Masters in Public Health- Community Assessment-Patan Academy of Health Sciences-Fourth Batch-Grand round Presentation

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Maternal, Newborn and Child Health Assessment in
Rural Municipalities of Lalitpur District,
Bagmati Province
Presented By MPH 4th Batch, PAHS
August 12 , 2022
Picture source USAID, 2021
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Table of Contents

• Introduction
• Objectives
• Methodology
• Results
• Conclusion

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Introduction

• Maternal and Child Health (MCH) refer to a
  package of comprehensive health care services
  which are developed to meet promotive,
  preventive, curative, rehabilitative needs of
  pregnant women before, during and after delivery
  of infants and pre-school children from birth to
  five years.
• The problems affecting the MCH are
  multifactorial.
• Despite current efforts, the health of mother and
  child still constitutes one of the most serious
  health problems in Nepal.

Source Simkhada B, van Teijlingen E, Porter M,
Simkhada P. Major problems and key issues in
Maternal Health in Nepal. Kathmandu University
medical journal. 20064(2 (Iss)258-63.
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Objectives
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Objectives of the study

• General Objective
• To assess maternal and child health care
  practices and service utilization of Rural
  Lalitpur.

Specific Objectives

• 1. To find out the prevalence of child marriage
  and teenage pregnancy
• 2. To determine the Antenatal Care knowledge and
  service utilization
• 3. To explore the delivery practices and the
  related factors in the study area
• 4. To determine the Postnatal Care knowledge and
  service utilization
• 5. To assess newborn care practices in the study
  area.
• 6. To find out the effect of COVID19 in the
  maternal and child health care utilization

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Methodology
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Study Area
Laitpur District
Konjyosom RM
5 wards
3 Rural Municipalities
Mahankal RM
6 wards
Bagmati RM
7 wards
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Methodology

• Sampling Frame
• Consisted of a list of 547 mothers of under 2
  children from all wards of 3 rural municipalities
• Name and contact list of mothers were obtained
  from FCHVs of respective wards

Study Method Mixed method (Majorly quantitative
followed by few qualitative aspects)
Study Design Descriptive cross-sectional study
Study Duration 4th August to 25th August, 2021
Study Population Mothers of under 2 years old
child
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Sampling Process
Sampling Technique Stratified Proportionate
Simple Random Sampling
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Data collection tools and techniques

• In cases where
• Participants' contact numbers were switched off
• Had network error, or
• Participants were unavailable due to other
  reasons
• Follow up was done for
• 2 days at least 3 times a day

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Data processing and analysis
Cleaning
Data Coding and Entry
Analysis
version 4.0.4
Descriptive statistics presented using frequency,
percentage, mean and standard deviation, median
and inter quartile range depending on the
distribution of variables.
Bivariate analysis of selected variables
Qualitative Verbatims quoted, synthesized and
analyzed manually
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Ethical Considerations

• Informed consent obtained from the participants
• Voluntary participation and the flexibility to
  withdraw at any stage from the study
• Anonymity of the participant maintained
  throughout the study.
• The computerized data was stored on
  password-protected computers

