Community Perceptions of Facilitators and Barriers to Post Natal Care access in Rural Laos

Abstract Background The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic. Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project. This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming. Methods From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted. Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province. Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD. Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders. Results Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC. Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice. Economic, road conditions, and transport challenges were also identified as significant barriers. Conclusions Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care. Thus, quality outreach with home visits are critical. Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access. Key messages Post natal care remains the most neglected phase in the provision of quality maternal and newborn care. Understanding what influences decision making around health care seeking optimised the goal to continue to increase the numbers of women who access a health facility for post natal care in Laos.


Background:
The COVID-19 pandemic demonstrates the important role of providing people with easy to access up-to-date health information in digital formats.People experiencing homelessness have limited access to health information and were hardly ever directly addressed through communication channels in Germany.Lack of digitalization within shelters and social services, as well as technical and socio-economic barriers in purchasing and maintaining a smartphone are further barriers to information.

Methods:
The Charite ´-COVID-19-project for and with homeless people has created digital health information videos and posters, with an interdisciplinary team and in a participatory approach.Two videos on general information and testing of COVID-19 were launched in 5 languages in February 2021.Vaccination posters in two language versions including 9 languages are available since April 2021.

Results:
We will present the collaboration of research, practice and community, the production process, the distribution and the acceptance of the formats.The web link refers to the videos, posters and further information: https://tropeninstitut.charite.de/forschung/charite_covid_19_projekt_fuer_und_mit_obdachlosen_menschen/ Conclusions: Exclusion from (digital) information is an increasingly important part of the structural marginalization of homeless people.This, as well as the inadequate consideration of this population in health communication and the pandemic response have to be addressed.Tackling the digital gap allows improved access to health information for homeless people and promotes health-seeking behaviour.Empowerment of the community through participation and a network between community, service providers, politics and research are also crucial for improvement of homeless people's health in the future.

Key messages:
Exclusion from (digital) information is an increasingly important part of the structural marginalization of homeless people that has to be addressed.Bridging the gap between research, practice and community was a key factor for the realisation of inclusive digital health communication with homeless people in this project.

Background:
The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic.Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project.This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming.

Methods:
From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted.Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province.Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD.Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders.

Results:
Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC.Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice.Economic, road conditions, and transport challenges were also identified as significant barriers.

Conclusions:
Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care.Thus, quality outreach with home visits are critical.Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access.

Key messages:
Post natal care remains the most neglected phase in the provision of quality maternal and newborn care.
Understanding what influences decision making around health care seeking optimised the goal to continue to increase the numbers of women who access a health facility for post natal care in Laos.
It is aimed at first-time parents and addresses early risk factors for child overweight such as parental skills and healthy habits related to food and meals, movement, screen time and sleep, and introduce a new theme: sense of security in the family.It will be integrated in existing services delivered by community health nurses supplemented with extra elements such as telephone consultations, family groups and a video library.Significant interactions between rs10830962 and interventions were found: In women homozygous for the G allele, but not in the other genotypes, the PA intervention reduced maternal fasting insulin (beta -0.16 [95%CI -0.33, 0.02], p = 0.08) and HOMA-IR (-0.17 [-0.35, 0.01], p = 0.06).In heterozygous women, HE intervention had no effect, whereas in women homozygous for the C allele, HE existing interventions, interviews with parents, and an organizational capacity assessment.Step 2: Development of program theory and matrices.Step 3: Selection of theoretical methods and practical applications for modifying personal and environmental determinants.Step 4: Development of intervention tools.Step 5: Planning of program adoption, implementation, and sustainability.Step 6: Generation of an evaluation plan.Results: The Bloom intervention is universal but with a strong focus on families with low socio-economic position and non-Danish ethnic background.intervention reduced GWG (-1.6 kg [-2.4,-0.8]).Discussion: In women homozygous for the risk allele of MTNR1B rs10830962, GDM risk was increased and PA intervention 15th European Public Health Conference 2022