end-line assessment on knowledge, attitude, practices and … · 2019-07-09 · end-line assessment...

End-line assessment on

“Knowledge, attitude, practices and coverage of

maternal, newborn and child health care at selected townships

in Southern Chin State”

Myo Myo Mon1, Kyaw Min Htut1, Aung Ye Naung Win1,

Khin Zaw2, Myo Win Tin2, Nyi Nyi Zayar1, Phyo Aung Naing1

January 2018

Table of Contents

List of Tables .......................................................................................................................... 4

List of Figures ........................................................................................................................ 5

Abbreviations ........................................................................................................................ 6

List of investigators ............................................................................................................... 7

Executive Summary ............................................................................................................... 8

1. Introduction .................................................................................................................... 10

2. Objectives ........................................................................................................................ 11

3. Methodology ................................................................................................................... 11

3.1. Study design and study population .......................................................................... 11

3.2 Sample size and sampling ......................................................................................... 12

3.3 Data collection .......................................................................................................... 13

3.4 Data management and analysis ................................................................................ 13

3.5 Ethical consideration ................................................................................................. 13

3.6 Limitations of the study ............................................................................................ 13

4. Findings ........................................................................................................................... 14

4.1 Background characteristics of the participants ........................................................ 14

4.2 Antenatal care ........................................................................................................... 14

4.2.1 Knowledge of mothers on antenatal care ......................................................... 14

4.2.2 Attitude of mothers towards antenatal care ..................................................... 16

4.2.3 Antenatal care practice of mothers ................................................................... 16

4.3 Consequences of pregnancy ..................................................................................... 18

4.3.1 Knowledge on consequences of pregnancy....................................................... 18

4.4 Birth preparedness .................................................................................................... 19

4.4.1 Knowledge of mothers on birth preparedness .................................................. 19

4.4.2 Birth preparedness among mothers .................................................................. 20

4.5 Intra-partum care ...................................................................................................... 20

4.5.1 Knowledge of mothers on intra-partum care .................................................... 20

4.5.2 Attitude towards intra-partum care and delivery practice of mothers ............. 21

4.6 Newborn care ............................................................................................................ 22

4.6.1 Knowledge of mothers on newborn care .......................................................... 22

4.6.2 Newborn care practices of mothers .................................................................. 23

4.7 Postpartum care ........................................................................................................ 24

4.7.1 Knowledge and attitude of mothers on postpartum care ................................. 24

4.7.2 Postpartum care practice ................................................................................... 25

4.8 Contraception............................................................................................................ 25

4.8.1 Knowledge of mothers on contraception .......................................................... 25

4.8.2 Contraceptive practice ....................................................................................... 27

4.9 Child health care and coverage ................................................................................. 27

4.9.1 Immunization coverage...................................................................................... 27

4.9.2 Childhood illness and health care seeking behavior .......................................... 28

4.9.3 Environmental health ......................................................................................... 28

4.9.4 Awareness on sustainable community network ................................................ 29

4.10 Providers’ perspective towards MNCH project ...................................................... 31

4.10.1 Scope and coverage of the project .................................................................. 31

4.10.2 Achievements of the project ............................................................................ 31

4.10.3 Challenges during implementation of the project ........................................... 33

4.10.4 Suggestions from the participants ................................................................... 33

5. Discussion and recommendations .................................................................................. 33

6. References ....................................................................................................................... 36

Annex .................................................................................................................................. 37

Map of Kanpetlet Township ............................................................................................ 37

Map of Paletwa Township............................................................................................... 38

Photos from Field Data Collection .................................................................................. 39

List of Tables

Table 1 Background characteristics of the participants ...................................................... 14

Table 2 Knowledge of mothers on antenatal care .............................................................. 15

Table 3 Antenatal care services received by mothers ........................................................ 17

Table 4 Practice of mothers regarding food intake and activity during pregnancy ........... 18

Table 5 Knowledge of mothers on danger signs during pregnancy.................................... 19

Table 6 Knowledge of mothers on birth preparedness ...................................................... 19

Table 7 Information on birth preparedness among mothers ............................................. 20

Table 8 Knowledge of mothers on intra-partum care ........................................................ 20

Table 9 Attitude towards intra-partum care and delivery practice of mothers ................. 21

Table 10 Knowledge of mothers on essential newborn care and infant feeding ............... 23

Table 11 Knowledge and attitude of mothers on postpartum care ................................... 24

Table 12 Postpartum care services received by mothers ................................................... 25

Table 13 Knowledge of mothers on contraception ............................................................ 26

Table 14 Contraceptive practice of mothers ...................................................................... 27

Table 15 Immunization practice of children ....................................................................... 28

Table 16 Feeding habit practiced by mothers during child’s illness ................................... 28

Table 17 Hygienic practice of mothers ............................................................................... 28

Table 18 Awareness of mothers on community network .................................................. 29

List of Figures

Figure 1 Knowledge of mothers on minimum number of AN care needed ....................... 15

Figure 2 Comparison of mothers’ responses on reason for AN care .................................. 16

Figure 3 Proportion of mothers who have positive attitude towards AN care at end-line 16

Figure 4 Comparison of AN care services received by mothers at baseline and end-line . 17

Figure 5 Delivery practice of mothers at end-line .............................................................. 22

Figure 6 Knowledge of mothers on danger signs of newborn at end-line ......................... 22

Figure 7 Essential newborn care practices of mothers at end-line .................................... 23

Figure 8 Awareness of mothers on presence of referral system at their villages .............. 30

Figure 9 VHC activities attended by mothers from end-line assessment ........................... 30

Abbreviations

AMW Auxiliary Midwives

AN Antenatal

BHS Basic Health Staff

CHW Community Health Worker

IDI In-depth Interview

IRC International Rescue Committee

KII Key Informant Interview

MNCH Maternal, newborn and child health

NGO Non-governmental Organization

VHC Village Health Committee

List of investigators

Investigators

1. Dr. Myo Myo Mon Deputy Director/Head, Epidemiology Research Division,

DMR

2. Dr. Kyaw Min Htut Research Officer, Epidemiology Research Division, DMR

3. Dr. Aung Ye Naung Win Research Officer, Epidemiology Research Division, DMR

4. Dr. Nyi Nyi Zayar Research Officer, Epidemiology Research Division, DMR

5. Dr. Phyo Aung Naing Research Officer, Epidemiology Research Division, DMR

Collaborators

1. Dr. Myo Win Tin Senior Health Coordinator, IRC

2. Dr. Khin Zaw Senior Monitoring & Evaluation Manager, IRC

Data Collection and Data Entry Team

1. Daw Zin Mar Aye Epidemiology Research Division, DMR

2. Daw Lwin Lwin Ni Epidemiology Research Division, DMR

3. U Aung Soe Min Epidemiology Research Division, DMR

4. Daw Ni Ni Htay Aung Epidemiology Research Division, DMR

Executive Summary

To tackle the Maternal, Newborn and Child Health (MNCH) care needs of communities,

International Rescue Committee (IRC) has designed a maternal and child health program

in partnership with Township Health Department and local non-governmental

organization. Strengthening local capacities to improve maternal, newborn and child

health was launched in 2010 across 100 villages in Southern Chin State up to 2013 by EC

fund. Starting from 2014, with support of 3 MDG fund, it was expanded to the whole

Paletwa and Kanpetlet Townships of Southern Chin State. A community-based, cross-

sectional end-line assessment was carried out to determine knowledge, perception and

practice in MNCH care after community intervention in Paletwa Township and Kanpetlet

Township in 2017, and compare with that of the baseline assessment which was conducted

in 2015.

