1 Maternal, Neonatal and Child Health Background in the World - - PowerPoint PPT Presentation

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1 maternal neonatal and child health background in the
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1 Maternal, Neonatal and Child Health Background in the World - - PowerPoint PPT Presentation

Jun 21, 2023 475 likes •707 views

1 Maternal, Neonatal and Child Health Background in the World Globally 289,000 women died due to complications of pregnancy and child birth in 2013 - 99% of maternal death occurred in MLIC countries 6.6 million children under five

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Maternal, Neonatal and Child Health Background in the World

Ghana EMBRACE Implementation Research

  • Globally 289,000 women died due to complications of pregnancy

and child birth in 2013

  • 99% of maternal death occurred in MLIC countries
  • 6.6 million children under five died worldwide in 2012
  • 80% of under five deaths occurred within 48h postpartum
  • MDG4 (reduce child mortality)
  • two-third MDG target countries are unlikely to achieve MDG4
  • MDG5 (improve maternal health)
  • AARD* is far below the needed (5.5%)

(WHO data in 2013) *AARD: average annual rate of decline

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What is the Ghana EMBRACE Implementation Research?

Ghana EMBRACE Implementation Research

Ensure Mothers and Babies Regular Access to Care

In 2012, Japanese government in conjunction with Ghanaian government launched the Ghana EMBRACE Implementation Research Aims

  • To develop a pathway to create feasible and sustainable

packages of interventions to improve MNCH outcomes and to test such packages in rural settings

  • To disseminate the findings and lessons learnt to the

wider global health community

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Continuum of Care (CoC)

CoC definition in MNCH

  • often explained by the time and space dimensions
  • up to 67% of newborn deaths could be prevented by improving

CoC

Ghana EMBRACE Implementation Research

(Haggerty 2003, Kerber 2007, Darmstadt 2005)

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  • ANC for 4 times
  • Delivery assisted by skilled birth attendants
  • PNC within 48h, at 7days, at 6weeks
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Navrongo HDSS site Kintampo HDSS site Dodowa HDSS site

Study Sites in Ghana

(Health and demographic surveillance system: HDSS)

Ghana EMBRACE Implementation Research

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANC +4 Facility delivery PNC 48h PNC 2wks PNC 6wks CoC completed Kintampo Navrongo Dodowa

Coverage of CoC related service indicators

Ghana EMBRACE Implementation Research

8.0%

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Low coverage of first PNC

N=1,500

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Findings from CoC Situation Analysis

Ghana EMBRACE Implementation Research

Factors negatively associated with CoC

  • Low mothers’ education
  • Low partners’ education
  • Multi parity
  • Non married status
  • Lack of family support
  • Long travel time to

facility Promoters for CoC

  • Easy access to facility
  • Availability of

professionals & equipments to manage complications

  • Positive attitudes of

HWs Barriers to CoC ANC/Facility Delivery/PNC

  • Financial difficulties
  • Long distance& bad

roads

  • Attitudes of HWs
  • Local beliefs
  • Lack of preparedness
  • Ignorance
  • Perception of being well

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Retrospective survey Focus group discussion

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EMBRACE Intervention Package

Ghana EMBRACE Implementation Research

24h retention at facility after delivery Home visit PNC CoC orientation for HWs

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Utilization of CoC Card

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Continuum of Care Card

Ghana EMBRACE Implementation Research 9

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Ghana EMBRACE Implementation Research 10

(Oct. 2014~ Sep. 2015)

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933 915 1045 2893 338 470 598 1406 395 609 506 1510 Dodowa Kintampo Navrongo Total

Oct. Nov Dec

  • Very high potential of adoptability
  • 5,809 CoC cards were distributed

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Initial Report of Intervention

(Oct.~Dec. 2014)

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  • Approx. 600 women stayed at health facility for 24 hrs.

postpartum and all received PNC within 48 hrs.

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Navrongo

229 210 187 191 30 14 20 21 16 Oct Nov Dec Retention Facility visit Home visit

B-1 coverage is high!

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Kintampo

26 19 44 27 61 68 66 37 Oct Nov Dec Retention Facility visit Home visit

Effect of B-2

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Missing data

  • Home visit PNC has been favorably received, where

women have custom to stay home for 6 weeks postpartum

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Dodowa

20 28 106 27 168 53 9 37 23 Oct Nov Dec Retention Facility visit Home visit 24hrs retention↑ Facility PNC and Home PNC↑

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“ When I properly follow w the Co CoC card and do good behavior,

  • r, I can get a

gold ld star” “I want to get all gold stars “

Understanding CoC

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“Using the Co CoC card, d, we we can now w spend quality ty time

  • n each mother.”

Quality works

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“Usually, women do not want to stay at facility after delivery. But looking at the CoC card, they understand that they should stay”

Useful tool to convince mothers

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Beyond the cultural barrier

“Traditionally, women of this region do not go out for 40 days after delivery. So, it is really good to visit their home and see if mother and baby are fine. They seem very happy.”

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“By home visit, many neonatal sepsis cases were found. It’s due to bad umbilical cord cutting practices, like use of salty sand and toothpaste”

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Discovering problems earlier

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“ Yesterday, I atten tende ded a de delivery.

  • ery. In the

evening, g, I found d the baby had 38.6℃, , so I referred.” “Now, I know how w importa rtant nt 24-hour

  • ur

retention is.”

Importance of 24h retention

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Study Protocol Registration & Publication

Ghana EMBRACE Implementation Research 21 RCT registration: ISRCTN90618993 http://www.isrctn.com/ISRCTN90618993 Trials 2015; 16: 22. Published online 2015 Jan 27. DOI 10.1186/s13063-014-0539-3

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