Effect of a maternal and child health handbook on maternal knowledge and behavior a community-based controlled trial in rural Cambodia

Transcription

1 The 10th International Conference on MCH Handbook Effect of a maternal and child health handbook on maternal knowledge and behavior a community-based controlled trial in rural Cambodia Satoko Yanagisawa Aichi Prefectural University)

2 Basic Indicators of Cambodia Indicators Population 13,441,000 15,578,000 GNI per capita (USD) 270 1,020 Life expectancy at birth Total adult literacy rate (%) Infant mortality rate (per 1000) Under five mortality rate (per 1000) Underweight (moderate-severe) (%) Maternal mortality rate (per 100,000) Skilled attendant at birth (%) UNICEF. The State of The World s Children 2002 & 2016.

3 Why MCH handbook? Perinatal period is the time when the most mothers and children die. Yet, perinatal period is the time when the least information available. Antenatal care 4+ Skilled attendant at birth Home delivery Urban 85.3% Rural 73.9% Urban 97.8% Rural 87.6% Urban 5.9% Rural 18.7% Cambodia Demographic and Health Survey 2014.

4 Why MCH handbook? Each sector develops its own recording system resulting in various kinds of records mothers have to manage. The lack of record integration makes a information gap among services. MCH Handbook bridges the gap.

5 Objectives 1. Develop Cambodian version of MCH handbook. 2. Conduct pilot implementation in selected areas. 3. Evaluate the impact of the MCH handbook on maternal knowledge and behavior.

6 Study Site: Kampong Cham Province Ponhea-Krek-Dombae (PKD) Population: Referral hospital: 1 Health Centers: 16 Memut Population: Referral hospital: 1 Health Centers: 10

7 Development of MCH Handbook Develop MCH Handbook and operating system Test the cultural appropriateness Revise the handbook Indicators for evaluation Study site selection Introduction of the handbook 4 health centers Intervention 2 MCH handbook Control 2 Child Growth Card Mother Health Record Baseline survey Implementation Post intervention survey

8 Development of Cambodian MCH Handbook First version Second version Final version Concept construction Khmer test version Revised version for intervention Test cultural appropriateness Interviews & FGDs Mothers(Khmer, Cham) Nurses & midwives

9 Study Design Mixed method: quantitative + qualitative Quantitative study Pre- and post-intervention surveys Women given birth 1 year before the surveys Two-stage cluster sampling Intervention pre 320 post 320 Control pre 320 post 320 Key Indicators Antenatal care (ANC) attendance Delivery with skilled birth attendants (SBA) Delivery at a health facility

10 Study Design Qualitative study Individual interviews Multiparous who had used both the MCH handbook & standard Child Growth Card/ Mother Health Record Health center nurses & midwives Village Health Volunteers (VHVs) & Traditional Birth Attendants (TBAs)

11 Frequency of ANC At least once 4 times or more (%) Intervention Control (%) * Intervention Control Pre Post Pre Post

12 Delivery with SBA (%) ** Intervention Pre Post Control

13 Delivery at Health Facilities ** ** (%) Intervention Pre Post Control

14 Maternal knowledge: Danger signs Knowledge items Danger signs during pregnancy Pre-post increase (%) Intervention(I) Control(C) Effect (I-C) Swelling Persistent vomiting Bleeding from vagina Premature rapture of membrane Danger signs during delivery Prolonged labor Severe bleeding after birth Malpresentation Placenta accreta Convulsion

15 Maternal knowledge: Prevention and childrearing Behavior items Pre-post increase (%) Intervention(I) Control(C) Effect (I-C) Know at least one method to prevent anemia Know at least one mode of transmission of intestinal parasites Know that HIV can be transmitted from mother to child Early breastfeeding

16 Advantages of the MCH handbook Mothers Health Staff Attractive appearance More health information with illustrations/pictures Illustrations/pictures convey messages to the illiterate Ease of storage/use because the records are combined Fewer chances of losing the handbook Durable Inclination to read the handbook/interest in the handbook Communication tool with husband Easy estimation of the expected date More frequent bringing of the handbook to ANC clinics Fewer instances of reissuing of the handbook Easy handling because the records are combines The handbook and health education by health staff had a combined effect Disadvantages of the MCH handbook Health staff Columns of the antenatal growth chart are too small More time required to fill the handbook The material of the cover page is difficult to write on Some contents are new, and health volunteers do not as yet understand them well. Some information is not updated

17 Advantages of MCH handbook to child growth card/mother health record MCH handbook positively influenced the promotion of ANC attendance, delivery with SBA and delivery at health facility. The MCH handbook was associated with increased health care knowledge in mothers. The qualitative data indicated that the handbook was well received and culturally appropriate. The handbook also served to facilitate communication between husbands and wives in terms of maternal health and family planning.

18 Conclusion Both the quantitative and qualitative analysis showed positive impact of the MCH handbook on maternal knowledge and behavior. Twenty years have passed since the first home-based maternal record was introduced. Policy makers should consider more effective alternatives. The MCH handbook is a reasonable and superior alternative to current card-type maternal and child records.

19 Memorial to Mr. Hang Vuthy