Family planning in the Sudan: a pilot project success story.

PIP: In 1980, the Department of Community Medicine of the University of Khartoum designed an operations research project to test the possibility of getting village midwives to be involved in the delivery of maternal and child health and family planning (MCH/FP) services. From 1981-1983 the project was implemented by the University of Khartoum in cooperation with the Ministry of Health. The project area covered 100 km. It encompassed a largely agrarian population of 93,000 in 90 villages north of Khartoum along the banks of the Nile. The focus was on training and supervising village midwives. Information was provided on contraceptives for birth spacing, distribution of oral contraceptives, and referral for other methods. Also provided to midwives was information for mothers on oral rehydration therapy for children with diarrhea, and distribution of oral rehydration solution packets. Nutrition education was given midwives with emphasis on breastfeeding and weaning procedures. Information was also supplied about vaccination for children under 5 years of age (in collaboration with the Sudan Expanded Program on Immunization). The project was expensive, particularly regarding incentive payments for supervisors and midwives. The project had a very good start, but when incentive payments were withdrawn, it almost collapsed. At first, what midwives could do to provide maternal and child health services was targeted, but as the project went on, there was more concern for involvement of midwives in broader rural health delivery. The project area was a conservative, Islamic one. An extension area was selected 5 hours travelling time from Khartoum in Shendi District of Nile Province. The project was begun in 60 villages of 75,000 inhabitants. The land stretched for 120 km along both banks of the Nile. In the extension area, a small fee (US$.025) was charged per cycle, half going to the midwives, and half towards the health teams' expenses. 21 health zones were created, and a health team created for each. Registers of women aged 15-49 and children 3 years have been set up for each health zone. There have been very good results in the management of diarrhea.^ieng

Planificación de la familia en el Sudán: Exito de un proyecto piloto / Family planning in Sudan: A pilot proyect success story

Un proyecto piloto ejecutado en el Sudán para determinar la aceptabilidad de la planificación familiar en las aldeas islámicas a orillas del Nilo ha sido un completo éxito, hasta el punto que, en lugar de desaparecer como suelen hacerlo los proyectos piloto, sigue siendo parte integrante del servicio de salud

Family planning in the Sudan: a pilot project success story

A pilot project in the Sudan to determine the acceptability of family planning in the Islamic villages along the Nile has proved completely successful- so much so that instead of expiring as most pilot projects do, it continues as an integral part of the health service

Perceived causes and traditional treatment of diarrhoea by mothers in Eastern Sudan.

Mothers of Eastern Sudan seek or practice traditional treatment for diarrhoeal disease in their children based on their perception of causation. Fifty-six mother groups from 39 villages and 17 urban centres were surveyed in this study. The collected data were grouped by definition of diarrhoea, its perceived causes and practiced treatment thought to be appropriate. Differences were shown between the urban and rural groups. A longer list of perceived causes was obtained from rural mothers. Fumigation and use of rice water and custard were the preferred managements of urban mothers, while cautery, use of mihaya and goat's milk prevailed in rural areas. The importance of having the definition of diarrhoea cited in future studies is discussed and recommended.

PIP: As part of a survey aimed at designing health education programs in Eastern Sudan, 56 mother groups from 39 villages and 17 urban centers were surveyed on the definition of diarrhea, its perceived causes, and appropriate forms of treatment. 83% of urban mothers and 82% of rural mothers understood diarrhea to refer to a change in the consistency or color of stools. Perceived causes of diarrhea included unsuitable food, teething, and exposure to cold. Rural women provided a longer list of possible causes than urban mothers, but did not cite bottle feeding, presumably because this practice is nonexistent in rural Sudan. Fumigation and use of rice water and custard were the preferred means of diarrhea management in urban areas; rural mothers preferred cautery and use of mihaya and goat's milk. Mothers in urban areas showed a greater tendency to reduce breastfeeding and the amount of fluid and food given to children during episodes of diarrhea than rural mothers. 77% of urban mothers, compared with only 13% of rural mothers, were familiar with oral rehydration sachets. 77% of urban mothers and 56% of rural mothers indicated they would seek help from the health care system is home remedies failed to treat the diarrhea. Of particular concern is that erroneous beliefs about the causes of diarrhea reflected in traditional folk medicine may retard acceptance of oral rehydration and result in inappropriate "starving" of the sick child. As long as the geographic distribution of health care remains inadequate in the Sudan, folk practices will continue to be influential, however.

Community and individual acceptance: family planning services in the Sudan.

PIP: The Sudan Community-Based Health Project, initiated by the University of Khartoum in cooperation with the Ministry of Health in 1980, sought to test the proposition that government-trained village midwives could provide maternal-child health and birth spacing services in addition to their ongoing obstetrical duties. The project area encompassed 92,000 people in 93 villages. The 120 midwives serving the project area received training in 4 interventions -- oral rehydration therapy, maternal and child nutrition, immunization, and birth spacing -- and introduced these services by means of 3 rounds of household visits over a 5-month period. Comparison of pre- and post-intervention survey data indicates that village midwives can indeed be used successfully to promote not only contraceptive use, but also health attitudes and practices that are positively associated with fertility regulation. Between the 2 surveys, the percentage of women who ever used contraception increased from 22% to 28%, while the percentage of current users rose from 10% to 13%. Parity was significantly related to current use; each child born multiplied the likelihood of contraceptive acceptance (by a factor of 0.76 in the post-intervention sample). Maternal education was the socioeconomic variable that most enhanced receptivity to contraceptive acceptance after the project's interventions. In terms of community-level variables, village location along the Nile and proximity to a paved road were significant correlates of contraceptive use. When variables related to the project itself were analyzed, women with vaccinated children were found to be twice as likely to contracept as those with nonvaccinated children and women who believed breast feeding should be continued during diarrhea episodes were 1.5 times more likely to use birth spacing than those who did not. Although midwives did not specifically emphasize contraceptive use, it appears women who were encouraged by midwives to take positive steps in the area of child health were also likely to become more innovative in terms of fertility regulation.^ieng

Introducing integrated health services in a traditional society: the Sudan community-based family health project.

The Sudan Community Based Family Health Project, begun in 1980, has sought to demonstrate that the existing cadre of practicing government-trained village midwives in the Sudan can be utilized to extend maternal and child health services to rural areas. A majority of these midwives are nonliterate, and attention was placed on effectively implementing a limited set of services, namely, oral rehydration, birth-spacing, nutrition education, and immunization. Carefully planned inservice training programs for midwives and local health workers and an intensive service introduction campaign implemented in phases resulted in mixed success over a relatively short period of observation. Perhaps the most important lessons that have emerged from the program have been about how to design and implement a rural MCH program building on local resources. The experience has since lead project staff to undertake, in a new area, a follow-up program designed to be a more cost-effective and replicable version of the original one.