COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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2. OBJECTIVES OF THE SITUATIONAL ANALYSIS The objectives of the situation analysis were: 1. To determine factors influencing utilisation of maternal health services and barriers to utilisation of maternal health services (including loss to follow-up of mothers and infants in the PMTCT programme). 2. To determine the level of awareness of the risk factors associated with poor maternal and perinatal health outcomes among women and men. 3. To determine the health seeking behaviours of HIV-positive and HIV-negative pregnant women. 4. To identify available programmes that empower women with appropriate information to participate effectively in promotion of the safer motherhood programme. 5. To assess the available material that provide communities with appropriate and necessary information for effective participation in safer motherhood and PMTCT programmes as well as reproductive health in general. HST together with the University of the Western Cape (UWC) took responsibility for providing insight for the first three objectives outlined above. Thus this report covers the findings related to objectives one to three from the HST/UWC consortium. The HST/UWC consortium was also responsible for providing technical assistance and mentoring to SANIB. Findings from the SANIB focus group research on objectives four and five will be made available in a separate report. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 2
3. METHODS Description of Research Sites In order to capitalise on extensive background data and to build on ongoing research, three sites were chosen for the research related to objectives one to three, where the HST/UWC consortium has longstanding research links. These sites are in the Western Cape, KwaZulu- Natal and the Eastern Cape. The three sites in these provinces represent diverse geographical settings in South Africa, namely; a peri-urban township, a rural district and a peri-urban farming region as well as differences in HIV prevalence and socio-economic situations. Also prospective PMTCT cohort studies have recently been completed at these sites. The Paarl District - is a peri-urban/rural area situated 60 km from Cape Town in the heart of the Winelands region. The approximate total population for the district is 198 546. Paarl East Hospital currently renders 97% of antenatal care services in the district with an average of 210 - 381 new bookings per month. All deliveries are done at Paarl Regional Hospital. Rietvlei in Umzimkulu Sub-district in the Eastern Cape - is situated in one of the poorest sub-district of South Africa. The 1998 Demographic and Health Survey estimated an infant mortality rate of 99/1000 live births. Diarrhoea, malnutrition and lower respiratory tract infections are the major causes of infant mortality. A community survey in the neighbouring Mount Frere district found out that 40% of mothers reported delivering their last child at home. 4 Umlazi - is a peri-urban formal township with interspersed informal settlements situated roughly 20km southwest of Durban, in the Durban-Ilembe health district in KwaZulu-Natal Province. There is one regional hospital, Prince Mshiyeni Memorial Hospital that serves as a referral hospital for the surrounding feeder clinics. Maternity services (including a 40-bed antenatal ward and 40-bed labour ward) and paediatric services (including a neonatal unit and paediatric outpatient services) are available at the hospital. District level health indicators cited in the recent South African Health Review 2005 5 for these areas showed the following: average ANC visits 2.9 for Alfred Nzo (Rietvlei), 2.9 for eThekwini Metro (Umlazi) and 5.7 for West Coast (Paarl); immunisation coverage under 1 year of 92%, 80% and 97% for Alfred Nzo, eThekwini and West Coast, respectively; and PHC utilisation rate (annualised) of 1.5 for Alfred Nzo, 1.9 for eThekwini and 2.8 for West Coast. To address objectives four and five focus groups discussions were held by SANIB in rural, urban and peri-urban areas in all 9 provinces. As mentioned above, findings from the focus groups discussions will be made available in a separate report. Study Design A cross sectional descriptive study was conducted. Quantitative and qualitative data were collected from households which participated in the national PMTCT cohort study as well as those which did not participate in this study. This included households with HIV-positive and HIV- negative women as well as households with women of unknown HIV serological status. Participants were selected randomly for each of the three sub-samples from each of the three PMTCT cohort sites. Twenty (20) women who were known to be HIV positive and 20 women who were known to be HIV-negative were randomly sampled from the list of original participants. CHWs that assisted with the cohort study were asked to identify all women in their communities who had delivered a baby in the last 9-12 months for the non-cohort study participants. This included women who had home births or did not attend antenatal clinic. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 3
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 and 14: Themes that emerged from the qualit
Page 15: COMMUNITY BASED SITUATIONAL ANALYSI
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
Page 71 and 72:
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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COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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