiveness analysis. , 2003, Pediatrics.

[36]  K. Wambach,et al.  Patient satisfaction with an early discharge home visit program. , 2003, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[37]  Shiliang Liu,et al.  Length of hospital stay, obstetric conditions at childbirth, and maternal readmission: a population-based cohort study. , 2002, American journal of obstetrics and gynecology.

[38]  B. Argus,et al.  Early postnatal discharge from hospital for healthy mothers and term infants. , 2002, The Cochrane database of systematic reviews.

[39]  G. Escobar,et al.  A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge. , 2001, Pediatrics.

[40]  V. Bhandari,et al.  Morbidity and Mortality of Preterm Twins and Higher-Order Multiple Births , 2001, Journal of Perinatology.

[41]  E. Keeler,et al.  Do longer postpartum stays reduce newborn readmissions? Analysis using instrumental variables. , 2000, Health services research.

[42]  A. Laptook,et al.  Problem Identification in Apparently Well Neonates: Implications for Early Discharge , 2000, Clinical pediatrics.

[43]  Diane P. Martin,et al.  Association between method of delivery and maternal rehospitalization. , 2000, JAMA.

[44]  G. Escobar,et al.  A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. , 2000, Pediatrics.

[45]  J. Britton.  Postpartum early hospital discharge and follow-up practices in Canada and the United States. , 1998, Birth.

[46]  G. Steineck,et al.  A comparison of women's memories of care during pregnancy, labour and delivery after stillbirth or live birth. , 1998, Midwifery.

[47]  E. G. Fishbein,et al.  Early postpartum discharge: how are mothers managing? , 1998, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[48]  B. T. Johnson,et al.  Enhancing early discharge with home follow-up: a pilot project. , 1998, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[49]  T. Brennan,et al.  Maternal and infant health: effects of moderate reductions in postpartum length of stay. , 1997, Archives of pediatrics & adolescent medicine.

[50]  M. Kotelchuck,et al.  Factors associated with early maternal postpartum discharge from the hospital. , 1997, Archives of pediatrics & adolescent medicine.

[51]  M. Cooper,et al.  A new paradigm for postpartum care. , 1996, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[52]  R. York,et al.  Controversial issues surrounding early postpartum discharge. , 1996, The Nursing clinics of North America.

[53]  V. Parisi,et al.  To stay or not to stay? That is the question. , 1995, The New England journal of medicine.

[54]  S. Charles,et al.  Early discharge, in the end: maternal abuse, child neglect, and physician harassment. , 1995, Pediatrics.

[55]  M. G. Macdonald,et al.  Hidden risks: early discharge and bilirubin toxicity due to glucose 6-phosphate dehydrogenase deficiency. , 1995, Pediatrics.

[56]  J. Hanson,et al.  Summary of workshop: early discharge and neonatal hyperbilirubinemia. , 1995, Pediatrics.

[57]  R. Marshall,et al.  Controversies of early discharge of infants from the well-newborn nursery. , 1995, Current opinion in pediatrics.