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Factors Conclusions and Summary Findings Informational • Only some women consider TT immunization to be important in 7 out of 9 districts and understand its benefits but most are not sure about the number and timing. • The knowledge about benefits of TT is not correct as it is believed that TT protects the newborns from tetanus, meningitis, polio and disabilities, etc. • Various misconceptions about T.T injections exists, such as it is required in only first pregnancy, these are family planning injections, they cause spontaneous abortions. • Some women do not go for immunization because theor families do not allow them. • Deliveries are mostly conducted at home by daiyan or family members and a few without any assistance. • Daiyan are preferred because of their personal relations with the mothers and their families. • Daiyan and family members appear to be concerned about clean delivery in 6 districts (Sukkur, Dadu, Jhelum, Haripur, Lakki marwat and Khuzdar) and they take measures for it. But some of them lack understanding of what is clean and safe. • Several items including new blade, thread, soap, dettol, cotton is arranged for deliveries. But new blade is often washed with dettol or boiled, which is unnecessary and could lead to its decontamination. • Few husbands also showed concerns about maintaining cleanliness during pregnancy in a few districts, but they were not aware of the specific measures. • Some women understand that infections of skin, eye and cord can occur due to transmission of germs but the cause is not known to many. However, the concept of dirt or filth causing it does exist. • Information regarding these infections is also built on traditional knowledge and beliefs, such as heat in mother’s womb, mothers diet, nazar, radiation of heat from newborn’s body etc., and measures are taken accordingly to treat them. • Home remedy is done because of tradition and because most of these problems are not thought to be dangerous. Neonates are taken to an HCP only when the problem becomes severe in most of the cases. However, in few districts, they are not taken to HCP even in severe condition. Socio-Cultural • Cleanliness is not ensured during delivery or for cutting and tying of cord and blade or thread in some districts, especially in rural areas (Khuzdar, Pishin, Haripur) . • Harmful practices of Daiyan were reported in some districts such as putting oil or cotton in vagina or inducing vomiting to ease delivery. • Tablets and IV infusions along with some home remedies are given in case of prolonged labor. • Female doctors or LHVs are called for home deliveries by those who can afford, especially in urban areas, in districts of NWFP (Charsadda, Haripur). • Application of ghee or its mixture, dettol, spirit, surma, etc is a common practice in all districts. • Home management practices for cord, eye and skin problems are derived both from tradition and medical science. • Spiritual healing is also done for all types of problems of the neonates. It may or may not involve taking the neonate to the healer. • Certain superstitions exist such as lunar eclipse causes skin and eye infection in some districts. • <strong>Newborn</strong> is avoided to be taken outside home in first forty days in almost all districts, which affects health care seeking. 30 l Formative Research on Neonatal Sepsis, Low Birth Weight AND Birth Asphyxia
Economic • Neonates suffering from cord, eye and skin problems are taken to a doctor when the problem gets severe otherwise the cure is done with the items like ghee, oil and antibiotic applications which are either commonly available at home or can be easily bought from market at cheap prices. • In some rural areas where there are no facilities T.T immunization is avoided as it costs to acquire injections and transport fare to the hospitals. • Hospitals and clinics are not approached for deliveries as they are considered expensive. Supply • It is common to acquire T.T immunization in areas where government hospitals, immunization teams and LHWs provide it. However, it is evident that these are not reaching to all the target population. • LHWs are advising daiyan to wash hands before conducting delivery in a few districts. • Some daiyan are receiving safe birth kits in Jhelum. • It was reported in Charsadda that a doctor advised mother against TT immunization, as she received injections in earlier pregnancy, indicating incorrect knowledge of HCPs. SAVE THE CHILDREN l 31
Page 1 and 2: National Report Formative Research
Page 3: National Report Formative Research
Page 6 and 7: Acronyms AAA ANC BPCR DTL FGDs FROs
Page 9: Background and Objectives of the St
Page 12 and 13: Tool 4: Guidelines for In-depth Int
Page 14 and 15: T:44 Janobi Noor Colony (U) 8 Pichi
Page 16 and 17: 8 l Formative Research on Neonatal
Page 18 and 19: Theme 1 - Antenatal Care to Prevent
Page 20 and 21: Some daiyan 1 reported that women a
Page 22 and 23: then they have to go for an operati
Page 24 and 25: dishes. Climbing stairs is also rep
Page 26 and 27: Theme 2 - Low Birth Weight Almost a
Page 28 and 29: 2.2 Management of LBW Two most comm
Page 30 and 31: Factors Conclusions and Summary Fin
Page 32 and 33: “I did not receive any TT injecti
Page 34 and 35: have never seen misses (LHVs/Lady d
Page 36 and 37: put in newborn’s eyes for thee da
Page 40 and 41: Theme 4 - Asphyxia About 5-10% of a
Page 42 and 43: “If the baby does not cry it is n
Page 44 and 45: “This problem is not a disease it
Page 46 and 47: to an hour after delivery. The firs
Page 48 and 49: “In past the babies were given im
Page 52 and 53: Theme 7 - Care Seeking Outside Home
Page 54 and 55: “In civil hospital no body listen
Page 58 and 59: In contrast to above, LHWs services
Page 61 and 62: Recommendations The Project should:
Page 63 and 64: Appendix - 1: Terminologies for LBW
Page 65 and 66: Appendix - 2 : Terminologies for Co
Page 67 and 68: Appendix 3: Terminologies for Eye P
Page 69 and 70: Appendix 4: Terminologies for Skin
Page 71 and 72: Appendix 5: Local Terminologies for
Page 73 and 74: White small daney on baby’s skin
Page 75 and 76: Blue baby Unconscious and dies afte
Page 77 and 78: Papules on the skin Swelling or red
Page 79 and 80: Turning blue Unconscious Less activ
Page 81 and 82: Blood deficiency Severe fever. It i
Page 83 and 84: Breathing problems Mucous in chest
Page 85 and 86: She stayed like that for seven days
Page 87 and 88: At delivery, the newborn was not br
Page 89 and 90:
Case Study 7 (Charsadda): Low Birth
Page 92:
Pakistan Country Office P.O. Box 19
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