A total of 291 mothers of under two year old children participated in the assessment. In

general, knowledge and practice of mothers regarding MNCH were improved including

antenatal, delivery, postnatal and newborn care. Specifically, 74% of mothers from end-

line received their first AN care within 1st trimester which was considerably higher than

that of baseline (38%). Significantly higher proportions of mothers from end-line

assessment received postpartum care services including newborn care (14.1% and 74.2%),

medical check-up (22.9% and 47.8%), wound care (2.4% and 46.4%) and health education

(6.8% and 32%) in comparing to baseline. More children from the end-line (>80%) received

immunization relevant to their age. In particular, among children over 2 months old, 82.2%

and 81.4% of children had received BCG and DPT respectively. Of children over one year

of age, 82.8% had already got measles immunization.

As part of community intervention, village health committees were strengthened to help

mothers for emergency referral, nutrition promotion, emergency fund raising and health

education. Volunteers from the project villages actively participated in all these activities

especially for detecting danger signs and referring the mothers to nearest health center.

About 78% of participants were aware of the presence of volunteers for supporting

mothers in their respective villages. Nearly 66% of mothers have received health education

from the volunteers. Over 64% of mothers knew the presence of referral system at their

villages.

Accountability, Equity, Inclusion (AEI) practice cycles were also carried out to enhance the

communication between community, local implementing partners and Basic Health Staff

(BHS). These cycles could identify the challenges and find the solutions for improving

MNCH care. During discussions with health care providers, responsible township health

officers acknowledged that there were significant improvement in immunization coverage

and increased referral from the villages because of community intervention.

A number of challenges in different stages of the project implementation were also

highlighted. Limited human resource in public sector, presence of restricted areas,

communication difficulty hindering the preparation of activities and language barriers

were the major challenges as identified by the local implementing partners.

In summary, areas of major improvement included mothers’ AN care practice & AN

services received, knowledge of mothers on newborn care and vaccination. Moderate

improvements were seen for knowledge of mothers on AN care, mother’s hygienic practice

and activities of village health committee. On the other hand, contraceptive practice of

mother showed slight improvement.

Following recommendations were made based on the findings from the assessment.

- Practical and sustained ways should be identified and implemented for maintaining

achievement in immunization coverage after the project ends.

- Ways and means for the sustainability of the village health committees and

volunteers should be considered as to maintain the achievements in MNCH care

after the project ends.

- Strengthening of the linkage between BHS and VHC is also recommended.

1. Introduction

Under 3MDG’s (3 Millennium Development Goals) activities, maternal, newborn and child

health (MNCH) is the largest component covering maternal and newborn health, child

health, immunization, nutrition and health promotion. Since the establishment of fund in

2012, the focus of investment was to support township health planning and service

delivery aiming to scale-up and strengthen access to health services. A strategy applying a

continuum of care approach was used to deliver an essential package of MNCH services.

Working in partnership with State and Region Health Departments under the Ministry of

Health and Sports, 3MDG is supporting the work of basic health staff (BHS). Besides

support to facility-based healthcare services, the fund is also providing significant financing

for community-based work as well as service provision through the private sector. There

were evidences from economic modeling and early design work undertaken by the Fund

which demonstrated that support to all these aspects of the health sector is critical to

reach the targets. Therefore, in areas where this approach to MNCH is supported, the fund

provides financing support to the public sector, to international and local non-

governmental organizations (NGOs) and to health care providers who use a social

franchising approach.

To tackle the MCH care needs of communities, IRC has designed a maternal and child

health program in partnership with Township Health Department and local NGO. The

program has supported for the strengthening of community health care network and

maternal and child health care services through community participation. In selected

townships of Chin State (Kanpetlet and Paletwa), awareness raising sessions to sensitize

the community on the benefits of safeguarding dedicated resource for MNCH are carried

out for a couple of years. Community Health Workers (CHW) and Auxiliary Midwives

(AMW) are the responsible decision-makers for identifying the need for an emergency

referral, with the exception of villages where there is a health facility in which case

responsibility belongs to Basic Health Staff (BHS).

Strengthening local capacities to improve MNCH was launched in 2010 across 100 villages

in Southern Chin State up to 2013 by EC fund. Starting from 2014, with support of 3 MDG

fund, it was expanded to the whole townships of Paletwa and Kanpetlet in Southern Chin

State. Project interventions were supporting BHS for MNCH activities, training of CHWs,

AMWs and VHC for raising awareness of community and emergency referral. The project

trained CHWs, AMWs and VHCs to implement community health prevention and

behaviour change communication (BCC) activities in collaboration with BHS. More mothers

in targeted villages are able to identify warning signs of childhood diseases and as a result

seek more timely care for their children from trained health care providers (mainly CHW).

Women’s behaviour concerning pregnancy and child care is strongly influenced by cultural

and religious beliefs, which are inherently difficult to transform within a short period of

time and require longer durations of programming. Strong geographic, cultural and social

constraints, in addition to the scarcity of health care service providers in Paletwa,

illuminate the importance of developing a “close to client health care system” and

“community based health care network”.1

Previous community intervention studies have documented the successful application of

various strategies including BCC in promoting maternal, newborn and child health care.2-6

The BCC strategy have been used to implement advocacy, communication and social

mobilization activities in order to increase knowledge and utilization of health services for

improved maternal and child health outcomes of the target population. According to the

project design, MW and supportive staff have to conduct individual support supervision

visits to each village, focusing on improving service delivery of community case

management, rational use of drugs, early detection and timely referral of MCH cases,

health education, community mobilization for health promotion, reporting, recording, and

diseases surveillance. CHWs/AMWs are expected to participate in MW outreach and

health education actions as part of hands-on training but also to provide opportunities for

strengthening the working relationship and linkages between CHWs, AMWs, VHCs and

MWs, and health facilities. Additional cluster visits are also planned to carry out by

supportive staff and BHS. BHS and IRC programme staff carried out continuous support

activities for CHW/AMWs, which foster sustainable capacity and improve the quality of

services. With the aim of determining progress of the project in the communities by

comparing with the baseline assessment,7 end-line assessment was carried out during

September and December 2017.

