COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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5. DISCUSSION: TRIANGULATION AND SUMMARY OF RESULTS In triangulating the results across the various sources of data in this study, many consistent themes emerged. This section provides a short summary of the primary themes that were seen in this analysis: • Transport and Distance to Care are the biggest problem faced by women and families in accessing health services. • Communication by health workers with families was shown to be inadequate leading to a decreased confidence in the health services. • Health Seeking Behaviour is good, and despite often poor treatment and lack of communication by the health services, the study showed that most people first seek help from the clinic or hospital and only when failed by the Western medical system did they access traditional medicine. Women and families appear to only delay or not access services when they cannot get there (see transport above) not because they do not want to access services, or do not feel the services are valuable. • Treatment by health providers and quality of care as reported by the mothers and families was mixed, as examples of both good and poor treatment and care were cited by respondents. • HIV/AIDS is a major issue but we cannot overlook basic maternity and neonatal service quality. • Families and Communities are untapped resources that play a crucial role in determining health seeking behaviour and utilisation of services. 6. RECOMMENDATIONS 1. 24-hour emergency transport services must be available within each community for emergency obstetric and paediatric care. 2. Community education about maternal and infant health and danger signs is imperative. 3. Hospital protocols for assessment and treatment of women and infants must be reviewed and current standards must be implemented. 4. All facilities must be adequately supplied with the essential medicines and supplies to promote maternal and infant health. 5. Sensitivity training for hospital staff working with mothers and infants should be explored and communication with families needs to be enhanced. 6. Given that Nevirapine is successful in reducing the transmission of HIV to newborns, it is essential that the PMTCT programme functions well and is monitored effectively. 7. HIV and AIDS services need to be expanded, integrated and comprehensive. 8. Cooperation and communication with families and communities needs to be enhanced. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care xiv
COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and Neonatal Follow Up Care Final Report 1. INTRODUCTION Reduction of mortality and morbidity in both mothers and newborns has been identified as priority areas needing urgent attention by the Department of Health (DoH). The maternal mortality ratio for South Africa was estimated in the South African Demographic and Health Survey of 1998 to be 150/100 000 births. 1 This rate is however, thought to be rising, and the estimate from the latest Saving Mothers Report 2 places it at 175-200/100 000 births. The extent of morbidity is not known but it is estimated that for every woman that dies of a pregnancy related complication, 20 more suffer from morbidity such as vesico-vaginal fistulae which may be severe and lead to long term disabilities. 3 According to the Saving Mothers report, since 1999 non-pregnancy related infections have become the main cause of maternal mortality in South Africa (33.7%), 2 mainly due to with AIDS. Hypertensive complications during pregnancy are the second commonest cause of mortality (18.1%) followed by obstetric haemorrhage (13.8%). Poor transport and lack of intensive care services were the major administrative problems reported. Medical personnel related problems included poor initial assessment and diagnosis of cases especially at secondary level of care, failure to follow standard protocols at primary and secondary levels and poor monitoring of patients at all levels of care. Over the past three years prevention of mother-to-child transmission of HIV (PMTCT) programmes have been established in most of the African countries of which the majority are in the process of scaling up PMTCT programmes to achieve national coverage. These programmes have often been implemented in a vertical fashion with little integration into existing maternal and child health programmes. Vertical PMTCT programmes interventions with sole emphasis on PMTCT may miss valuable opportunities to avert common obstetric and postpartum emergencies. PMTCT has the potential to strengthen maternal and child health services while reducing vertical transmission at the same time. Integration of PMTCT into existing maternal and child health services may help to minimise stigma and ‘normalise’ PMTCT interventions as part of routine maternity care. Thus the synergy between PMTCT and safe motherhood programmes should improve maternal and newborn survival and wellbeing. There were two aims for carrying out this project. Firstly, to conduct a community situational analysis to determine factors that impact on the utilisation of maternal health services, with a focus on PMTCT services. Secondly, to encourage health facilities to use the results of the research to develop appropriate interventions for improving acceptability and utilisation of safe motherhood and PMTCT programmes as well as to test strategies for integrating PMTCT within maternal and child health services. To this end, the Maternal, Child, Women’s Health and Nutrition (MCWHN) directorate, with financial assistance from Centers for Disease Control (CDC) contracted Health Systems Trust (HST) and South African Nurses in Business (SANIB) to conduct a community-based situational analysis on maternal and neonatal follow-up care. The situation analysis was to be conducted throughout the country and the findings of this study are to be used to target interventions aimed at improving maternal and infant mortality rates, with a particular focus of enhancing utilisation of services. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 1
Page 1 and 2: COMMUNITY BASED SITUATIONAL ANALYSI
Page 3 and 4: Table of Contents ABSTRACT ........
Page 5 and 6: COMMUNITY BASED SITUATIONAL ANALYSI
Page 7 and 8: Executive Summary COMMUNITY BASED S
Page 9 and 10: It was not possible to identify par
Page 11 and 12: With regard to knowledge of risk fa
Page 13: Themes that emerged from the qualit
Page 17 and 18: 3. METHODS Description of Research
Page 19 and 20: Data Collection The study utilised
Page 21 and 22: inclusion criteria required women t
Page 23 and 24: Table 2: Demographic Data Average a
Page 25 and 26: Graph 2: Comparing Average Travel T
Page 27 and 28: household members gave to women's h
Page 29 and 30: a source of information. CHWs were
Page 31 and 32: Provincial governments to improve h
Page 33 and 34: NO ANC ATTENDANCE The most commonly
Page 35 and 36: Attitude of nurses: Only one woman
Page 37 and 38: SECTION 2: MATERNAL DEATH REVIEW Me
Page 39 and 40: There was no delay from the time of
Page 41 and 42: women from Umlazi (33%) and neither
Page 43 and 44: SECTION 3: INFANT DEATH REVIEW Meth
Page 45 and 46: Maternal and infant HIV status for
Page 47 and 48: The role of traditional healers: In
Page 49 and 50: programme. This was all clearly doc
Page 51 and 52: 6. RECOMMENDATIONS: 24-hour emergen
Page 53 and 54: transport will likely not be succes
Page 55 and 56: APPENDIX A: RESULTS* *Notes to Tabl
Page 57 and 58: Appendix A2: Distribution of Select
Page 59 and 60: Appendix A5: Barriers to accessing
Page 61 and 62: OBJECTIVE 2: To determine the level
Page 63 and 64: Appendix A15: What Are Some Dangero
Page 65 and 66:
Appendix A17: Household Member: Wha
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Appendix A20: Quality of Care by HI
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Appendix A22: Family Involvement in
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Appendix A25: Family Involvement af
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APPENDIX B1: MATERNAL VERBAL AUTOPS
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APPENDIX B2: INFANT VERBAL AUTOPSY
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areas covered during the interview
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way home after having been admitted
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APPENDIX B3: FACILITY SUB-STUDY REP
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Staff at all facilities felt that t
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8. HUMAN RESOURCES The District HIV
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DATA FROM PMTCT REGISTER Page Numbe
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counseling and not ongoing support
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year. It has not been possible to l
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8. HUMAN RESOURCES When the PMTCT p
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Each clinic had a register in which
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APPENDIX B5: FACILITY SUB-STUDY REP
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THEMES PAARL RIETVLEI attached by t
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