mira nepal presentation
DESCRIPTION
presented in Delhi conferenceTRANSCRIPT
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Importance of social and behavior change in improving child survival
Impact of Participatory women’s groups on maternal and neonatal
health: Experience from Nepal
JR Shrestha MPHResearch Program Coordinator
Mother and Infant Research Activities (MIRA)
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Supply Demand
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Improving the Demand Side• Bringing awareness in the family – avoiding harmful
practices and promoting good practices, promoting delivery by a SBA or in a health facility
• Recognising danger signs and seeking help from health workers or at appropriate health facilities
• Developing strategies in the community to manage the problems
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Impact of Health Education
The effects of postnatalhealth education formothers on infant careand family planningpractices in Nepal: arandomised controlledTrialShowed no effects after 6months of standard healtheducation
· Bolam et al BMJ, 1998
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How to change behaviour?
• Telling people what to do? NO
• Communication for social change: dialogue not monologue
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MIRA MakwanpurMother and Newborn Care Study- a cluster randomised trial using participatory women’s groups
implemented in collaboration with the Institute of Child Health, London
One of the largest such studies in the world involving 30,000 married
women of reproductive age in 24 V.D.Cs of Makwanpur district
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Two strategies
Facilitationa participatory community
action cyclein the intervention area
Health service strengtheningin both control and intervention areas
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Trial design24 clusters
in 12 matched pairs1600 sq km
population 170,000
Surveillance of pregnancies28,931 women
Supply sideHealth service activities
12 intervention clustersDemand side
Women’s groups
12 control clusters
No women’s groups
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Neonatal mortality rate
Stillbirth rate
Maternal mortality ratio
Home care practices
Health care seeking
Primary outcome
Secondary outcomes
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The intervention1 local woman facilitator per clusterNot a health worker7000 population, 60 sq km9 monthly women’s groupsOnly 8% coverage of MWRA
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The participatory action cycle
Problem Identification
Planning together
Implementation
Participatory evaluation
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Why mothers and newborns die
How women approach maternal and neonatal issues
Common local maternal and neonatal problems
Strategies to gather information in the community
The first ten meetings
Information sharing
Strategies to address these problems
Wider presentation of problems and strategiesAdoption of community strategies
Identification of key problems
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Problem Identification
Planning together
Implementation
Participatory evaluation
Developing strategies
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Health Service Strengthening in both study areas
Training of the health staff
and TBAs and FCHVs
Supply
•Some essential equipment
• Some essential drugs
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30% reduction in neonatal mortality!Major impact on maternal mortality!
Lancet 2005
How do the groups work?
SDK Hand washing Family support
Postnatal care Use of Nets Funds Breastfeeding
Communication Solidarity
EmpowermentCritical consciousnessDecision-making Political action 17
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Cost Effectiveness• The average provider cost of the women's group
intervention was USD 0.75 dollars per person per year (0.90 dollars with health-service strengthening) in a population of 86,704.
• The incremental cost per life-year saved (LYS) was 211 dollars
• Expansion could rationalize on start-up costs and technical assistance, reducing the cost per LYS to 138 dollars .
• Sensitivity analysis showed a variation from 83 dollars to 263 dollars per LYS for most variables.
• This intervention could provide a cost-effective way of reducing neonatal deaths.
BorgJoJhi et al Lancet 2005
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Expansion of the Trial
Similar intervention trials with some localmodifications have been undertaken in :• Rest of Makwanpur district• Dhanusha in Nepal• Mumbai and Jharkhand in India• Bangladesh • MalawiResults from other studies also showed positive effect on reduction of neonatal mortality particularly from Ek Jut trial Recently a systematic review and meta analysis of participatory women’s groups on maternal and neonatal mortality has been submitted to the Lancet
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Conclusions & Recommendations
• Participatory women’s groups have been found to be effective in reducing NMR and (MMR) and thus helping Child survival.
• This method has been found successful in high mortality situations in rural areas and but not that effective in high institutional delivery areas with low mortality rates .
• For effectiveness of this process, a facilitator should be available for about 800 population
• This strategy should be scaled up in above situations
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