2. Objectives

1. To determine the knowledge, perception, attitudes and practice in MNCH care

after community intervention in Paletwa Township and Kanpetlet Township, Chin

State

2. To compare the knowledge, perception, attitudes and practice in MNCH care after

community intervention with the baseline characteristics in Paletwa Township and

Kanpetlet Township, Chin State

3. Methodology

3.1. Study design and study population

A community-based, post intervention assessment on knowledge, attitudes and practices

in MNCH care among mothers of under 2 years old children was conducted applying a

mixed-methods design at Southern Chin State during September-December 2017.

Inclusion criteria

Mothers of under 2 years old children who are staying at least 2 years at the study

township

Exclusion criteria

Mothers of under 2 years old children who are moving into the study township after the

child birth

3.2 Sample size and sampling

Sample size for the end-line assessment is calculated using the following formula:

N = D [Z (2P (1-P))1/2 + Z (P1 (1- P1) + P2 (1-P2)) 1/2] 2 / (P2– P1)2

where

N = required sample size

D = design effect

Z = the z-score for alpha error, corresponding to the probability with which it is desired

to be able to conclude that an observed change of size (P2-P1) would not have occurred

by chance;

Z = the z-score for beta error, corresponding to the degree of confidence with which it

is desired to certain of detecting a change of size (P2– P1), if one actually occurred.

P1 = the estimated proportion of the study population who have knowledge about

danger signs during pregnancy at the baseline assessment

P2 = the proportion of the study population who would have knowledge about danger

signs during pregnancy at the endline assessment such that the quantity (P2– P1) is the size

of the magnitude of change it is desired to be able to detect;

P = (P1+ P2) / 2

The proportion of mothers who have knowledge about danger signs during pregnancy

before the interventions, that is P1, is 0.5 according to baseline information and that

proportion would be expected to go up to 0.75 at least after the completion of the

intervention (that is P2=0.75). So if we take alpha error as 5% and beta error as 20%, Z

would turn out to be 1.96 and Z 0.84. Design effect was taken as 2 since cluster sampling

was used.

N = 2 [1.96 (2 x 0.6 (1-0.6)) 1/2 + 0.84 (0.5 x (1- 0.5) + 0.7(1-0.7)) ½]2/ (0.7- 0.5) 2

= 132

Adding non-response rate 10%, then

150 (each township)

Therefore, total sample size = 150 + 150 = 300

Cluster sampling was applied to recruit the adequate sample size. At each township, seven

villages were randomly chosen considering to include from different geographical areas

and after excluding the no-go zones and conflict areas. At each selected village, a total of

20-25 eligible participants were recruited.

Purposive sampling was applied for qualitative data collection. In each township, in-depth

interviews and key informant interviews were conducted with responsible service

providers from public sector as well as from IRC. Focus group discussions were also done

with mothers and informal group discussions were carried out with volunteers.

3.3 Data collection

Same structured questionnaire from baseline assessment was used after adding the new

questions regarding intervention activities. FGD guides and KII guides were revised

accordingly to explore the strengths, weaknesses and lessons learned during the

intervention period. Participants were interviewed by trained research assistants by using

a structured questionnaire.

3.4 Data management and analysis

EpiData version 3.1 and SPSS version 20 were used for data entry and data analysis.

Descriptive information were shown as frequency for categorical variables and

mean/median for continuous variables. Comparison of main outcome measures was done

using Chi square test or t-test as appropriate. Thematic analysis was applied for qualitative

information. Triangulation of the research results was done from both quantitative and

qualitative information to capture the comprehensive understanding of the program.

3.5 Ethical consideration

Verbal informed consent was taken from all the participants after thorough explanation

about the assessment. Anonymity and confidentiality of the information were ensured

using the code numbers and only investigators have accessed to the information.

3.6 Limitations of the study

There were certain limitations which should be acknowledged. First of all, at the time of

data collection, the survey team could not get access to many villages from very hard to

reach and conflict areas and we could not know the situation of mothers from these areas.

Therefore, findings from current assessment reflect only to the areas which are free from

these constraints. Secondly, there was a limitation in communication at some areas due to

language barrier though we were using translators for interviewing the participants.

4. Findings

4.1 Background characteristics of the participants

A total of 291 respondents participated in the end-line assessment. Socio-demographic

characteristics of the participants are presented in Table 1. Age of the mothers ranged

from 17 to 49 years with the mean age of (29.3±6.1 years and 29.1±6.7 years). Mean

number of children under 5 years old was 1.5 ± 0.7. Background characteristics of the

participants were not different between baseline and end-line.

Table 1 Background characteristics of the participants

Characteristics Baseline (n=405)

n (%)

End-line (n=291)

n (%)

Paletwa

(n=205)

Kanpetlet

(n=200)

Paletwa

(n=151)

Kanpetlet

(n=140)

Age of respondent

Mean ± SD

Range

28.4 ± 5.8

17-49

29.7 ± 6.5

17-47

29.3 ± 6.1

18-45

29.1 ± 6.7

17-49

Age of respondent

15-24

25 and above

58 (28.3)

147 (71.7)

47 (23.5)

153 (76.5)

37 (24.5)

114 (75.5)

40 (28.6)

100 (71.4)

Age of children (month)

Mean ± SD

Range

13.0 ± 7.5

-

12.8 ± 7.3

-

11.7 ± 6.5

1-26

14.7 ± 8.2

1-30

4.2 Antenatal care

4.2.1 Knowledge of mothers on antenatal care

Minimum number of AN care needed was stated as at least four times by 67.3% of mothers

from end-line which was significantly higher than that of baseline (44.9%) (Figure 1). Table

2 describes the knowledge of mothers on antenatal care. Participants mentioned that

mean gestation age at first booking was 10.6 ± 5.6 months. Much higher proportion of

mothers from end-line stated the reason for receiving AN care as “to know the position of

fetus” than baseline (32% and 68%). Immunization was also mentioned as one of the

reasons by 48.1% and 15% of mothers respectively. Most common source of information

was health staff in both assessments (51% and 77%).

Figure 1 Knowledge of mothers on minimum number of AN care needed

Table 2 Knowledge of mothers on antenatal care

Characteristics Baseline

n (%)

End-line

n(%)

Paletwa(n=205) Paletwa (n=151) Kanpetlet (n=140)

Reasons for AN care#

To detect danger signs

To know fetal position

To receive regular check up

To get treatment

To get safe delivery service

To receive immunization

-

66 (32.0)

47 (23.0)

-

-

30 (15.0)

65 (43.0)

98 (64.9)

54 (35.8)

74 (49.0)

56 (37.1)

70 (46.4)

52 (37.1)

100 (71.4)

53 (37.9)

78 (55.7)

54 (38.6)

70 (50.0)

Source of AN information

Parents

Family members

Neighbors

Village informal health provider

Health staff

-

-

27 (13.0)

164 (20.0)

105 (51.0)

46 (30.5)

36 (23.8)

19 (12.6)

30 (19.9)

117 (77.5)

32 (22.9)

43 (30.7)

24 (17.2)

35 (25.0)

107 (76.4)

# Multiple responses

55.1%

32.6%

44.9%

67.3%

Base-Line (n= 405) End-line (n= 291)

1-3 times > 4 times

Figure 2 Comparison of mothers’ responses on reason for AN care

4.2.2 Attitude of mothers towards antenatal care

Figure (1) describes the attitude of mothers towards antenatal care. Majority of mothers

from the end-line assessment have positive attitude towards antenatal care. Specifically,

86.6% disagreed the statement “AN care is not always needed” and 93.5% disagreed the

statement “TT immunization is not important”. Moreover, 90.7% agreed that good

nutrition is needed during pregnancy.

