a community-based maternity care program improves utilization of antenatal care and referral...
Post on 01-Apr-2015
217 Views
Preview:
TRANSCRIPT
A COMMUNITY-BASED MATERNITY CARE PROGRAM IMPROVES UTILIZATION OF ANTENATAL CARE AND REFERRAL OBSTETRIC SERVICES IN KONO DISTRICT, SIERRA LEONE: 12-MONTH OUTCOMES
M. Bailor Barrie, M.B.Ch.B.,1 J. Daniel Kelly, M.D.1,2
1 Wellbody Alliance, Koidu Town, Sierra Leone2 Baylor College of Medicine, Houston, TX, USA
Background
Why maternal deaths? Utilization of services Emergent obstetric services
Drop-offs in ANC visits Home-based deliveries Lack of referral system
Program Goal
Implement a community-based program designed to increase utilization of maternal health services.
Support PHUs Strengthen the
referral system Support Koidu
Government Hospital
Prior experience in community-based program implementation
Adapted our model to maternal health
In Kono District, we work in partnership with the Ministry of Health and Sanitation
Methods
In August 2011, WA trained 45 former traditional birth attendants and traditional health care providers to serve as community health workers.
WA launched its maternal mortality reduction program in September 2011 at three peripheral health clinics in Kono District, Sierra Leone.
They received monthly incentives for accompanying pregnant women to the clinic for their antenatal (ANC) care, delivery, and postnatal care, tracing those who missed appointments, referring women with pregnancy-related complications to the clinic, and educating them about the value of facility-based care.
Methods
Clinic staff performed deliveries and decided when to refer women with pregnancy-related complications from the clinic to the district hospital.
We analyzed data routinely collected from ANC and delivery registers to compare service utilization 12-months before and 12-months after implementation of the program.
Results
The average number of first and fourth ANC visits increased from 48.3 to 56.9 per month and from 22.5 to 30.7 per month, respectively.
*statistically significant
1st ANC visit 4th ANC visit
Facility 2010-11 2011-12 2010-112011-
12 Manjama 183 181 141 184 Small Sefadu 142 121 84 97 Koeyer* 255 381* 45 87* Total 580 683 270 368
Our program demonstrated higher rates of women being initiated and retained in antenatal care.
Conclusion
Results
During the first year of the program, 83 women with complications were successfully referred to the district hospital compared to 27 in the preceding year.
Emergent caesarean sections decreased from 11 to 8.
No maternal deaths occurred among the women served by the program.
Referral rates to the hospital dramatically improved.
Conclusion
Results
Facility-based deliveries increased on average from 27.4 to 31.5 per month.
*statistically significant
Facility-based deliveries PHUs 2010-11 2011-12 Manjama 107 105 Small Sefadu 102 82 Koeyer* 120 191 Total 329 378
Home-based deliveries remain a common practice, and further studies need to develop an intervention that de-incentivizes them.
Conclusion
Limitations
Quality of facility-based care Strength of overall health system and
referral services Cultural barriers of home-based
deliveries Supervisor system of community-based
program Variable performance of facilities
Story of Edna
Further investigations need to be conducted to fully understand the reasons for Koeyer’s success
Why was Koeyer successful?
Way forward
Strengthening of facility-based care Essential to the development of a community-based
program Accompaniment of family members to initial ANC
visit to discuss value of facility-based delivery Incentive packages for mother and child if facility-
based delivery occurs Expansion of emergent obstetric referral services Restructuring of supervision system Integration of community health work
top related