COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

Twenty (20) women were then randomly selected from the list of births generated by the CHWs
to provide a sample of women who were not in the PMTCT cohort study. Those who had
home births and those who did not attend antenatal care were not included in this study but
were saved for the case studies. A sample of 60 households per site yields 95% confidence
intervals of ± 7-10% within each site and ± 5-7% for the total sample for the data items listed
below (assumes strata and sites can be combined). A husband/partner or another significant
household member was also interviewed from each of these 60 households to explore
knowledge and understanding of family members around pregnancy risks and maternity care.
In addition, to the cross-sectional descriptive survey qualitative case-studies of adverse
outcomes were also conducted. A sub-sample of women/households was purposely selected
to examine particular cases of interest, for example households with a known maternal or infant
death, a mother with no antenatal care or who had a home birth. The semi-structured
interviews in these households were supplemented with a qualitative interview examining the
circumstances and issues around the event of interest, e.g. the maternal death. Having prior
data to identify relevant case studies was a key strength of this project. As this component is
more qualitative in nature, households who had experienced the incidents of interest were
identified and the key informants in these households interviewed using an in–depth interview
technique. Approximately 20 case studies were to be done in each of the sites. The majority of
women were sampled from the Cohort Study, except those with no antenatal care or home
birth who were selected from non-Cohort Study women identified by CHWs.
Home visits were made to the selected women and a written informed consent was obtained
from each woman in the study prior the interview. A written informed consent was also
obtained from those women who had participated in the PMTCT cohort study. Data was
collected using semi-structured interviews with pregnant women, partners and other key
informants. The instruments had modules on basic socio-demographic data; utilisation of and
barriers to utilisation of maternal health services; knowledge of risk factors associated with poor
maternal and perinatal health outcomes; frequency of postnatal health service contacts;
sources of community information on maternal health and PMTCT; and attitudes towards
maternal health services.
Where it was found that a household experienced a known maternal or infant death, or women
did not attend ANC or delivered at home, or defaulted from the PMTCT programme, an
additional in-depth qualitative interview examining the circumstances and issues around the
event of interest was administered. Maternal deaths included deaths from the PMTCT cohort
study, deaths identified in a review of the local hospital delivery register, or deaths identified by
the CHWs.
As the interviews included family planning and postpartum care it was decided that women who
did not access these services would not be examined as a separate sub-group.
It was not possible to identify participants on the PMTCT programme who had defaulted and
avoided obtaining their infants’ HIV testing results or full infant immunisation at nine months. A
facility based qualitative case study was therefore conducted at two of the three sites, to
compare PMTCT programmes, which have been in existence for four years, and determine
what systems factors contribute to the functioning of these programmes. The study was
conducted at Paarl and Rietvlei to determine reasons for defaulting from the programme.
Umlazi unfortunately did not participate in this sub-study because the researchers were not
aware at the time that PMTCT defaulters could not be identified at this site either.
Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 4