Figure 3 Proportion of mothers who have positive attitude towards AN care at end-line

4.2.3 Antenatal care practice of mothers

Antenatal care practice of mothers is shown in Table (3). Mean gestational age at first AN

booking of mother from end-line was 11.9 ± 6.5 weeks which was earlier than that of

32%

23%15%

68%

36.8%

48.1%

Foetal position Regular check up Immunization

Base Line End Line

86.6%

34.4%

93.5%

90.7%

0% 20% 40% 60% 80% 100%

Necessity of AN care

Just for birth registration

For TT immunization

For good nutrition

Paletwa at baseline (14.0 ± 8.0). Mean number of AN care received by the mothers at end-

line was 4.4 times (± 1.9). Over 74% of mothers from end-line received their first AN care

within 1st trimester which was considerably higher than that of baseline at Kanpetlet (38%).

Almost all mothers (99.3%) from end-line assessment received at least one time of AN care.

Higher proportions of mothers from end-line (62.9% and 72.1%) received AN care for 4

times and above than baseline (44.9% and 37%).

In addition, more mothers from end-line got AN care services than baseline (Figure 3). In

particular, higher proportions of mothers received regular examination (31.5% and 87.6%),

iron + F/A tablets (49.7% and 89.7%), blood examination (2.5% and 37.8%) and TT

immunization (38.1% and 92.8%).

Table 3 Antenatal care services received by mothers


n (%)

End-line (n=291)

n(%)

Paletwa

(n=205)

Kanpetlet

(n=200)

Paletwa

(n=151)

Kanpetlet

(n=140)

Number of AN care

<4 times

4 times & above

113 (55.1)

92 (44.9)

126 (63.0)

74 (37.0)

56 (37.1)

95 (62.9)

39 (27.9)

101 (72.1)

AN care provider#

TBA/TTBA

VHW

MW/LHV/HA/Nurse

Medical doctor

9 (4.5)

4 (2.0)

164 (80.0)

-

16 (8.0)

38 (19.1)

154 (77.0)

26 (7.8)

14 (9.3)

1 (0.7)

132 (87.4)

3 (2.0)

24 (17.1)

1 (0.7)

108 (77.1)

4 (2.9)


Figure 4 Comparison of AN care services received by mothers at baseline and end-line

31.5%

49.7%

2.5%

38.1%

87.6% 89.7%

37.8%

92.8%

Regular examination Iron + F/A tablets Blood examination(Malaria, HIV)

TT immunization

Base Line End Line

Table (4) describes the practice of mothers regarding food intake and activity during

pregnancy. Mother who avoided some food during pregnancy was reduced at end-line

assessment (30% vs. 19.2% & 20.7%). Proportion of mothers who had increased activity

was also lessened at the end-line (30% vs. 0.7% & 5.0%).

Table 4 Practice of mothers regarding food intake and activity during pregnancy

Characteristics Baseline, n (%) End-line, n(%)

Paletwa

(n=205)

Paletwa

(n=151)

Kanpetlet

(n=140)

Avoidance of food during

pregnancy

Yes

No

62 (30.0)

143 (70.0)

29 (19.2)

122 (80.8)

29 (20.7)

111 (79.3)

Amount of meal during

pregnancy

No change

Increase amount

Reduce amount

107 (52.0)

51 (25.0)

47 (23.0)

68 (45.0)

65 (43.0)

18 (11.9)

89 (63.6)

33 (23.6)

18 (12.9)

Regular activity during

pregnancy

No change

Increase activity

Reduce activity

55 (27.0)

62 (30.0)

88 (43.0)

93 (61.6)

1 (0.7)

57 (37.7)

82 (58.6)

7 (5.0)

51 (36.4)

4.3 Consequences of pregnancy

4.3.1 Knowledge on consequences of pregnancy

Knowledge of mothers on danger signs during pregnancy was shown in Table (5). Common

dangers signs mentioned by the mothers from end-line were vaginal bleeding (73.5% and

75.7%), high BP (71.5% and 61.4%), headache/dizziness (55.0% and 70.7%) and edema

(53.0% and 66.4%). Almost all mothers (94.9%) from end-line knew at least one danger

sign during pregnancy. Moreover, 86.6% of mothers could mention at least two danger

signs which was much higher than that of baseline at Kanpetlet (47.5%). About 30%

(87/291) of mothers from end-line had experience of danger sign during pregnancy. More

mothers from end-line sought health care for danger signs from basic health staff than

baseline (64.2% vs. 48.0%) (Not shown in the table).

Table 5 Knowledge of mothers on danger signs during pregnancy


Paletwa

(n=205)

Paletwa

(n=151)

Kanpetlet

(n=140)

Danger sign during pregnancy#

Edema

High BP

Headache/Dizziness

Reduce fetal movement

Vaginal bleeding

Foul smelling discharge

Fever

Blurred vision

Dyspnoea

Severe vomiting

-

-

47 (23.0)

-

-

-

55 (27.0)

-

-

57 (28.0)

80 (53.0)

108 (71.5)

83 (55.0)

40 (26.5)

111 (73.5)

62 (41.1)

52 (34.4)

34 (22.5)

34 (22.5)

25 (16.6)

93 (66.4)

86 (61.4)

99 (70.7)

46 (32.9)

106 (75.7)

54 (38.6)

51 (36.4)

44 (31.4)

41 (29.3)

39 (27.9)


4.4 Birth preparedness

4.4.1 Knowledge of mothers on birth preparedness

Knowledge of mothers on birth preparedness is shown in Table (6). More mothers from

end-line could mention “availability of clean delivery kits” (36.0% vs. 76.8% and 76.4%) and

“preparation of clean clothes” (30.0% vs. 83.4% and 89.3%) than baseline assessment at

Paletwa.

Table 6 Knowledge of mothers on birth preparedness


Paletwa

(n=205)

Paletwa

(n=151)

Kanpetlet

(n=140)

Identification of skill birth attendant

Preparation of expenses

Arrange for transport

Availability of clean delivery kit

Preparation of clean clothes

201 (98.5)

164 (80.0)

158 (77.0)

74 (36.0)

62 (30.0)

147 (97.4)

127 (84.1)

110 (72.8)

116 (76.8)

126 (83.4)

119 (85.0)

99 (70.7)

98 (70.0)

107 (76.4)

125 (89.3)


4.4.2 Birth preparedness among mothers

Table (7) shows the information on birth preparedness among mothers. At end-line assessment, 75.5% of mothers from Paletwa stated that they planned to give birth with Basic Health Staff which was higher than baseline (40%).

