maternal and child health handbook initiative among tagbanua mothers of coron, palawan: an...
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Maternal and Child Health Handbook Initiative among Tagbanua Mothers
of Coron, Palawan:An Alternative Strategy of Promoting
Health to Indigenous Peoples in the PhilippinesCalvin de los Reyes1, Marilyn Crisostomo2 and Yasuhide Nakamura1
1International Collaboration Division, School of Human Sciences, Osaka University, Japan2MEC Health Research and Statistics Consultancy
Maternal and Child Health in the Philippines
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50
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150
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250
1993 1998 2006 2015
Figure 1. Maternal mortality ratio in the Philippines, 1990-1998, 2006, 2010 and 2015.(Sources of data: 1990-1998 and 2006 – NCSB, 2007; 2010 and 2015 targets – DOH, 2005.)
Leading Causes of Maternal Mortality
Maternal Mortality by Main Cause Number Rate/1000 Livebirths & Percentage Distribution
Philippines, 2003
Cause Number Rate Percent
1. Other Complications related to pregnancy occuring in the course of labor, delivery and puerperium
811 0.5 45.1
2.Hypertension complicating pregnancy, childbirth and puerperium
479 0.3 26.6
3. Postpartum hemorrhage 319 0.2 17.7
4. Pregnancy with abortive outcome 189 0.1 10.5
* Percent share to total number of maternal deaths
Last Update: January 11, 2007
Maternal and Child Health in the Philippines
Figure 2. Child Mortality Trends, Under-5 mortality, infant mortality and neonatal mortality 1988 to 2006.(Source of data: DOH, 2008.)
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10
20
30
40
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60
70
80
1988 1993 1998 2003 2006
UFMR IMR NMR
Leading Causes of Infant Mortality Infant Mortality: Ten (10) Leading Causes
Number & Rate/1000 Livebirths & Percentage Distribution Philippines, 2003
Cause Number Rate Percent
1. Other perinatal conditions 9,695 5.8 42.4
2. Pneumonia 2,314 1.4 10.1
3. Bacterial sepsis of newborn 1,439 0.9 6.3
4. Congenital malformation of the heart 1,127 0.7 4.9
5. Diarrhea and gastroenteritis of presumed infectious origin 984 0.6 4.3
6. Congenital Pneumonia 783 0.5 3.4
7. Other congenital malformation 550 0.3 2.0
8. Respiratory distress of newborn 462 0.3 2.0
9. Neonatal aspiration syndromes 440 0.3 1.9
10. Disorders related to short gestation and low birth weight
433 0.3 1.9
Source: THe 2003 Philippine Health Statistics* percent share from total infant deaths, all causes, Philippines
Maternal and Child Health in the Philippines
Goals Baseline Indicators
Target by 2010
MDGs by 2015
Reduce MMR
209 90 52
Reduce U5MR
72 32 27
Reduce IMR
46 17 <17
Table 1. Maternal, neonatal and child health targets and MDGs 4 and 5
(Source of data: Baseline indicator for MMR – NSO, 1990; U5MR and IMR – NSO, 1998.)
Comparison With Other Countries
Comparison With Other Countries
Total Fertility Rate
Existing Health Cards in the Philippines
Existing Health Cards in the Philippines
Existing Health Cards in the Philippines
The MCH Handbook in the Philippines
Mother-Baby Book•The Mother-Baby book is a compilation of existing vital health information acquired from both the mother and the baby.
•Department of Health revised the booklets and integrated all the record forms being used in health clinics into a simple, concise and most affordable material.
The MCH Handbook in the Philippines
BOOKLET NI MOMMY AT BABY
•The MCHH is nationally initiated and decentralized to the provinces.
•Initially 500,000 copies were printed by the central office of the Department of Health, with reprinting as a responsibility of the local government unit.
•Each copy is estimated to be at $ 0.50.
•It is aimed to be a part of the National Health Insurance Maternity Care Benefit Package
Comparison Among Regions
Comparison Among Regions
Comparison Among Regions
Indigenous Peoples of the Philippines
ETHNOGRAPHIC REGIONS
CAR and Region I
Region II
Region III and Rest of Luzon
Island Group
Southern and Eastern Mindanao
Central Mindanao
Northern and Western Mindanao
(Source: National Commission on Indigenous Peoples – Philippines)
Indigenous Peoples of the Philippines
According to the International Labor Organization“Peoples in independent countries whose social, cultural and economic conditions distinguish them from other sections of the national community, and whose status is regulated, wholly or partially by their own customs or traditions or by special laws or regulations.”
