Annex
1. Merlin conducted a Knowledge Practice
Coverage (KPC) Survey in December 2005, in one of the remote Townships
in South Burma. The purpose of the study was to provide further
insight into:
— Key determinants of maternal and
newborn health such as coverage of knowledge and practices at
the community/household level.
— Unmet need for focussing on continuum
of care for maternal and newborn health at health facility and
community/household levels.
2. The study found system failures, namely
inadequate Antenatal care (ANC), childbirth and Postpartum care
(PPC) services including essential newborn care. The vast majority
of the services are provided by midwives (in private) and untrained
birth attendants or private practitioners, demonstrating extreme
under-utilisation of public health services. The KPC survey found
that the vast majority of mothers deliver at home and in most
cases are assisted by untrained birth attendants and Traditional
Birth Attendants (TBAs). Limited capacity of the public health
facilities (including no BEOC services) and long travel distances
to the referral hospitals were given as some reasons why skilled
workers cannot attend most deliveries.
3. Other survey findings indicate extremely
low awareness and knowledge of the population. Women are not consuming
enough food during their pregnancies and it is likely that many
women suffer from iron deficiency. Respondents' understanding
of birth planning and emergency preparedness is also extremely
low. It is possible that the strong prevention and promotive work
with communities through behaviour change and communication (BCC)
as advocated in the Safe Motherhood Initiative and current reproductive
health strategies has never been integrated into ANC services.
This initiative encompasses education and empowers women, families
and communities to prepare for safe delivery and for motherhood.
The approach promotes early recognition of complications for mother
and baby at any time during pregnancy, delivery or after delivery
and maximises the likelihood of timely referral and management
(three delays at the community and fourth at the facility level).
This involves preparedness within the community and within the
formal health care system.
The summary finding of key safe motherhood indicators
are shown below in figures and tables:
Figure A
KNOWLEDGE OF MAIN DANGER SIGNS DURING PREGNANCY
GIVEN BY MOTHERS
Figure B
PLACE OF MOST RECENT DELIVERY REPORTED BY
MOTHERS
Table 1
ASSISTANT DURING MOST RECENT DELIVERY
|
| Assistant at deliveries | Frequency
| Percent |
|
| Untrained attendant |
| |
| Untrained TBA | 231
| 48.5 |
| Untrained Relative | 9
| 1.9 |
| Trained Relative | 2
| 0.4 |
| CHW/CHW | 1
| 0.2 |
| Herself | 1
| 0.2 |
| Husband | 3
| 0.6 |
| Mother-in-Law | 1
| 0.2 |
| Neighbour | 1
| 0.2 |
| Subtotal | 249
| 52.1 |
| | |
|
| Trained and skilled attendant |
| |
| Doctor | 24
| 5 |
| Nurse | 6 |
1.3 |
| LHV | 21 |
4.4 |
| Midwife | 73
| 15.3 |
| Subtotal | 124
| 26.0 |
| | |
|
| Trained but unskilled attendant |
| |
| Auxiliary Midwife/TTBA | 103
| 21.6 |
|
| Total | 476
| 100 |
|
Table 2
CORD CARE AFTER BIRTH AS REPORTED BY MOTHERS
|
| Description of cord care after birth
| Frequency
(n=476)
| Percent |
|
| Timing of cord cutting |
| |
| Immediately after birth
| 269 | 56.5
|
| After delivery of placenta
| 132 | 27.7
|
| Don't know | 75
| 15.8 |
| | |
|
| Instrument used to cut cord |
| |
| Razor blade | 200
| 42.0 |
| Scissors | 68
| 14.3 |
| Bamboo | 41
| 8.6 |
| Knife | 14
| 2.9 |
| Other (thread, palm, coin)
| 21 | 4.4
|
| Don't know | 131
| 27.5 |
| | |
|
| Sterilisation of instrument |
| |
| Boiled | 114
| 23.9 |
| Not boiled | 203
| 42.7 |
| Don't know | 159
| 33.4 |
|
Table 3
MATERNAL KNOWLEDGE OF ILLNESS SIGNS IN NEWBORN
|
| Signs of illness in the newborn |
Frequency
(N=476) |
Percent |
|
| Considered correct |
| |
| Fever | 217
| 45.5 |
| Not active | 157
| 33.0 |
| Poor feeding | 113
| 23.7 |
| Runny nose (cough and cold) | 63
| 13.2 |
| Redness/discharge from eye | 43
| 9.0 |
| Jaundice | 12
| 2.5 |
| Fast breathing | 11
| 2.3 |
| Irritable | 10
| 2.1 |
| Cold (lips turned blue) | 8
| 1.6 |
| Redness around the cord | 5
| 1.1 |
| Fits | 4 |
0.8 |
| | |
|
| Other responses | |
|
| Suck more milk | 162
| 34.0 |
| Chest congestion | 21
| 4.4 |
| Dysentery | 16
| 3.4 |
| Lowering of forehead | 8
| 1.6 |
| Staying too close to the mother | 8
| 1.6 |
| Abdominal pain | 4
| 0.8 |
| Newborns never become sick | 2
| 0.4 |
| Other | 54
| 11.3 |
|
| 
