RESUMO
Background & objectives: India has recorded a marked increase in facility births due to government's conditional cash benefit scheme initiated in 2005. However, concerns have been raised regarding the need for improvement in the quality of care at facilities. Here we report the monitoring patterns during labour and delivery documented by direct observation in reference to the government's evidence-based guidelines on skilled birth attendance in five districts of India. Methods: A cross-sectional study design with multistage sampling was used for observation of labour and delivery processes of low-risk women with singleton pregnancy in five districts of the country. Trained research staff recorded the findings on pre-tested case record sheets. Results: A total of 1479 women were observed during active first stage of labour and delivery in 55 facilities. The overall frequency of monitoring of temperature, pulse and blood pressure was low at all facilities. The frequency of monitoring uterine contractions and foetal heart sounds was less than the expected norm, while the frequency of vaginal examinations was high at all levels of facilities. Partograph plotting was done in only 15.8 per cent deliveries, and labour was augmented in about half of the cases. Interpretation & conclusions: The findings of our study point towards a need for improvement in monitoring of maternal and foetal parameters during labour and delivery in facility births and to improve adherence to government guidelines for skilled birth attendance.
RESUMO
This study investigated the reasons for high perinatal deaths among newborns delivered in health facilities in rural northwest Ethiopia. Qualitative in-depth interviews were conducted with 11 survivors of obstetric complications and 11 normal home deliveries. The interviews were audio recorded and transcribed verbatim. Open code qualitative 3.6 software was used for managing data and analysis. The primary reasons attributed to high mortality among health-facility-delivered babies were delay in recognizing danger signs of labor and delay in decision to seek care. Most women arrive to health institutions late with seriously complicated labor. Lack of transport, finance, and perceived poor quality of services are additional reasons to delayed seeking of health care during labor. Increasing public education on danger signs of labour, improving quality of emergency obstetric care in the nearby health facilities, and facilitating affordable referral mechanisms are critical to enhance prompt household decisionmaking and decreasing perinatal deaths in rural communities.
RESUMO
This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan’s maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed.
RESUMO
<b>Objective</b><br>To assess the effects of the utilization of Maternal and Child Health Handbook (MCHH) in West Sumatra on the utilization of maternal health services.<br><b>Methods</b><br>A repeated cross sectional study design was used. Three consecutive surveys were conducted in two districts, in 1999, 2001 and 2003, involving respectively 611, 621, and 630 mothers (pregnant and/or with one or more children under age three) as respondents. Respondents for each survey were selected from the same sub-districts and villages, using a multistage random sampling method. Data were collected primarily by using a pre-tested structured questionnaire. Multiple logistic regression analyses were carried out to estimate the net effects of the MCHH on mother's use of maternal health services.<br><b>Results</b><br>After controlling for other influencing factors, utilization of MCHH was found to be associated with better maternal knowledge regarding antenatal care (ANC), tetanus toxoid (TT) immunization and skilled birth attendance. MCHH utilization was also associated with higher likelihood of mothers' utilizing ANC, TT immunization and family planning services, and of use or planned use of skilled birth attendance. Simply owning the handbook did not affect maternal knowledge and was only associated with higher utilization of skilled birth attendance.<br><b>Discussion</b><br>The MCHH needs some modification, taking into account the educational level of the targeted mothers. Appropriate health care provider training is needed to promote the use of the MCHH as a tool for encouraging and focusing communication between mothers and health care providers, as well as to ensure that health care providers are able to use the handbook.<br><b>Conclusion</b><br>Utilization of the MCHH has the potential both to improve maternal knowledge and to increase the utilization of maternal health services. For maximum benefits, the handbook should be actively used by both mothers and health care providers.