Abstract
Background and IntroductionMaternal and neonatal morbidity and mortality rates are high in low and middle income countries, where access to quality antenatal and postnatal care remains limited. This study investigates the effectiveness of a comprehensive antenatal and postnatal training workshop in improving the capacity of healthcare providers in Togo, as well as examining the experiences of women receiving care. It contributes to the broader goal of achieving Sustainable Development Goal 3, which aims to reduce maternal and neonatal mortality and improve health outcomes globally. The study also assesses the perspectives of healthcare providers on the delivery of antenatal and postnatal care and the women’s experiences of respectful maternity care.
Methods
A systematic review was conducted, following the GRADE guidelines, to identify key components of antenatal and postnatal care. A pre- and post-training design was employed to evaluate the effectiveness of an antenatal and postnatal training programme for healthcare providers using an adapted four-level Kirkpatrick framework. Mixed-methods research, including quantitative and qualitative approaches was utilised to assess the impact of the training. SPSS version 20 was used for quantitative data analysis, while NVivo 9 supported qualitative data analysis. Descriptive statistics, t-tests, and framework analysis were employed to analyse the data.
Results Systematic review
The systematic review identified 221 studies related to antenatal care and 53 studies related to postnatal care. A content analysis identified 28 essential components of antenatal care and 22 components for postnatal care, which were used to propose 15 signal functions aimed at guiding monitoring and evaluation efforts.
Healthcare Provider Capacity
A total of 500 participants attended the training across 28 healthcare facilities. Knowledge testing revealed a mean improvement of 7.1% (59.8% improvement overall), and skills testing showed a mean improvement of 26.7% (94.8% improvement overall). Participants expressed high satisfaction with the training, noting its relevance to professional practice and the potential to improve patient care. Behavioural change was reported, with improvements in healthcare provider behaviour, increased patient satisfaction, and better utilisation of services observed.
Antenatal and Postnatal Care Delivery
Across six healthcare facilities, 53 midwives took part in 32 key informant interviews and five focus group discussions. The participants highlighted the importance and timing of antenatal and postnatal care and were able to articulate the benefits and value of antenatal and postnatal care. Four key themes emerged essential components of antenatal and postnatal care valued by midwives, providing a model of routine care within a resource-limited environment, promotion of relational and respectful care, and challenges and resilience through COVID-19.
Women's Experience of Care
A questionnaire administered to 330 women across five healthcare facilities assessed their experience of respectful maternity care. The majority (79%) reported experiencing respectful care, with the highest scores provided for caring and friendly healthcare providers. However, long waiting times and verbal abuse from healthcare providers were reported by 48% and 23% of women, respectively. Timeliness of care was identified as a key area for improvement.
Conclusion
This study highlights the effectiveness of a comprehensive antenatal and postnatal care training programme in improving healthcare providers' knowledge, skills, and behaviours. It also underscores the importance of respectful maternity care in enhancing women's experiences. Despite improvements, further work is needed to address barriers to care, including long waiting times and instances of verbal abuse. There is also a need to expand the application of effective antenatal and postnatal care programmes in low-and-middle-income-countries’ settings.
| Date of Award | 9 Feb 2026 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Tina Lavender (Supervisor) & Carol Bedwell (Supervisor) |
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