Table 7 Information on birth preparedness among mothers

Characteristics Baseline, n (%)

Paletwa

(n=205)

End-line, n(%)

Paletwa

(n=151)

Kanpetlet

(n=140)

Planned birth attendant

TBA

TTBA/AMW

MW/LHV/HA/Nurse

Medical doctor

Obs&Gy

25 (12.0)

80 (39.0)

82 (40.0)

8 (4.0)

-

2 (1.3)

18 (11.9)

114 (75.5)

15 (9.9)

-

30 (21.4)

15 (10.7)

64 (45.7)

26 (18.6)

1 (0.7)

4.5 Intra-partum care

4.5.1 Knowledge of mothers on intra-partum care

As shown in Table (8), much higher proportion of participants at the end-line assessment could mention intra-partum danger signs than at baseline assessment. Common danger signs they stated were heavy vaginal bleeding (62.8% and 75.0%), unconsciousness (58.1% and 52.9%), high blood pressure (31.8% and 39.0%), prolonged labour (33.1% and 36.8%) and edema (27.0% and 40.4%). Over 87.8% and 79.0% of mothers from end-line identified MW/LHV/ HA/Nurse as skilled birth attendant.

Table 8 Knowledge of mothers on intra-partum care


Paletwa

(n=205)

End-line, n(%)

Paletwa

(n=151)

Kanpetlet

(n=140)

Danger sign during delivery#

Edema

Heavy vaginal bleeding

Unconsciousness

Eclampsia

High BP

Dyspnoea

No fetal movement

Prolonged labour

-

55 (27.0)

-

-

-

-

47 (23.0)

129 (63.0)

40 (27.0)

93 (62.8)

86 (58.1)

31 (20.9)

47 (31.8)

39 (26.4)

44 (29.7)

49 (33.1)

55 (40.4)

102 (75.0)

72 (52.9)

48 (35.3)

53 (39.0)

41 (30.1)

38 (27.9)

50 (36.8)

Skilled birth attendant

TBA

21 (10.0)

36 (24.3)

48 (34.8)

TTBA/AMW

MW/LHV/HA/Nurse

Medical doctor

Obs&Gy

90 (44.0)

-

-

-

31 (20.9)

130 (87.8)

75 (50.7)

8 (5.4)

25 (18.1)

109 (79.0)

43 (31.2)

15 (10.9)


4.5.2 Attitude towards intra-partum care and delivery practice of mothers

As shown in Table (9), lesser proportion of mothers from end-line responded that delivery

at home is better than at hospital (44% vs. 33.1% and 25.7%). Over 85% of mothers

experienced vaginal delivery. Transportation difficulty (20%) and financial constraint (17%)

were mentioned as reasons for not going to skilled birth attendant (SBA) at baseline.

Similarly, commonest reasons at end-line were “no SBA at village (16.2%)”, “financial

constraint (9%)” and “transportation difficulty (8.3%)”.

Table 9 Attitude towards intra-partum care and delivery practice of mothers


Paletwa

(n=205)

End-line, n(%)

Paletwa

(n=151)

Kanpetlet

(n=140)

Delivery at home is better than

at hospital

90 (44.0)

50 (33.1)

36 (25.7)

Seeking care for delivery

consequences

TBA

Family members

TTBA/AMW

MW/LHV/HA/Nurse

Medical doctor

-

-

84 (41.0)

-

-

(n=15)

2 (13.3)

1 (6.6)

3 (20.0)

8 (53.3)

7 (46.6)

(n=38)

14 (36.1)

13 (34.2)

2 (5.2)

23 (60.5)

13 (34.2)

Figure 5 Delivery practice of mothers at end-line

4.6 Newborn care

4.6.1 Knowledge of mothers on newborn care

Knowledge of mothers on danger signs of newborn care at end-line is illustrated in Figure

(5). Commonest danger sign mentioned by the respondents was dyspnea (71.8%) which

was followed by fever (61.5%) and blue pale colour (60.5%).

Figure 6 Knowledge of mothers on danger signs of newborn at end-line

Table (10) shows the knowledge of mothers on essential newborn care and infant feeding.

Considerably higher proportions of mothers from end-line stated that thermal care (71.7%

85.6%

2.1% 12.4%

Vaginal delivery Instrumental delivery LSCS

71.8%

61.5% 60.5%56.7%

51.2%

39.9%

Dyspnoea Fever Blue palecolour

No cry Nomovement

Hypothermia

vs. 89.4% and 97.1%), cord care (38.5% vs. 80.1% and 83.6%) and breast feeding (25% vs.

94.0% and 97.9%) were the essential components of newborn care.

Table 10 Knowledge of mothers on essential newborn care and infant feeding


Paletwa

(n=205)

End-line, n(%)

Paletwa

(n=151)

Kanpetlet

(n=140)

Essential newborn care#

Thermal care

Cord care

Breast feeding

146 (71.7)

79 (38.5)

51 (25.0)

135 (89.4)

121 (80.1)

142 (94.0)

136 (97.1)

117 (83.6)

137 (97.9)

Infant feeding (0-6 months)#

Breast milk

Warm water

Cow milk

Cereal

Honey & sugar

200 (98.0)

162 (79.0)

121 (59.0)

115 (56.0)

62 (30.0)

149 (98.7)

25 (16.6)

7 (4.6)

2 (1.3)

18 (11.9)

138 (98.6)

20 (14.3)

5 (3.6)

2 (1.4)

14 (10.0)


4.6.2 Newborn care practices of mothers

Figure (6) illustrated the essential newborn care practices of mothers at end-line. Almost

all mothers practiced thermal care (99.3%) and cord care (95.9%). Moreover, 57% of

mothers initiated breast feeding within an hour.

Figure 7 Essential newborn care practices of mothers at end-line

99.3% 95.9%

57.0%

Thermal care Cord care Breast feeding within an hour

4.7 Postpartum care

4.7.1 Knowledge and attitude of mothers on postpartum care

Table (11) describes the knowledge and attitude of mothers on postpartum care.

Knowledge of mothers on postpartum danger signs was not significantly different between

baseline and end-line. Mothers had different opinion on the duration of puerperium. Mean

durations of puerperium (days) as mentioned by the mothers were 14 ± 18 days in baseline

and 20.7 days in end-line assessment. More mothers (68.9% and 69.3%) from end-line

desired to choose Basic Health Staff as a post-partum care provider than baseline (53.7%).

Considerably higher proportion of respondents from end-line (55.0% and 44.3%) than

baseline (2.5%) mentioned “wound care” as one of the PN care services. Majority of

mothers (80.1% and 73.6%) from end-line mentioned that newborn care is needed during

postnatal period, however lesser proportion of mothers (10.8%) from baseline described

about it.