National Commission on Indigenous Peoples“In modern times, they are known as cultural minorities, or tribal Filipinos, lately been lumped in the generic term ‘indigenous cultural communities’ or the more politically correct term ‘indigenous people’ of the Philippines.”
(Source: Cadiogan, 2004)
Issues faced by IP in the Philippines
•displacement from their ancestral land and land-grabbing
•non-recognition of indigenous social, political and cultural systems
•commercialization of indigenous culture to the extent of exploitation by tourism-related industries and even by the government
•discrimination and misrepresentation in statistics
•neglect of both local and national government (Source: Cadiogan, 2004)
Issues Faced by IP in the Philippines
•In addition, health facilities are often located in areas that are not easily accessible to the poorest families, who tend to live in more remote areas.
(Source: Cadiogan, 2004)
Palawan
Palawan
Barangay Cabugao, Coron Island, Palawan
Development of MCHJ Handbook for Indigenous Peoples
General Objective
To determine the feasibility of utilizing the maternal and child health (MCH) handbook and assess its influence on the MCH of Tagbanua mothers and children in Coron Island, Palawan one year after the introduction of the handbook (August 2007 to August 2008)
Development of MCHJ Handbook for Indigenous Peoples
Specific Objectives
●To determine the knowledge, attitude and practice of Tagbanua mothers regarding MCH at baseline
●To develop and introduce an indigenous-specific MCH handbook suited to the needs of the community
●To assess the influence on the Tagbanua mothers’ MCH knowledge after the introduction of the MCH handbook
●To assess the influence on the Tagbanua mothers’ MCH practices after the introduction of the MCH handbook
Development of MCHJ Handbook for Indigenous Peoples
Study design:Cross-sectional study composed of qualitative and quantitative methods
Location:Barangay Cabugao, Coron Island, Coron Municipality, Palawan Province, Philippines
Population and subject:Tagbanua indigenous population of PalawanThe subjects consisted of: Tagbanua mothers, pregnant and or have been pregnant for the last 6 years; Tagbanua fathers, elders and TBAs; Local municipal health officers, midwife and health volunteers.
Development of MCHJ Handbook for Indigenous Peoples
Quantitative MethodInterview guided by semi-structured questionnaires (Fifty Tagbanua mothers, pregnant or with children under 6 years old (with ages 15-49 years old) were interviewed before and one-year after the introduction of the MCH handbook)
Qualitative Method•Key-informant Interview (MHO, Public health nurse, local midwife and health volunteers)•Focus group discussion (Pregnant and new mothers; Women (experienced); Fathers; Community elders (TBAs)
Data collection, handling and analysis:Data were collected from Tagbanua mothers through interview, guided with semi-structured questionnairesEpi Info and Stata (ver10) for quantitative data at the Department of Biostatistics and Epidemiology, College of Public Health
The MCH Handbook in the Philippines
Antenatal CareCard
ImmunizationCard
Family PlanningCard
GrowthCard
Health InformationLeaflets
Contents of Tagbanua-MCH Handbook
Contents of Tagbanua-MCH Handbook
Introduction of Tagbanua-MCH Handbook
Introduction of Tagbanua-MCH Handbook
Results of the Evaluation
Socio-economic Indicators No. %
Age (in years)< 2021-2526-3031-3536-40> 40
ReligionCatholicBaptistOther Christian Sect
4171211
33
2814
9
8342422
66
562818
Maternal Characteristics (n=50)
Results of the Evaluation
Socio-economic Indicators No. %
Formal EducationNo formal educationElementary levelElementary graduateHigh school level
Type of OccupationNoneFarmingFishingRetail
33313
1
1928
21
66626
2
3856
42
Maternal Characteristics (n=50)
Results of the Evaluation
Indicators of reproductive history No. (%)
Children living with them< 2 children3-4 children> 4 children
Children under 6 years of agePregnant with first child1 child2 children3 children
238
19
513266
461638
10265218
Description of some indicators of reproductive function (n=50)
Results of the Evaluation
Maternal Health Knowledge Pre-(%)
Post-(%)
Knowledge of pregnancy risk factors
Antenatal Care ConsultationFirst prenatal care consultation within the 1st tri.Consultation 4 times during pregnancy
Care during pregnancyNeed for tetanus toxoid vaccinationProper number of vaccination (2 times)
Appropriate care during deliveryAppropriate birth attendant (Skilled)Traditional birth attendant
