COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and Neonatal Follow Up Care Research commissioned by: The Maternal, Child, Women’s Health and Nutrition Directorate of the National Department of Health, South Africa Research funded by: The Centers for Disease Control and Prevention, South Africa Research Report written by: • Debra Jackson, School of Public Health, University of the Western Cape • Marian Loveday, Health Systems Trust • Tanya Doherty, Health Systems Trust • Nomafrench Mbombo, School of Nursing, University of the Western Cape • Alyssa Wigton, School of Hygiene and Public Health, Johns Hopkins University • Lyness Matizirofa, Statistics Department, University of the Western Cape • Mickey Chopra, Health Systems Research Unit, Medical Research Council and School of Public Health, University of the Western Cape • Gugu Nzimande, School of Public Health, University of the Western Cape • Eric Cele, Health Systems Trust • Mildred Joyi, Health Systems Trust • Latasha Treger, Centers for Disease Control and Prevention (South Africa) • Pulani Tlebere, National Department of Health (South Africa) Suggested citation: Jackson D, Loveday M, Doherty T, Mbombo N, Wigton A, Matizirofa L, et.al. Community Based Situation Analysis: Maternal and Neonatal Follow-up Care. Durban: Health Systems Trust. 2006. The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care ii
Table of Contents ABSTRACT ...............................................................................................................................................................V EXECUTIVE SUMMARY .........................................................................................................................................VII 1. INTRODUCTION...................................................................................................................................................1 2. OBJECTIVES OF THE SITUATIONAL ANALYSIS.............................................................................................2 3. METHODS ............................................................................................................................................................3 4. RESULTS .............................................................................................................................................................8 4.1. DEMOGRAPHIC AND SOCIO-ECONOMIC INFORMATION ........................................................................8 4.2. SEMI-STRUCTURED HOUSEHOLD INTERVIEWS....................................................................................11 SECTION 1: FACTORS ASSOCIATED WITH UTILISATION OF HEALTH SERVICES............................11 SECTION 2: LEVELS OF AWARENESS OF RISK FACTORS AND SOURCES OF HEALTH INFORMATION...........................................................................................................................................14 SECTION 3: HEALTH SEEKING BEHAVIOUR OF HIV-POSITIVE AND HIV-NEGATIVE WOMEN.........16 SECTION 4: FAMILY INVOLVEMENT IN PREGNANCY, BIRTH AND CARE OF INFANT ......................16 SECTION 5: DISCUSSION AND CONCLUSION .......................................................................................16 4.3. QUALITATIVE RESULTS ............................................................................................................................18 SECTION 1: NO ANC ATTENDANCE AND HOME BIRTH REVIEW ........................................................18 SECTION 2: MATERNAL DEATH REVIEW............................................................................................... 23 5. DISCUSSION: TRIANGULATION AND SUMMARY OF RESULTS..................................................................36 6. RECOMMENDATIONS: .....................................................................................................................................37 7. ACKNOWLEDGEMENTS...................................................................................................................................39 8. REFERENCES....................................................................................................................................................40 APPENDIX A ...........................................................................................................................................................41 APPENDIX B ...........................................................................................................................................................59 LIST OF TABLES Table 1: Categories and Number of Study Respondents..........................................................................................8 Table 2: Demographic Data ......................................................................................................................................9 Table 3: Utilisation Score .........................................................................................................................................12 Table 4: Age at death and Suspected Causes of Death in Infants ..........................................................................29 Table 5: Maternal and Infant HIV Status Correlated with Infant Deaths ..................................................................30 LIST OF GRAPHS Graph 1: Comparing Household Water Source at the Three Sites.........................................................................10 Graph 2: Comparing Average Travel Times to the Nearest Clinic and Hospital from the Three Sites ...................11 Graph 3: Sources of Health Information on Pregnancy by Site ..............................................................................15 Community Based Situation Analysis: Maternal & Neonatal Follow-up Care iii
Page 1: COMMUNITY BASED SITUATIONAL ANALYSI
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 and 16: COMMUNITY BASED SITUATIONAL ANALYSI
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
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transport will likely not be succes
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APPENDIX A: RESULTS* *Notes to Tabl
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Appendix A2: Distribution of Select
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Appendix A5: Barriers to accessing
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OBJECTIVE 2: To determine the level
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Appendix A15: What Are Some Dangero
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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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