Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar.

BACKGROUND: In Myanmar a large proportion of antenatal and intrapartum care in rural areas is provided by skilled birth attendants (SBAs), this study assessed the coverage by these health workers of all births, their adherence to service guidelines, and community opinion on the antenatal and delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Region to identify the challenges and improve antenatal and intrapartum service delivery provided by the SBAs. METHOD: A structured questionnaire was used to interview 304 women who had infants under one year of age, and in-depth interviews were held with 12 SBAs and 10 community members. RESULTS: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these were covered by SBAs at an average 15 weeks' gestation. The average frequency of ANC visits was 9. Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries, use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers (traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysis showed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education at primary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of the rural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. The categories of supervision, referral, and health education activities of SBAs were not in line with service guidelines. The main reasons were lack of access and community acceptance of TBAs. CONCLUSION: Heavy workload, geographical location, transportation and financial concerns were major challenges for SBAs, along with community compliance and mutual coordination. Good communication and service management skills were important to overcome these challenges.

Why person affected by leprosy did not look after their plantar ulcer? Experience from Pakokku zone, Myanmar.

A cross-sectional study was carried out to identify methods of caring plantar ulcers in leprosy patients and the underlying causes of poor plantar ulcer care during January and February 2008. This was conducted in Pakokku zone as it was one of the "9 selected townships of the Disabilities survey, i.e., Basic Health Staff project 2003/4", which was funded by Japan International Cooperation Agency. After getting consent, all available leprosy cases, i.e., 101 cases with foot disability grade 2 were interviewed with the pre-tested questionnaire. Among 101 cases, 13 cases who took care of their ulcer poorly and 20 who did none of the recommended measures were recruited for in-depth interview (IDI). The subjects were largely old people, males and people with no marriage partner. The majority had earned money by doing sedentary job. Prolongation of ulcers was observed in 78 cases. Most had been suffering from ulcers for years. When asking face-to-face interview, all the recommended care measures were not reported. Among these recommended measures, a large number of respondents reported about soaking measure. However, these reported measures were contradicted to the preventive methods which they disclosed in IDI. Plantar ulcer care seemed to be an individualised practice. The individual ways of performing were related to their view of ulcer, the environment, and occupation, and custom, communication with family and health staff. The findings identified the actual practice of plantar ulcer care in study areas. It is suggested that the current performance of planar ulcer care is inadequate and more attention should be given to achieve the target set by the programme as a recommendation.

Needs assessment for income generation training of youths in leprosy families of a leprosy village in Myanmar.

After Myanmar eliminated leprosy in 2003, the prevention of disability (POD), as well as prevention of worsening disabilities (POWD) and rehabilitation became a new agenda, which is one of three national strategies of leprosy control beyond 2005. Since the training needs for income generation for youths living in leprosy villages were not well known, a small-scale survey was conducted in May 2005. This study found that the youths in Mayanchaung village, Yangon Division, were eager to receive training on income generation. After training they wanted to practice and improve their skills with the resources available, because they perceived that a short training course would not enable them to get a proper job. Although they were fully aware of income generation skills, they found it difficult to adequately consider issues such as resources for practicing skills after training, social marketing, and seeking job opportunities. They also felt that mediators could be helpful between villagers and external customers / retailers. On the other hand, the elders, most of whom had disabilities, wanted the youths to stay in the village to take care of them. A basic sewing and stitching training course that was planned to match the study results was produced in January 2006. After 11 months it was observed that a newly opened sewing workshop was busy operating 12 sewing machines because of a big order of making primary school uniforms. How effective the needs assessment was still unknown, but it was found that prior need assessment activities followed by a training course upon the real needs might promote the proper processes of social rehabilitation of youths in a leprosy village of Myanmar.