COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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Results In triangulating the results across the various sources of data in this study, many consistent themes emerged. The following provides a short summary of the primary themes that were seen in this analysis: • Transport and Distance to Care - biggest problem • Communication with Families - very poor • Health Seeking Behaviour - good • Treatment by health providers and quality of care - mixed • HIV/AIDS is a major issue - but cannot overlook basic maternity and neonatal service quality • Families and Communities - an untapped resource Conclusions/Recommendations • 24-hour emergency transport services must be available within each community for emergency obstetric and paediatric care. • Community education about maternal and infant health and danger signs is imperative. • Hospital protocols for assessment and treatment of women and infants must be reviewed and current standards must be implemented. • All facilities must be adequately supplied with the essential medicines and supplies to promote maternal and infant health. • Sensitivity training for hospital staff working with mothers and infants should be explored and communication with families needs to be enhanced. • HIV and AIDS services need to be expanded, integrated and comprehensive. • Cooperation and communication with families and communities needs to be enhanced. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care vi
Executive Summary COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and Neonatal Follow Up Care 1. INTRODUCTION Reduction of mortality and morbidity of both the mother and the newborn have been identified as priority areas needing urgent attention by the Department of Health. 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, as the estimate from the latest Saving Mothers Report 2 places the estimate 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 with AIDS being the main cause. Hypertensive complications of pregnancy are the second commonest (18.1%) followed by obstetric haemorrhage (13.8%). Poor transport and lack of intensive care services were the major administrative problems reported. Medical personnel oriented 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. To this end, the Maternal, Child, Women’s Health and Nutrition (MCWHN) directorate, with financial assistance from 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 situational 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 the utilisation of services. 1 National Department of Health, South African Demographic and Health Survey 1998. Pretoria: Department of Health/Medical Research Council/Macro International. 1998. 2 NCCEMD, Saving Mothers 1999-2001, Pretoria: National Department of Health/NCCEMD. 2002. 3 World Health Organization. Making Pregnancy Safer: Why is this issue important? Fact Sheet No. 276. Geneva: World Health Organization. 2004. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care vii
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Page 3 and 4: Table of Contents ABSTRACT ........
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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
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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
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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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