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Improving the health of pregnant women and children in Ntcheu District, Malawi
Mikey Rosato, Ros Davies
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Nynke Van den Broek, Luigi D’Aquino, Thidar Pyone, Sarah Bar-‐Zeev, Joe Onwude,
Helen Owolabi, Florence Mgawadere
Arsenia Banda, Wandie Kayira, Mackson Mtambo, Violet Mateta,
Ann Phoya
Background
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Projects 2010-‐2015 • WCF in partnership with the Malawi Ministry of Health and Ntcheu District Hospital – Perinatal Care Project (PCP)
• Improve maternal, newborn and child health and reduce mortality in Ntcheu • 2005-‐2010: Big LoYery Fund, UCL Ins[tute for Global Health and other UK Trusts (86 villages)
• 2010-‐2015: Comic Relief (4 TAs – 144 villages)
Background
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Ntcheu • NMR = 33 per 1000 live births (2010) • U5MR = 125 per 1000 live births (2010) • MMR (Malawi) = 510 per 100,000 (2013) • Coverage of MCH interven[ons inline or above na[onal averages (2010)
Approach
Demand side • PLA groups • OrientaOon and support of chiefs • Community sensi[sa[on • Sensi[sa[on of male involvement • Community maternal and neonatal
death reviews • Training and deployment of
community growth-‐monitoring volunteers
• Training and deployment of ‘secret mothers’
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Supply side • Maternal and neonatal mortality
surveillance system • Training and mentorship of
health workers including HSAs and midwives
• Provision of medical equipment • Support for outreach ANC clinics
EvaluaOon methods
• Evalua[on of ac[vi[es 04/2010 – 12/2014 • Baseline (PCP), Midline (PCP) and Endline (LSTM)
• Household surveys – 400 women with children <24 months. Two stage random selec[on (village > household).
• Health facility assessment – All 14 health facili[es. • Endline (LSTM)
• Focus group discussions – 10 groups with 113 female and male par[cipants. Snowball sampling.
• Key informant interviews – 12 respondents from NGOs, health workers, District Health Management team, Tradi[onal Authori[es, Village Headmen, PCP and Comic Relief. Snowball sampling.
• Secondary sources – Project reports and monitoring data. Health Management Informa[on System data.
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Results – MNCH home-‐care pracOces
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Indicator Baseline Achievement (2014)
Average annual rate of change
Percentage of mothers exclusively breasheeding their children for 6 months aier birth
67% (2013) 76% Project = +4.5% Malawi = 0%
Results – MNCH care-‐seeking pracOces
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Indicator Baseline Achievement (2014)
Average annual rate of change
Percentage of women aYending (4+ ANC visits) 42% (2010) 42% Project = 0%
Malawi = 0%
Percentage of pregnant women aYending ANC in the 1st trimester 9% (2013) 19% NA
Skilled Birth AYendance 51% (2010) 93% Project = +11% Malawi = +4%
Percentage of newborns receiving PNC within 7 days of delivery 49% (2010) 93% NA
Percentage of children U-‐1 receiving completed course of vaccina[ons 67% (2013) 89% Project = +11%
Malawi = -‐2%
“The project has made the women aware of what to do. They are able to know when to start antenatal care, they know the importance of delivering at a health facility and they also know that when a baby is born they need to receive immuniza=ons…..because they were going in the villages to teach them on health issues (Nurse Midwife Technician, Nsiyaludzu Health Centre)
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“Another issue about growth monitoring and under five clinics. We tried on our own to take the responsibility to mould bricks and we built a clinic aBer hearing the importance of doing that. This =me around we operate our under five services in our own clinic” (TradiOonal Authority)
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Results – Male involvement in MNCH
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Indicator Baseline Achievement (2014)
Percentage of communi[es indica[ng that men of reproduc[ve age express posi[ve antudes and behaviour towards MNCH
30% (2013) 100%
Percentage of ANC visits aYended by the pregnant women's partners 35% (2013) 42%
Percentage of u5 growth monitoring events aYended by fathers 7% (2013) 82%
Percentage of mothers escorted to PNC by their partners 21% (2013) 21%
Percentage of mothers accessing FP with their partners 44% (2010) 20%
“When a child is sick while you are pregnant, the husband now takes the child to the hospital and gets help while you are at home relaxing. So that is how the men help us now that Perinatal Care Project (PCP) is here. Before PCP when you tell them to take the child to the hospital they would slap you and tell you to take the child to the hospital yourself. So you would be heavy with pregnancy and carry another child on your back, but right now we have seen changes in men from their involvement in the groups and hearing other men saying they are helping their wives too.” (FGD 4)
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Results – MNCH service quality
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Indicator Baseline Achievement (2014)
Percentage of mothers breasheeding their newborns, born at facili[es, immediately aier birth (within 60 minutes of birth) 93% (2010) 89%
Percentage of newborns, born at health facili[es, wrapped immediately aier birth 98% (2013) 96%
Percentage of newborns, born at health facili[es, receiving KMC if indicated 2% (2013) 47%
Percentage of sick children referred to health facili[es by HSAs 9% (2012) 9%
Percentage of PPH cases in health facili[es managed according to MoH protocols 94% (2013) 88%
Percentage of women delivering at a health facility who report sa[sfac[on with the services received 54% (2010) 71%
Percentage of midwives with good knowledge of clinical care 81% (2010) 60%
Summary
• Improvements in MNCH care and care-‐seeking prac[ces
• Improvements in male involvement in MNCH, although not in FP and PNC
• Project ac[vi[es, par[cularly PLA group ac[vi[es, may have contributed to progress
• Study design does not allow for isola[on of incremental impact of project ac[vi[es
• Lack of progress in MNCH service quality • Due to external factors such as a lack of sufficient
personnel, lack of equipment and resources, staff turnover, and irregular suppor[ve supervision.
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Conclusion
• Addi[on to the PLA group evidence base? • Improvements in home care prac[ces • Improvements in care-‐seeking prac[ces
• Reminder of the need for an interven[on package • Demand (PLA groups +) • Supply
• Enhancing quality of MNCH care at facility level requires further aYen[on • Staffing – total numbers, turnover, knowledge and skills • Resources, supplies and equipment • Formal feedback mechanisms to evaluate pa[ent
sa[sfac[on • Advocacy for policy strengthening and resource alloca[on
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www.womenandchildrenfirst.org.uk
www.womensgroups.tumblr.com
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