Maternal Health

A situational analysis of positive post-natal experience in two districts in Haryana

A situational analysis of positive post-natal experience in two districts in Haryana

The postnatal period begins immediately after the birth of the baby and extends up to six weeks (42 days) after birth. It is critically important for the survival of the mother and the baby. It also determines the future growth and development of the baby and the health of the mother. World Health Organization (WHO) had developed guidelines on post-natal care for mothers and newborns in 2013 with the intention to assist policy makers, program managers, educators, and providers involved in caring for women and newborn after birth. Keeping this in mind, a situational analysis was done during 1st July, 2019 to 30th November, 2019 on positive postnatal experience in two districts of Haryana.

Objectives of the study were to assess the post-natal services used and source (s) of service utilization by the clients, to document the experience of post-natal care in facilities (private and government) and at home - with a focus on crowding, respect and dignity, emotional support and counselling and to assess the socio economic profile, family support, physical health of the mother and the newborn and maternal mental health.

Assessment tool was developed after in-house discussions. It was revised thrice as per the feedback received from the discussions. The assessment tool was divided into 6 sections i.e. Socio-demographic profile of the client, Delivery details and dates of contact with health care providers, Discharge advise in case of institutional delivery, Experience of follow up visit in the facility, Details of home visit by provider and Knowledge assessment of post natal women. Additionally, Edinburg Postnatal Depression Scale (EDPS) was used to assess the mental health of the mother. One day training was provided to 4 field investigators, one social scientist and one computer assistant on case selection and interview technique by the principal investigator and the project coordinator. They also explained each and every question of the protocol. Field investigators took the help of ASHA to identify the case in the village. A total of 531 cases were included in the study. Data thus, collected was entered into excel sheet and was analyse with the help o SPSS.

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Assessment of use of Antenatal Corticosteroids and National Operational Guidelines in Haryana State, India.

Assessment of use of Antenatal Corticosteroids and National Operational Guidelines in Haryana State, India.

Preterm babies are defined as babies who are born before 37 weeks of gestation. The World Health Organization (WHO) has classified preterm birth into three categories based on completed gestation period: extremely preterm (less than 28 weeks), very preterm (28 to 32 weeks), and moderate to later preterm (32 to 37 weeks). Premature birth is a leading cause of death among children under the age of 5 years. It is estimated that nearly 14% of 26 million annual live births in India are born preterm. Of these 3.5 million babies born preterm, nearly 10% die due to complications of preterm birth. Many survivors live with learning disabilities and hearing and vision problems. The use of antenatal corticosteroids (ACS) can help reduce preterm deaths of newborns by more than 30%. The timely use of ACS is recommended for the management of preterm labour from 24 weeks to 34 weeks of gestation under specific conditions. WHO therefore strongly recommends ACS use when the following conditions can be met: accurate assessment of gestational age, preterm birth is considered imminent within 7days, no clinical evidence of maternal infection, availability of adequate childbirth care and adequate preterm newborn care. The WHO recommendations are based on current available evidence to operationalize safe and effective ACS use at delivery points, with an emphasis on quality of care.

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A Situational analysis on positive pregnancy experience during antenatal period in 2 districts in Haryana India

WHO revised the recommendations on antenatal care in 2016 and its aim was to provide a positive pregnancy experience to the pregnant women with the intention of reducing perinatal mortality. Keeping this in mind, a situational analysis was done during 1st September 2018 to 28th February 2019 on positive pregnancy experience during antenatal period in two districts of Haryana, India.

The objectives were to assess the antenatal services used by the pregnant women and source of service utilization by the clients, to document the experience of antenatal care in private as well as government facilities with a focus on crowding, respect and dignity, emotional support and counselling and to assess the socio economic profile including use of social endowments included in the government programs, family support, maternal mental health and well being, parenting capacity and safe water sanitation and environment.

A total of 900 pregnant women were covered in two districts namely Yamuna Nagar and Ambala in Haryana state, India. The investigation was done on phone as well on site in the field. SWACH is implementing a project on strengthening of home based postnatal care. Under this project, all pregnancies are reported by ASHAs to SWACH staff on a daily basis. The investigators short listed those pregnant women who were between 24-30 weeks of pregnancy for phone investigation and repeated follow-ups were done after an interval of 4-6 weeks. The consent was taken prior to the investigation. On site visit was made only once in the field between 30-40 weeks since follow ups in on site investigation was logistically a problem. Guidelines and formats were developed and field tested. The same protocol was used to investigate the up to date coverage of pregnancy care. Tools to assess the mental health of the pregnant women, use of social entitlements by the family, water and sanitation, parenting capacity and family support were used during on site investigation in the field.

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Community Mobilization for safe motherhood in district Karnal, Haryana

The Government of India is implementing the Reproductive and Child Health (RCH)-II program to reduce maternal and neonatal mortality and increase access to contraception. The White Ribbon Alliance of India has helped in developing guidelines for skilled birth attendants (SBA), allowing Auxiliary Nurse Midwives (ANMs) and Lady Health Visitors (LHVs) to assist during delivery and provide emergency care. CEDPA, India is working with state governments in Gujarat, Haryana and Uttarakhand to pilot the feasibility of implementation of these guidelines and increase community awareness about birth preparedness and complication readiness. Current study was conducted in 2 blocks i.e. Nilokheri (well performing with good health infrastructure and staff in position) and Indri (poorly performing) of district Karnal, Haryana from June, 2008 to November, 2009. The study included training of SBAs and building awareness in the communities for birth preparedness and complication readiness.

