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Recognition of Maternal and Newborn Complications

Recognition of Maternal and Newborn Complications

Although under-five child mortality has decreased significantly, the rate of neonatal mortality remains high, especially in low and middle income countries (LMICs). Most maternal and neonatal deaths occur during labor or in the early neonatal period, and delayed access to care in the face of maternal complications can be a major factor contributing to mortality. TRAction funded mixed-methods case studies in six countries to explore recognition of illness and care seeking patterns for both newborn and maternal complications. This work is crucial to understanding barriers to recognition and care-seeking, who the primary decision-makers are, and general care-seeking patterns and processes for both maternal and neonatal illness. Ultimately this research will lead to policy changes that improve access to and quality of services for women and children. This research was unique due to the use of a common protocol, common data collection and analysis methods, and collaboration between countries, leading to generalizable results with a global relevance. 

 

Key Results

These research studies were conducted within the context of larger health interventions aimed at improving maternal and neonatal health outcomes.  Several common qualitative findings emerged across all study sites, including:
  • Common barriers to care-seeking including delay in symptom recognition, socio-cultural influences, problems accessing health facilitates due to distance and lack of transport, and lack of providers and resources at the health facilities.
  • The importance of husbands as decision-makers in the care-seeking process for maternal complications and the importance of mothers and mothers-in-law as decision-makers in the care-seeking process for newborn complications.
  • Common facilitators of illness recognition including re-occurrence of the symptoms, severity of the condition, previous knowledge of the illness, etc.
There were also a number of country-specific research findings that will influence local policy and practice.  For example, postpartum bleeding is normalized in India, leading to a lack of danger sign recognition and delayed care-seeking.  In addition, there is a cultural practice of confinement in the home following delivery, which leads family members to seek care for maternal complications at the household level. In Uganda, the main barrier to illness recognition was presence of cultural beliefs. For example, pustules on babies were thought to be associated with the mother eating a lot of salt during pregnancy and therefore this was not considered an illness.
 

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Events

Collaborative Efforts

Quality Management Approach in East Africa

In northern Tanzania, a mother waits with her newborn to see a midwife for vaccinations and health education
Assessing a Community-Based Quality Management Approach

The aim of this study is to identify factors that influence illness recognition and care-seeking. Research questions include:

  • What was the process of illness recognition and care seeking for mothers and newborns?
  • What was the sequence of actions for care seeking?
  • How did the intervention impact care seeking?
  • How do demographic factors influence care seeking?
Location: Mtwara Region, Tandahimba and Newala Districts, Tanzania; Busoga Region, Mayuge and Namaingo Districts, Uganda
Timeline: January, 2015 to August, 2015

Community Outreach Model in Nigeria

A trainer explains major warning signs of a dangerous pregnancy to a group of villagers in Jigawa State, Nigeria
Assessing the Impact of a Community Outreach Model

The aim of this study is to describe recognition and care-seeking behaviors and determine the impact of the CoRPs program. Research questions include:

  • What was the process of illness recognition and care seeking for mothers and newborns?
  • What was the sequence of actions for care seeking?
  • How did the CoRPs intervention impact care seeking?
  • What is the role of husbands in the decision-making process?
  • How does risk perception influence the decision-making process?
Location: Jigawa State, Nigeria
Timeline: January, 2015 to August, 2015

Health BCC Through Social Platforms in India

A self-help group (SHG) member provides a mother with information on infant and newborn care during a home visit in India
HEALTH BEHAVIOR CHANGE COMMUNICATION THROUGH SOCIAL PLATFORMS

This case study aims to examine whether HBCM has resulted in improved recognition and appropriate care seeking. Research questions include:

  • What was the process around recognition of and care seeking for maternal and newborn complications?
  • What sequence of actions were taken by families of mothers and newborns?
  • How did the HBCM intervention influence decision-making and care seeking?
Implemented by Population Council
Location: State of Uttar Pradesh, India
Timeline: January, 2015 to August, 2015

 

Barriers and Facilitators to Skilled Care Seeking

Midwives attend a birth asphyxia management training in Jayawijaya District, Papua, Indonesia
Barriers and Facilitators to Skilled Care Seeking in Indonesia

The aim of this study is to describe recognition and care-seeking behaviors related to maternal and newborn complications. Research questions include:

  • What was the process of illness recognition and care seeking for mothers and newborns?
  • What was the sequence of actions for seeking care and treatment for mothers and newborns? 
Implemented by World Vision
Location: Jayawijaya District, Papua Province, Indonesia
Timeline: January, 2015 to August, 2015

 

Factors Influencing Care Seeking in Ethiopia

A young mother and her infant in the Oromiya Region, Ethiopia
Identifying Factors Influencing Skilled Care Seeking in Ethiopia

This case study aims to understand the facilitators and barriers to care seeking for maternal complications. Research questions include:

  • How did families reach decisions about whether to seek care?
  • What was the sequence of action taken by families for care and/or treatment seeking?
  • How did the intervention influence families’ decision-making or care seeking?
  • Are there regional differences in illness recognition, decision-making, and care seeking?
Implemented by Emory University
Location: Amhara and Oromiya Regions, Ethiopia
Timeline: October 2014 to June 2015