Table 11 Knowledge and attitude of mothers on postpartum care

Characteristics Baseline

n(%)

Paletwa (205)

End-line

n(%)

Paletwa (n=151) Kanpetlet (n=140)

Postpartum danger sign#

Heavy bleeding

Oedema

Fever

Foul smelly discharge

Lower abdominal pain

172 (83.9)

157 (76.6)

186 (90.6)

157 (76.6)

186 (90.6)

136 (90.1)

111 (73.5)

125 (82.8)

117 (77.5)

118 (78.1)

132 (94.3)

115 (82.1)

129 (92.1)

117 (83.6)

112 (80.0)

Duration of puerperium (ds)

Mean ± SD

Median

Range

14 ± 18

-

2 - 90

20.7 ± 24.0

8.0

2-90

20.7 ± 18.9

10.0

3-90

PN provider

Family member

BHS

Medical doctor

TBA/VHW

92 (44.9)

134 (53.7)

-

13 (5.0)

56 (37.1)

104 (68.9)

5 (3.3)

18 (11.9)

43 (30.7)

97 (69.3)

1 (0.7)

22 (15.7)

PN care#

Breast care

Immunization

Medical check-up

Wound care

Health education

17 (8.3)

87 (42.2)

47 (23.0)

5 (2.5)

7 (3.4)

51 (33.8)

63 (41.7)

73 (48.3)

83 (55.0)

48 (31.8)

43 (30.7)

50 (35.7)

66 (47.1)

62 (44.3)

50 (35.7)

Newborn care

Contraception

22 (10.8)

2 (1.0)

121 (80.1)

27 (17.9)

103 (73.6)

30 (21.4)


4.7.2 Postpartum care practice

Postpartum care services received by mothers are described in Table (12). Significantly

higher proportions of mothers from end-line assessment received postpartum care

services including newborn care (14.1% vs 76.2% and 72.1%), medical check-up (22.9% vs.

45.7% and 50.0%), wound care (2.4% vs. 49.7% and 42.9%) and health education (6.8% vs.

26.5% and 37.9%).

Table 12 Postpartum care services received by mothers


Paletwa

(n=205)

End-line, n(%)

Paletwa

(n=151)

Kanpetlet

(n=140)

PN care#

Breast care

Immunization

Medical check-up

Wound care

Health education

Newborn care

Contraception

19 (9.3)

92 (44.9)

47 (22.9)

5 (2.4)

14 (6.8)

29 (14.1)

2 (1.0)

48 (31.8)

61 (40.4)

69 (45.7)

75 (49.7)

40 (26.5)

115 (76.2)

23 (15.2)

41 (29.3)

58 (41.4)

70 (50.0)

60 (42.9)

53 (37.9)

101 (72.1)

28 (20.0)


4.8 Contraception

4.8.1 Knowledge of mothers on contraception

Table 13 describes the knowledge of mothers on contraception. Injection and oral

contraceptive pills were the two most common contraception method identified by the

participants from both baseline and end-line assessments. In particular, 75.6% of mothers

from base-line assessment had knowledge about oral contraceptive pills while over 92.1%

of mothers from end-line assessment could mention it. Similarly, majority of them

recognized the injection method for contraception (84.2% and 95.5%). About 58% of

mothers from end-line assessment and 43% from baseline assessment considered that

injection method is suitable for them. Most of them received information about

contraception from health staff (59.3% and 85.2%) followed by family members/friends

(13.3% and 36.8%). Around half of them received family planning services from health

center at both baseline and end-line assessments (48.6% and 52.9%). Considerably higher

proportion of mothers from end-line received the service from volunteer health workers

(7.7% and 51.9%) than baseline.

Table 13 Knowledge of mothers on contraception


n (%)

End-line (n=291)

n(%)

Contraceptive methods#

OCP

Injection

IUCD

Implant

Female sterilization

Male condom

EOC

Male sterilization

Traditional Method

306 (75.6)

341 (84.2)

156 (38.5)

144 (35.6)

29 (7.2)

60 (14.8)

3 (0.7)

5 (1.2)

17 (4.2)

268 (92.1)

278 (95.5)

135 (46.4)

162 (55.7)

47 (16.2)

55 (19.8)

2 (0.7)

-

-

Preferred contraceptive methods#

OCP

Injection

IUCD

Implant


Male condom

Male sterilization

Don’t want to use

54 (13.3)

174 (43.0)

24 (5.9)

55 (13.6)

23 (5.7)

12 (3.0)

1 (0.2)

22 (5.4)

42 (22.3)

109 (58.0)

8 (4.3)

18 (9.6)

9 (4.8)

3 (1.6)

-

-

Source of information#

Family members/ Friends

Radio/TV/Newspaper/Journal

VHW

Health staff

54 (13.3)

6 (1.5)

7 (1.7)

240 (59.3)

107 (36.8)

20 (6.9)

11 (3.8)

248 (85.2)

Family planning service

Health center

VHW

Private clinic

Hospital

NGO

197 (48.6)

31 (7.7)

22 (5.4)

97 (24.0)

23 (5.7)

154 (52.9)

151 (51.9)

24 (8.2)

64 (22.0)

15 (5.2)


4.8.2 Contraceptive practice

Table 14 describes the contraceptive practice of mothers. Just over 43% of mothers from

baseline assessment and 55.3% from end-line assessment are using contraception. Mean

duration of initiating contraception after delivery was 186 days at baseline and 134 days

at end-line. Most common reason for not using contraception was “unwillingness” (52.2%

and 84.7%). Nearly 59% of mothers used injection method for contraception and about

24% of them used oral contraception pills at end-line assessment.

Table 14 Contraceptive practice of mothers


n (%)

End-line (n=291)

n(%)

Contraceptive use

Yes

No

175 (43.2)

230 (56.8)

161 (55.3)

130 (44.7)

Contraceptive methods

OCP

Injection

IUCD

Implant


(n=175)

29 (16.6)

78 (44.6)

4 (2.3)

18 (10.3)

2 (1.1)

(n=161)

38 (23.6)

94 (58.4)

5 (3.1)

13 (8.1)

11 (6.8)

Reason for not using contraception

Could not afford

Don’t know method

Don’t know the source

Cultural norm/tradition

Unwillingness

(n=230)

12 (5.2)

58 (25.2)

-

4 (1.7)

120 (52.2)

(n=130)

1 (0.8)

7 (5.3)

3 (2.3)

5 (3.8)

111 (84.7)

4.9 Child health care and coverage

4.9.1 Immunization coverage

Immunization coverage among children at end-line assessment is described in Table (15).

Among children over 2 months old, 82.2% and 81.4% of children had received BCG and DPT

respectively. Of children over one year of age, 82.8% had already got measles

immunization.