Objectives of the study were to develop a midwifery focused model of maternal care and to test feasibility of new guidelines for ANMs for skilled birth attendance/ emergency obstetric care, to develop suitable management models to monitor the new interventions and to create awareness in the community about birth preparedness and complication readiness.

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Global Maternal Sepsis Study (GLOSS)

A review of the global maternal sepsis study protocol was done. The study was conducted in partnership with the State Institute of Health and family Welfare (SIHFW), Haryana and Post Graduate Institute of Medical education and Research (PGI) Chandigarh under a memorandum of understanding with PGIMER.

Identification of study districts and institutions

Identification of study districts and institutions was done in a meeting held with partners. Two districts (Panchkula and Ambala), where deliveries take place and the number of cases of maternal sepsis and infections that are likely to be seen during one week of the study, were selected. There are 169 healthcare facilities in the two districts, with 49 facilities providing maternity care. There are 11 intensive care units, however, the serious maternity cases are referred to only 2 hospitals in the government sector. Private hospitals and nursing homes handle over 50% of deliveries. Based on available data, it was found that 35% of deliveries occur at district and sub-district hospitals, 10% at health centres, and 5% at tertiary institutions in the government sector. Six institutions from government hospitals in the two districts were selected for the study, while smaller health centres were excluded due to logistical challenges. The two tertiary institutions where seriously ill cases are referred (i.e. PGI and Government Medical College and Hospital Chandigarh), were also included. The selection of the two districts was based on geographical proximity, familiarity, and working relationships. The population, estimated number of live births, and live births in the selected hospitals were communicated to GLOSS for approval. The challenge was that most women in tertiary centres come from Chandigarh, Punjab, Haryana, Himachal Pradesh and other neighboring states, but plans were made to accurately include them in order to capture cases of maternal sepsis. Even though these are referral institutions the identification of women from these districts was relatively easy since there is an operational electronic registration system in these two hospitals that identifies the residential address of the clients.

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A study on maternal mortality in selected districts of Punjab and Madhya Pradesh

Background

Approximately 1 million women worldwide die annually due to pregnancy and childbirth-related causes, primarily occurring in developing countries. The risk of maternal mortality in developing countries is significantly higher compared to developed countries, with rates up to 100 times greater. Maternal Mortality Rates (MMRs) in India have varied widely across studies and locations. A longitudinal morbidity survey in Baskripal Nagar, Rajasthan, reported an MMR of 592/100,000 live births, while a risk approach study in rural Maharashtra showed an MMR of 253/100,000. A case-control study in Anantapur, Andhra Pradesh, found an MMR of 545 in urban areas and 830 in rural areas, with an overall rate of 798/100,000. A multi-centre study by the Indian Council of Medical Research (ICMR) reported MMRs ranging from 55 to 3245/100,000 live births in different hospitals across India. These variations may be due to factors such as the type of healthcare facility, the population served, and the availability of resources.

With an aim to determine the causes of maternal mortality, a community-based study was conducted in six districts of Punjab and Madhya Pradesh to between September 1994 to April 1995. The study highlights the processes involved in determining the outcome of maternal deaths and the importance of considering socio-cultural and behavioural factors in addition to biological causes.

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Management of High Risk Pregnancy (HRP)

Whereas most women enjoy healthy experience of pregnancy and childbirth, a proportion of women may experience complicated or high risk pregnancies (HRP). These HRP Conditions can occur anytime during the whole course of the pregnancy and childbirth and can contribute to deaths and adverse outcomes. A project entitled “Improving the management of high risk pregnant women in a district in Haryana, India” was undertaken in district Ambala with support from state National Health Mission and World Health Organization. The goal was timely recognition, appropriate referral, completion of appropriate treatment and resolution of high risk pregnancy to reduce adverse foeto-maternal outcomes.

Objectives of the project were:

  • Identification of appropriate pathways in management of selected high risk conditions in pregnancy that contribute to adverse foeto-maternal outcomes.
  • Recognition of modifiable barriers to implementation and how to overcome these barriers.
  • Assessment of district hospital for their readiness to provide appropriate services to the patients referred.
  • Appropriate management of high risk pregnant women through iterative engagement of NHM and district health system.
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Develop and field test a package of audio recordings for pregnant women as per WHO (2016) guidelines

Pregnancy is a period when a woman requires antenatal care by a skilled healthcare provider in order to ensure the optimum health status for both mother and baby. WHO revised the recommendations on antenatal care in 2016. The overarching aim of the 2016 WHO ANC model is to provide a positive pregnancy experience (PPE) to the pregnant women with the intention of reducing perinatal mortality.

Swach did a situational analysis on positive pregnancy experience (PPE) during the antenatal period in two districts of Haryana, India. The findings of the study showed that less than 50% of the families had smart phone. Antenatal visits were made by the pregnant women and more than 50% of the beneficiaries met WHO standard of minimum 8 antenatal visits. The coverage of ultrasound was good. The clients were not satisfied with the short interaction done by the provider. More than 21% of the pregnant women were depressed as per EDPS scale. In addition, nearly 35% of the woman had varying degree of anxiety. when asked 90% 'of the women were willing to become a member of a participatory learning group.

Implementation Question

Is it feasible to develop and test a learning package to promote positive pregnancy experience (PPE) through participatory learning for action (PLA) groups.

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