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Results
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Participant Flow
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Child Marriage
Teenage Pregnancy
3 among every 10 respondents
2 among every 10 respondents
30
20
n163
n163
19 of the total pregnancies were unplanned
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Knowledge on ANC
DECREASING
92.64 Knew about ANC Visit (n163)
64.9 Knew about minimum four times ANC visits
(n151)
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Practice of ANC services
1-4 visits (55.56)
gt4 visits (44.43)
99.39 atleast one ANC visit
n163
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Time to reach nearest health facility
For 4 out of 9 respondents it takes more than
30 minutes to reach nearest health facility
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Bypassing nearest birthing centers
32 delivery in nearest health facility
77.3 birthing centers in nearest health facility
The GAP!!
We Explored the reasons.
n141
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Bypassing Nearest Birthing Centre
I liked services at Patan hospital. If any
complication happens hospital can address it
easily. Even health post refers there if
something happens. So why not to go
earlier? Janajati, 23 years old, Konjyosom-5
When I went to health post for ANC, health
worker said that since I had done Cesarean
Section before I may not be able to do normal
delivery and suggested me to visit
hospital. Brahmin, 21 years old, Bagmati-1
During my previous delivery, I went to health
post but I couldnt deliver for 1 day then they
referred me to Patan hospital, so this time I
went to Kist beforehand. Janajati, 25 years
old, Mahankal-1
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Place of delivery
Place of delivery Frequency Percent
Government Hospital 83 50.92
Health Post 39 23.93
Home 22 13.50
Private Health Institutions 16 9.82
On the way 3 1.84
Total 163 100
n163
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Reasons
Home Delivery Reason Frequency Percent
Didnt feel necessary 7 31.81
Health facility too far 6 27.25
Delivered before reaching to health facility 6 27.25
Trend is like this 4 18.16
Happened before date 2 9.00
Short labor time 2 9.00
No female health worker in Health Facility 1 4.5
No permission from husband or family member 1 4.5
Because of covid 1 4.5
n22
13.5
Home delivery
Multiple Responses
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Mode of delivery as per institutions
n138
24
Got Travel Incentives after delivery in health
institution
Got Nyano Jhola after delivery in health
institution
n138
n138
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62
25
PNC Knowledge and Practice
Went for PNC Checkup
Home Delivery (n22)
Only (5) 22.7
80.37 mothers did not know about 3-protocol
visit (within 24 hours, 3days and 7 days after
birth)of PNC
Only (39) 28
Institutional Delivery (n141)
Visited for 3rd PNC after discharge
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First thing fed to child after birth
n163
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First time mothers milk fed to child
n163
28
Baby warming practice after birth
1
47
n163
5
Skin to Skin Contact
47
47
Wrapped in Cloth
5
47
Use of fire/heater
1
Dont Know
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Exclusive Breastfeeding
Average completed month of exclusive
breastfeeding 5.4 month (Mean) 1.66(s.d)
48
Exclusive Breastfeeding
n133
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MCH Service Uptake Challenges during COVID-19
n163
Fear of SARS-CoV-2 (43)
Transportation Difficulty (43)
Health service disruption (12)
Closure of immunization (7)
Multiple Responses
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Prioritization Matrix using Criteria Weighing
Method
S.N. Observed Problems Magnitude of problem Benefits after solving the problem Availability of resources to solve problem Feasibility of implementing solution Community Acceptability Total score
1 Adolescent Pregnancy 4 4 3.5 3 3 17.5
2 Home delivery 3.5 4 3 3 3.5 17
3 Low coverage of Exclusive Breastfeeding 4 4 3.5 2.5 2.5 16.5
4 Bypassing of nearest birthing center for delivery 3.5 3 3 3.5 3 16
5 Low coverage of Aama Program Incentive 3 2.5 3.5 3.5 3.5 16
6 Inadequate PNC knowledge and Practice 4 3 3.5 2.5 2.5 15.5
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Conclusion
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Conclusion

• Adolescent pregnancy, home delivery, low
  proportion of exclusive breast feeding,
  bypassing nearest health facility for delivery,
  and gap between knowledge and practice of PNC are
  some prioritized problems identified in the
  survey.
• Based on laws and policies intensive campaigns
  and programs with community participation must be
  developed to address teenage pregnancy
• Health institutions must be available within the
  range of 30 min of walking distance.
• PNC Home visit must be promoted.

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References

• Simkhada B, van Teijlingen E, Porter M, Simkhada
  P. Major problems and key issues in Maternal
  Health in Nepal. Kathmandu University medical
  journal. 20064(2 (Iss)258-63.
• Bagmati Rural Municipality. Available from
  https//bagmatimunlalitpur.gov.np/
• Mahankal Rural Municipality . Available from
  https//mahankalmun.gov.np/.
• Konjyosom Rural Municipality. Available from
  https//konjyosommun.gov.np

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(No Transcript)
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Thank You
Picture source USAID, 2021