Postnatal consultation
10
2638
7224
3644
44
84
7458
9290
9010
44
Maternal Health Knowledge of Mothers (n=50)
Results of the Evaluation
Maternal Health Practices Pre-(%)
Post-(%)
Pregnancy at riskMother’s age is <20 or >35 years oldMother has delivered >4 times
Antenatal Care ConsultationFirst trimester prenatal care consultationConsultation of at least 4 times
Care during pregnancyCompleted tetanus toxoid vaccination (5 times)Amount of food should be greater during pregnancy
Appropriate care during deliveryAppropriate birth attendant (Doctor and Midwife)Traditional birth attendant
Postnatal consultation
2048
126
220
496
4
2416
1034
1288
12
Maternal Health Practices of Mothers (n=50)
Results of the Evaluation
Child Health Knowledge Pre-(%)
Post-(%)
Infant NutritionOn breastfeeding within 30 minutes after birthPeriod of exclusive breastfeeding (6 months)Introduction of solid food (6 months)
Child ImmunizationBCG (Tuberculosis)DPT (Tetanus) X 3 shotsOPV (Polio) X 3 shotsAMV (Measles)
Vitamin A Supplementation
Treatment of diarrhea (Oresol treatment)
Family Planning (Named at least one method)
606620
7610
42
12
64
64
46
989866
94867672
80
96
90
90
Child Health Knowledge of Mothers (n=50)
Results of the Evaluation
Child Health Practices Pre-(%)
Post-(%)
Infant NutritionOn breastfeeding within 30 minutes after birthPeriod of exclusive breastfeeding (6 months)
Child ImmunizationBCG (Tuberculosis)DPT (Tetanus) X 3 shotsOPV (Polio) X 3 shotsAMV (Measles)
Treatment of diarrhea (Oresol treatment)
Family Planning PillsCondomInjection
640
6200
6
62
2
9068
38323430
66
24814
Child Health Practices of Mothers (n=50)
Results of the Evaluation
Reading the MCH Handbook No. (%)
ReadingRead the whole bookRead parts of the bookNever read the book
Completing the handbookCompletedCompleted some partsLost handbook
Bring during consultationAlwaysSometimes NeverLost
29165
4073
828113
583210
80146
1656226
Utilization of the MCH Handbook (n=50)
Results of the Evaluation
Information Useful Somewhat useful
Not so useful
Didn’t read
Pregnancy and antenatal
Childbirth and postnatal
Family planning
Newborn care
Immunization
Nutrition
Growth Monitoring
Endemic diseases
44 (88)
43 (86)
43 (86)
43 (86)
43 (86)
43 (86)
43 (86)
43 (86)
3 (6)
3 (6)
4 (8)
3 (6)
3 (6)
3 (6)
3 (6)
3 (6)
1 (2)
1 (2)
1 (2)
1 (2)
1 (2)
1 (2)
1 (2)
3 (6)
3 (6)
3(6)
3 (6)
3 (6)
3 (6)
3 (6)
3 (6)
Useful information in the MCH Handbook (n=50)
Results of the Evaluation
Utilization of the MCH Handbook No. (%)
Reader other than the motherHusbandElder offspringNone
Over-all impression/satisfactionSatisfiedModerately satisfiedMissing
Over-all impression on improving healthSatisfiedModerately satisfiedMissing
4029
4613
4613
802
18
9226
9226
Utilization of the MCH Handbook (n=50)
Discussion
Maternal Health Knowledge Pre Post p-value *Remark
First trimester prenatal care consultation
Antenatal visits should be 4 or more
Pregnancy risk factors
Tetanus toxoid vaccination
13 (20)
19 (38)
5 (10)
36 (72)
37 (74)
29 (58)
42 (84)
46 (92)
0.0001
0.0213
0.0001
0.0020
Significant
Significant
Significant
Significant
Maternal Health Practice Pre Post p-value *Remark
Antenatal Care ConsultationFirst trimester prenatal care consultation
6 (12) 12 (24) 0.0312 Significant
*Note: If p-value is less than alpha or level of significance (usually =0.05) then reject Ho (null hypothesis and conclude the alternative hypothesis)
Discussion
Utilization of the MCH Handbook
•Most mothers have read and completed the handbook provided by the midwife. Those who lost the handbook however didn’t bother asking for another copy from the midwife.
•Majority of the mothers find the handbook informative and useful. They are also quite satisfied with the way the MCH handbook was designed for them.
MCH Handbook in the Philippines
•It should be responsive of the population and not the other way around; adapting to the needs of its clients.
•Prior to the introduction of the handbook, health care providers must be able to meet the minimum level of MCH needs in the community.
•It is necessary for local units to make MCH services readily available for mothers and children in the community.
•Policies directed at implementing the MCH handbook system are instrumental in institutionalizing the program.
•Sustainability activities should be planned and implemented in securing the program.
•The people’s pride in the program should be heightened to create the sense of ownership.
Maraming Salamat Po!