The effects of predischarge postnatal care interventions following institutional deliveries in India on maternal and newborn health outcomes in the first year after discharge: A systematic review of quantitative and qualitative studies.

Abstract

This systematic review evaluated the effects of postnatal care (PNC) interventions provided to mothers delivering in hospitals or health centers in India, compared to alternative interventions or usual care, on maternal and neonatal health outcomes over the first year after discharge. We searched seven electronic databases for eligible quantitative and qualitative studies published between January 2000 and December 2024. Study selection, data management, and data synthesis were protocol-driven (PROSPERO-CRD42024554919). After screening 1212 records retrieved, we included only two nonrandomized interventional studies reported in five publications. We assessed the risk of bias using the ROBINS-I assessment tool and reported results following the synthesis without meta-analysis (SWiM) guidelines. One study, reported in four publications, evaluated the Companion Care Programme (CCP), a structured, predischarge, postnatal educational and skills-building package incorporating evidence-based PNC interventions for mothers and family members to improve newborn care, followed by postdischarge support, compared to preintervention usual care. Moderate certainty evidence from a sample of 133,733 mothers from 28 public hospitals across four Indian states demonstrated that CCP reduced the risk of neonatal deaths by 18% (95% CI 7 to 29%). Outpatient visits increased by 27% (95% CI 1 to 47%), but readmissions reduced by 56% (95% CI 39 to 66%), maternal complications reduced by 12% (95% CI 3 to 21%), and neonatal complications by 16% (95% CI 9 to 14%). The effects on exclusive breastfeeding rates were less certain with the CCP, and with a video-based breastfeeding educational program added to standard lactational counseling, versus only lactational counseling.