Table 15 Immunization practice of children

Characteristics Number of eligible

children

Immunization received

n(%)

BCG (>2 months old children)

DPT

>2 months old children


Measles


>12 months old children)

>18 months old children)

269

269

224

186

134

77

221/269 (82.2)

219/269 (81.4)

188/224 (83.9)

134/186 (72.0)

111/134 (82.8)

64/77 (83.1)

4.9.2 Childhood illness and health care seeking behavior

During one year, 58.4% (170/291) children got at least one episode of diarrhea. Among

them, 90.6% (154/170) of children had taken ORS, 14.7% (25/170) had antibiotics and 2.9%

(5/170) had zinc tablets. Nearly 76% (221/291) of children had experienced at least one

symptom of respiratory tract infection. For any kind of illness, 52.9% of mothers chose

Basic Health Staff for seeking health care for their children. More than 63% of the mothers

from end-line and 50.8% from baseline stated that they fed their children as usual or

increase amount during illness.

Table 16 Feeding habit practiced by mothers during child’s illness


n (%)

End-line (n=291)

n (%)

Amount of food during illness

As usual/increase amount

Reduce amount

Avoid some food

Prepare digestible food

205 (50.8)

175 (43.3)

15 (3.8)

4 (1.0)

185 (63.5)

33 (11.3)

25 (8.6)

32 (11.0)

4.9.3 Environmental health

As shown in Table (17), improvement in hand washing practice of mothers was seen at

end-line. More than 80%, 88.7% and 84.9% of mothers washed their hands after having

meal, before meal and after using toilet respectively. In addition, family members who

used fly proof latrine were also increased at end-line.

Table 17 Hygienic practice of mothers


n (%)

End-line (n=291)

n(%)

Hand washing practice

After having meal

Before meal

After using toilet

212 (52.5)

212 (52.5)

212 (52.5)

234 (80.4)

258 (88.7)

247 (84.9)

Use of fly proof latrine

Yes

No

284 (70.0)

121 (30.0)

239 (82.1)

52 (17.9)

4.9.4 Awareness on sustainable community network

As shown in Table (18), at end-line assessment, 77.7% of mothers were aware of the

presence of village health committee and 65.6% had received health education from VHC.

However, only 47% knew that funding support was provided to mothers who were

referred to the hospital. According to Figure (7), 64% of mothers knew the presence of

referral system at their villages. Figure (8) shows the VHC activities attended by mothers

from end-line assessment. Commonest activity they had attended was health education

(64.9%) which was followed by VHC meeting (30.6%) and cooking demonstration (27.5%).

Table 18 Awareness of mothers on community network


n (%)

End-line (n=291)

n(%)

Presence of MSG/VHC

Yes

No/Don’t know

245 (60.5)

160 (39.5)

226 (77.7)

65 (22.4)

Receive HE from MSG/VHC

Yes

No

284 (70.0)

121 (30.0)

191 (65.6)

100 (34.4)

Funding support for referral

Yes

No/Don’t know

175 (43.2)

230 (56.8)

137 (47.1)

154 (52.9)

Figure 8 Awareness of mothers on presence of referral system at their villages

Figure 9 VHC activities attended by mothers from end-line assessment

186, 64%29, 10%

76, 26%

Yes

No

Don't know

64.9%

30.6%27.5%

14.1%

Health education VHC meeting Cookingdemonstration

Referalinformation

4.10 Providers’ perspective towards MNCH project

4.10.1 Scope and coverage of the project

Project activities were carried out in all villages of Kanpetlet and Paletwa townships.

However, there were some villages that cannot be accessed during raining season.

Moreover, some villages were situated in “no go zone” or “conflict area”.

- Support the meetings

o Monthly RHC meeting

o Quarterly sub-center meeting (attended by volunteers)

o 4 monthly RHC meeting (attended by VHC)

- Trainings

o Support AMW and CHW training

o Accountability Equity Inclusion (AEI) awareness multiplier training

o Fund management training to VHC

- Outreach and supervision support

o Support for EPI and outreach activities

o Support for township supervision on child and maternal death

o Support for RHC to sub-center supervision

- AEI practice cycle

- MCH mobile clinic tour

- Nutrition promotion: cooking demonstration

- Environmental sanitation in coordination with Township Administrative Department

4.10.2 Achievements of the project

Focal persons from public sector acknowledged the achievement of MNCH project

especially on the success of EPI coverage and referrals from the villages. With the support

of IRC, midwives from each RHC could attend monthly meeting at Township Hospital.

Therefore, MWs could carry back the immunization boxes which could able to enhance the

immunization programs at the villages. Revitalization of the village health committees

(VHC) was another major achievement of the program. VHC members actively participated

in the MNCH care as well as environmental sanitation. Promotion of community

participation is also achieved through VHC activities. Another important achievement was

establishment of “emergency fund” at each village run by VHC.

“IRC give travel support to all midwives, so they could attend the monthly meeting at Township

Hospital. Then, they could carry back the immunization boxes. It helps to improve EPI coverage. In

the past, EPI coverage is about 70%. Now, it becomes 90%. This is the main success of the

program…”

“IRC က ဆရာမေတြ လကနအစညးအေဝးတကဖ႔ ခရးစရတေပးေတာ သတ႔ေတြ လတငးလာနငတယေလ…

အျပနကရင ကာကြယေဆးပးေတြ သယသြားနငေတာ EPI coverage တကလာတယ… အရငက ၇၀% ေလာက

ကေန ခဆ ၉၀% ေကာလာတယ … အဒါေတြ အဓက ေအာငျမငတာ …” (Focal person, public sector)

“In the past, EPI was carried out in only 19 villages. After initiation of the MNCH project, we could

cover the whole township for EPI…”

“အရငက EPI က ၁၉-ရြာဘ ထးႏငတယ … MNCH project ဝငၿပးမ တၿမ႕နယလး cover ျဖစလာတာ…”

(Focal person, local NGO, Kanpetlet)

AEI practice cycles were conducted in the villages and trying to find the ways for improving the

communication between the community and BHS. Step-by-step process enabled

“…AEI practice cycle is useful … and also successful. We like the process as it could help in

negotiating the gaps between community and BHS …”

“… AEI practice cycle လပေပးတာ အကးရတယ ေအာငျမငတယလ႔လညး ေျပာလ႔ရတယ … community န႔

BHS ၾကားက ကြာဟတာေတြ လအပခကေတြ ရေနတာက ညႏႈငးေပးႏငေတာ ႀကကပါတယ …”

(Focal person, local NGO, Paletwa)

“… Community participation is improved. In the past, villagers were not willing to help the midwives

for carrying immunization box. Now, it’s good that volunteers are helping the MWs for EPI …”

“… Community participation ေကာငးလာတယ .. အရငကဆ ရြာကလေတြက ဆရာမက ေဆးပးေတာင

သယမေပးၾကဘး … ခေနာကပငးေတာ volunteer ေတြက EPI အတြက ကေပးၾကေတာ အဆငေျပတယ …”

(Focal persons, local NGO, both townships)

“Establishment of ‘emergency fund’ led by VHC is successful. In some villages, they have about 10

lakhs …”

“VHC က ဥးေဆာငၿပး emergency fund စခငးတာ ေအာငျမငတယလ႔ ေျပာရမယ… တခ႕ရြာေတြမာ ၁၀-သနး

ေလာကရေနၿပ …” (Focal person, local NGO, Paletwa)

4.10.3 Challenges during implementation of the project

Service providers also highlighted the challenges and difficulties they have faced during

different stages of the project implementation. One of the main barriers while doing

implementation activities was presence of restricted areas or villages in some project sites.

