COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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2. OBJECTIVES OF THE SITUATIONAL ANALYSIS HST together with the University of the Western Cape (UWC) took responsibility for providing insight for the first three objectives of the project, namely: 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 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. 3. METHODS Research Sites Three sites were chosen for the research from communities where the HST/UWC consortium has longstanding research links. These sites are situated in the Western Cape, KwaZulu-Natal and the Eastern Cape. The three sites 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. Study Methods A cross sectional descriptive study was conducted. Quantitative and qualitative data were collected from households that participated in the national PMTCT cohort study (HIV-positive and HIV-negative) and from households that did not participate in this study (unknown HIV status). From each of the three PMTCT cohort sites, 20 women who were known to be HIVpositive and 20 women who were known to be HIV-negative were randomly sampled from the list of original participants. 20 women were also randomly selected from the list of births in the last 9-12 months generated by Community Health Workers (CHWs) to provide a sample of women who were not in the PMTCT cohort study. A husband/partner or other 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. Approximately 20 case studies were to be done in each of the sites. Home visits were made to selected women and written informed consent was obtained from all women prior to initiation of the interview. Data was collected using semi-structured interviews with pregnant women, partners and other key informants by trained field researchers. 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. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care viii
It was not possible to identify participants on the PMTCT programme who had defaulted and avoided obtaining infant 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 (Paarl and Rietvlei), to compare PMTCT programmes, which have been in existence for four years, and determine what systems factors contributing to the functioning of these programmes. Data Capturing & Data Analysis Quantitative data were entered into an EXCEL spread sheet and analysed using both SAS and EPI-INFO software packages. Primarily descriptive statistics were employed, including means and standard deviation for continuous data, and frequencies and cross-tabulations for categorical data. A content-theme approach focusing on study questions was used for the qualitative analysis. Two researchers from the study team were allocated to each type of qualitative interview: The data from the Facility Based PMTCT Follow-up Study is a combination of quantitative data from the data available at the two sites and a qualitative process description focusing on the follow-up services at each facility and the challenges described by the key informants. Finally, data from the quantitative semi-structured interviews, the three types of case studies, and the facility review were triangulated. 4. RESULTS Household Interviews In total there were 226 respondents. Of these, 68 lived in Paarl, 78 in Rietvlei and 81 in Umlazi. Of the 226 respondents 178 were involved in semi-structured interviews and 48 in indepth studies. In addition 178 household members were interviewed. The average age of the women interviewed (not household members) was similar across the sites between 25 and 27 years. The mean infant age across sites was similar (p=0.61) There were significantly more single women in Umlazi (81%) than at the other two sites (Paarl 69% and Rietvlei 51%). The results for a number of socio-economic variables show that participants from Rietvlei have significantly poorer resources than those in Paarl and Umlazi. These included poorer water source, sanitation facilities, cooking fuel, and lower rates of employment. Women in Rietvlei lived substantially longer distances from both the clinic and the hospital than in the other two sites. In order to examine factors associated with the utilisation of maternity and newborn services, a composite index was developed using the six items listed in Table 3 below. One point was allocated for each item with a score of 1 indicating better utilisation and 0 poorer utilisation. A mean score was then derived, which indicated that Paarl had the best utilisation score and Rietvlei the lowest. The score was further dichotomized to =5, with >=5 indicating better utilisation of services. Paarl had the highest percentage of women (77%) with a score of at least five and Rietvlei the lowest at only 11% (Utilisation Score). Community Based Situation Analysis: Maternal & Neonatal Follow-up Care ix
Page 1 and 2: COMMUNITY BASED SITUATIONAL ANALYSI
Page 3 and 4: Table of Contents ABSTRACT ........
Page 7: Executive Summary COMMUNITY BASED S
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 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
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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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