COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

More documents

Recommendations

Info

Table 5: Maternal and Infant HIV Status Correlated with Infant Deaths Case # Maternal HIV Status Infant HIV Status PA-1 Positive Positive PA-2 Positive Positive PA-3 Positive Unknown PA-4 Positive Positive RT-1 Negative NA RT-2 Positive Positive RT-3 Negative NA RT-4 Positive Positive RT-5 Positive Negative RT-6 Positive Unknown RT-7 Negative NA RT-8 Positive Positive RT-9 Positive Unknown RT-10 Positive Positive RT-11 Positive Negative RT-12 Positive Unknown RT-13 Positive Unknown RT-14 Positive Unknown RT-15 Positive Unknown RT-16 Positive Unknown RT-17 Negative NA UM-1 Positive Positive UM-2 Positive Positive UM-3 Positive Unknown UM-4 Positive Positive UM-5 Positive Positive UM-6 Positive Unknown UM-7 Positive Positive UM-8 Positive Positive UM-9 Positive Unknown UM-10 Positive Unknown UM-11 Positive Unknown UM-12 Positive Unknown UM-13 Positive Unknown UM-14 Positive Positive UM-15 Positive Unknown UM-16 Positive Unknown UM-17 Positive Positive UM-18 Positive Unknown UM-19 Positive Positive 20 15 10 5 0 16 HIV Status of Infant Deaths # per group in sample 2 18 Infant HIV+ Infant HIV- Infant HIV Unk 4 NA (Mom HIV-) Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 30
Maternal and infant HIV status for the 40 cases can be found in Table 5. The HIV status of many of the infants is unknown as they died before an HIV test was done. To place the above deaths in context - overall there were 75 infant deaths in the Good Start Cohort Study. Nine (9) month mortality rates in infants born to HIV-positive women was 10.1% while for those born to HIV-negative women it was 3.7% (p=0.003). The infant mortality rate in Rietvlei was also significantly higher than in Paarl and Umlazi (15.0% vs. 5.7%, p=0.000005). Infant feeding method (ever breastfeeding) was not predictive of infant death in the overall cohort study, but it was a significant predictor of late HIV transmission. 7 This qualitative case-study design provides insight into some of the behavioural, structural, and systemic factors that played a role in the deaths of infants in the three sites that was not available in the Good Start Cohort Study analysis. Factors influencing utilisation of health services The results suggest that the utilisation of health services is related to socio-economic constraints; beliefs about the cause of illness; an awareness of when care is needed for the infant; and the quality of care available. The role of traditional healers is also significant. Socio-economic constraints: Some respondents reported that they were unable to take their child for health care services even though they realised the child needed it. This sometimes occurred because the child was sick in the evening when no transport was available or when no one was available to accompany them to a facility (i.e., the caregiver did not feel safe taking the child alone). Other respondents reported that they were unable to afford the cost of transport to a health facility. One mother in Rietvlei, for example, reported that although the local clinic had referred her baby to hospital to treat his dehydration, she didn’t have the money to take him there. Over the course of two weeks, she took the child back to the clinic several times for help, each time getting referred to hospital. Since this was not an option for her and since the child was not getting better, the mother eventually starting mixing the clinic medicines with traditional medicines. After three days of this treatment, the baby’s condition worsened and he died as they were taking him, once again, back to the clinic. Beliefs about the cause of illness: In other cases, beliefs about the cause of the infant’s illness sometimes determine whether or not the respondent feels health services are desirable. One respondent in Umlazi, for example, reported that her baby became sick at night and she was afraid to go to hospital alone in the dark. Her neighbours who heard the baby crying told her that there was nothing she could do for the baby because the cause of the illness was witchcraft (“Ishawe Yinyoni”). Because the mother then felt that witchcraft was responsible, she did not feel that she could send the baby for western medicine. When asked “what would have made things better or easier for you?” she stated that the child should have been taken to her father’s place to have the cultural ceremony in which the family burns the plant “Impepho” and the child is introduced to the ancestors. She also expressed her belief that if the baby had been taken to a traditional healer to fight witchcraft she would still be alive. This mother did not appear to believe that health services could have prevented the death. Lack of awareness of the danger signs for infants: Some mothers are not aware of the danger signs indicating their child needs medical attention. Several respondents reported that they did not realise the seriousness of their child’s condition until it had progressed to a very severe stage. One mother in Rietvlei, for example, reported that her baby vomited for three days before the baby’s grandmother decided to take her to a traditional healer for medicines. Another mother from Umlazi described how her baby became ill in the evening and, not Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 31
Page 1 and 2: COMMUNITY BASED SITUATIONAL ANALYSI
Page 3 and 4: Table of Contents ABSTRACT ........
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 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: SECTION 3: INFANT DEATH REVIEW Meth
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
Page 67 and 68: Appendix A20: Quality of Care by HI
Page 69 and 70: Appendix A22: Family Involvement in
Page 71 and 72: Appendix A25: Family Involvement af
Page 73 and 74: APPENDIX B1: MATERNAL VERBAL AUTOPS
Page 75 and 76: APPENDIX B2: INFANT VERBAL AUTOPSY
Page 77 and 78: areas covered during the interview
Page 79 and 80: way home after having been admitted
Page 81 and 82: APPENDIX B3: FACILITY SUB-STUDY REP
Page 83 and 84: Staff at all facilities felt that t
Page 85 and 86: 8. HUMAN RESOURCES The District HIV
Page 87 and 88: DATA FROM PMTCT REGISTER Page Numbe
Page 89 and 90: counseling and not ongoing support
Page 91 and 92: year. It has not been possible to l
Page 93 and 94: 8. HUMAN RESOURCES When the PMTCT p
Page 95 and 96:
Each clinic had a register in which
Page 97 and 98:
APPENDIX B5: FACILITY SUB-STUDY REP
Page 99 and 100:
THEMES PAARL RIETVLEI attached by t
show all

COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?