Other challenges they mentioned were:

- Limited human resource in public sector

- Lack of trained focal person

- Language barrier in most rural areas

- Difficulty in communication which hinder the preparation of activities

- Absence of communication channel like telephone to monitor village health

volunteers

- No or very few referrals from remote villages

- Very sparse situation of villages

- Weakness in volunteer reporting system

- Attrition of volunteers in some villages

4.10.4 Suggestions from the participants

A number of suggestions were given by the focal persons from public sector, local NGO

and VHC members.

- To establish Township Health Committee Fund

- To strengthen the linkage between VHC and BHS

- To monitor for the sustainability of emergency fund

- To enhance motivation of BHS for improved ownership of the projec

5. Discussion and recommendations

IRC has designed a maternal and child health program in partnership with Township Health

Department and local non-governmental organization (LNGO). Intervention activities were

implemented in these townships to promote MNCH care and environmental sanitation

with the aim of reducing maternal and child morbidity and mortality since 2014. Baseline

assessment was done in 2015 and an end-line assessment was carried out in Kanpetlet and

Paletwa townships, Southern Chin State at the end of 2017. A total of 291 mothers

participated in the end-line assessment and background characteristics were not different

with that of the baseline.

Main intervention approaches were the strengthening of community health care network

through community participation and supporting BHS in provision of MNCH care services

with the help of local NGO. Geographic situation in most areas of these townships was very

hard to reach and community was facing difficulty in accessing health care services.

Therefore, a strategy of using voluntary health workers was very useful for those areas

where BHS could not get access. Applying AEI practice cycle could also identify the gaps in

MNCH care after discussions have been made between local NGO, BHS and VHC thereby

aiming for improving MNCH care. Step-by-step approach of AEI could able to recognize

challenges, search for the solutions and make final decision after discussion with focal

person from public sector. Such kind of approach seems very useful since all concerned

people included in the process which could enhance the community participation and

ownership.

Different intervention strategies have been documented in previous studies showing

improvements in MNCH care as well as challenges faced by the implementers.2-6,8 In

Vietnam, assessment on MCH handbook intervention was done and challenges were

identified. Although MCH outcomes were improved, weakness in recording handbook by

mothers as well as provider was seen as a challenge.3 In Kenya, assessment was done to

see the MNCH outcomes after using monitoring and tracking tool for community health

volunteers. After using the tool, volunteers could able to plan their activities and

workloads, identify requirements of beneficiaries for MNCH care. Voluntary health

workers acknowledged the usefulness of the tool and MNCH outcomes were also

improved.8

One of the successful outcomes in current study was improvement in knowledge as well

as practice of mothers regarding MNCH. Specifically, knowledge of mothers on AN care,

danger signs during pregnancy, delivery and postpartum were improved at end-line. More

mothers from end-line received AN, delivery and PN care services than baseline. In

addition, more mothers from end-line practiced essential newborn care than that of

baseline.

Another major achievement of the current MNCH project was increased immunization

coverage in both townships. Supporting midwives to attend the monthly meeting could

enable them to carry back the immunization boxes thereby increasing the immunization

coverage at remote areas where routine immunization was impossible. All the focal

persons from public sector and local NGO acknowledged the success of immunization

coverage after initiation of the project.

Successful MNCH outcomes were achieved along with the improvement in community

participation. It was also linked with the revitalization of village health committees (VHC)

and establishment of “emergency fund” at the villages. As part of community intervention,

village health committees were strengthened to help mothers for emergency referral,

nutrition promotion, emergency fund raising and health education. However,

sustainability of these VHCs and their activities after the project remained as a challenge.

Besides achievements, there were challenges in different stages of the project

implementation. Limited human resource in public sector, presence of restricted areas,

communication difficulty hindering the preparation of activities and language barriers

were the major challenges as identified by the local implementing partners.

Following recommendations were made based on the findings from the assessment.

- Practical and sustained ways should be identified and implemented for maintaining

achievement in immunization coverage after the project ends.

- Ways and means for the sustainability of the village health committees and

volunteers should be considered as to maintain the achievements in MNCH care

after the project ends.

- Strengthening of the linkage between BHS and VHC is also recommended.

6. References

1. Knowledge, Practice and Coverage (KPC) Survey for Maternal and Child Health

Paletwa Township, Southern Chin State, Union of Myanmar. End of Project Survey

Report. October 2012

2. Horii N, Habi O, Dangana A, Maina A, Alzouma S, Charbit Y. Community-based

behavior change promoting child health care: a response to socio-economic

disparity. Journal of Health, Population, and Nutrition. 2016;35:12.

doi:10.1186/s41043-016-0048-y.

3. Aiga H, Nguyen VD, Nguyen CD, Nguyen TTT, Nguyen LTP. Knowledge, attitude and

practices: assessing maternal and child health care handbook intervention in

Vietnam. BMC Public Health. 2016;16:129. doi:10.1186/s12889-016-2788-4.

4. Department of Medical Research and Burnet Institute. Baseline and endline report

on “Male participation in maternal and newborn health: community-based

intervention”. 2014.

5. Cofie LE, Barrington C, Akaligaung A, et al. Integrating community outreach into a

quality improvement project to promote maternal and child health in Ghana.

Global public health. 2014;9(10):1184-1197. doi:10.1080/17441692.2014.952656.

6. Perry H, Morrow M, Borger S, et al. Care Groups I: An Innovative Community-Based

Strategy for Improving Maternal, Neonatal, and Child Health in Resource-

Constrained Settings. Global Health: Science and Practice. 2015;3(3):358-369.

doi:10.9745/GHSP-D-15-00051.

7. Kyaw Oo, Thida, Yadana Aung, Kyaw Thu Soe, Nyein Nyein Thaung. Department of

Medical Research (Pyin Oo Lwin Branch) and International Rescue Committee.

Knowledge, attitude, practices and coverage of maternal, newborn and child health

care at selected townships in southern Chin State. February 2016.

8. Avery LS1, Du Plessis E, Shaw SY, et al. Enhancing the capacity and effectiveness of

community health volunteers to improve maternal, newborn and child health:

Experience from Kenya. Can J Public Health. 2017 Nov 9;108(4):e427-e434. doi:

10.17269/cjph.108.5578.

Annex

Map of Kanpetlet Township

Map of Paletwa Township

Photos from Field Data Collection

end-line assessment on knowledge, attitude, practices and … · 2019-07-09 · end-line assessment...

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