Recently-delivered Women Research Articles

Perceived Social Networks and Newborn Health: Evidence from Self-Help Group Communities in Northern India.

The limitations of individual level interventions in changing behaviors to improve global maternal, newborn and child health have generated more interest in the patterns of social influence and decision making embedded in families, friends and communities. The purpose of this study is to expand the understanding of village dynamics in India and how first degree social and advice networks and cognitive perceptions of 185 recently delivered women (RDW) in areas with and without women’s Self-Help Groups (SHGs) affect immediate breastfeeding. Data was collected in 6 blocks and 36 villages in Uttar Pradesh, India. The expansion of RDW’s social worlds and creation of social capital through the organization of Self-Help Groups in their villages allowed us to examine basic relationships and advice formation as well as perceptions of interconnectedness of known groups. RDW living in SHG villages and blocks had consistently higher numbers of relationship ties, health advice ties and higher density of health advice networks than RDW living in the non-SHG areas. RDW’s perceived knowing ties were also significantly higher between family and health workers in the SHG areas with related higher immediate breastfeeding rates. These results suggest that SHGs can accelerate community social capital and promote more accountability in the health system to engage with families and support the change from traditional to more evidence-based health practices.

Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: a qualitative study

BackgroundOral health behavior and attitudes of pregnant women in low-income countries are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases. We aimed to understand dental care-seeking behavior, as well as oral health knowledge and attitudes of oral health among pregnant women in rural Nepal.MethodsSemi-structured in-depth interviews (n = 16) and focus group discussions (3 groups, n = 23) were conducted among pregnant and recently-delivered women in Sarlahi, Nepal. Transcripts were translated from the local language to English then analyzed using a hybrid approach to thematic coding with Atlas.ti version 7.ResultsWomen felt confident describing the signs and symptoms of tooth decay and gum disease, but were not knowledgeable about where to receive care for tooth and/or gum pain and relied heavily on the knowledge of their community. Some women used a toothbrush and toothpaste at least once a day to clean their teeth, but many reported the traditional use of a branch of a local shrub or tree as their teeth cleaning instrument. Women suggested a willingness to consider using an oral rinse throughout pregnancy, perceiving that it might have a positive impact on infant health.ConclusionsFuture studies should focus on providing adequate and sustainable resources for pregnant women in Nepal and other low income settings to engage in good oral health behaviors (possibly supported through community-based workers), to maintain dental hygiene, and to access qualified dentists as a means of improving their oral health.Trial registrationClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

The Use of Facilities for Labor and Delivery: The Views of Women in Rural Uganda.

The aim of the paper is to explore factors associated with home or hospital delivery in rural Uganda. Qualitative interviews with recently-delivered women in rural Uganda and statistical analysis of data from the 2011 Ugandan Demographic and Health Survey (DHS) to assess the association between socio-demographic and cultural factors and delivery location in multivariable regression models. In the DHS, 61.7% (of 4907) women had a facility-based delivery (FBD); in adjusted analyses, FBD was associated with an urban setting [adjusted odds ratio (aOR) 3.38, 95% confidence interval (CI) 2.66 to 4.28)], the upper wealth quintile (aOR: 3.69, 95%CI 2.79 to 3.87) and with secondary education (aOR: 3.07, 95%CI 2.37 to 3.96). In interviews women quoted costs and distance as barriers to FBD. Other factors reported in interviews to be associated with FBD included family influence, perceived necessity of care (weak women needed FBD), and the reputation of the facility (women bypassed local facilities to deliver at better hospitals). Choosing a FBD is a complex decision and education around the benefits of FBD should be combined with interventions designed to remove barriers to FBD.

Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study

BackgroundLow knowledge of danger signs has been shown to delay seeking obstetric care which leads to high maternal mortality and morbidity worldwide. In Tanzania about half of pregnant women are informed about obstetric danger signs during antenatal care, but the proportion of those who have full knowledge of these obstetric danger signs is not known. This study assessed the knowledge of obstetric danger signs and its associated factors among recently-delivered women in Chamwino District, Tanzania.MethodsA community-based cross-sectional study was conducted in January 2014 in Chamwino District, Tanzania. A woman was considered knowledgeable if she spontaneously mentioned at least five danger signs in any of the three phases of childbirth (pregnancy, childbirth and postpartum) with at least one in each phase. Multistage cluster sampling was used to recruit study participants. Descriptive and bivariate analyses were conducted. Multivariable logistic regression analyses were performed to control for confounding and other important covariates.ResultsA total of 428 women were interviewed. The median age (IQR) was 26.5 (22–33) years. Only 25.2% of respondents were knowledgeable about obstetric danger signs during pregnancy, childbirth/labour and postpartum. Significant explanatory variables of being knowledgeable about obstetric danger signs were found to be maternal education (AOR = 1.96; 95% CI: 1.01, 3.82), maternal occupation (AOR = 2.23; 95% CI; 1.10, 4.52), spouse occupation (AOR = 2.10; 95% CI: 1.02, 4.32) and counseling on danger signs (AOR = 3.42; 95% CI: 1.36, 8.62) after controlling for the clustering effect, confounding and important covariates.ConclusionA low proportion of women was found to be knowledgeable about obstetric danger signs in Chamwino district. Therefore, we recommend the Ministry of Health to design and distribute the maternal health booklets that highlight the obstetric danger signs, and encourage antenatal care providers and community health workers to provide frequent health education about these danger signs for every pregnant woman in order to increase their level of knowledge about obstetric danger signs.

FACTORS RELATED TO KNOWLEDGE ON NEWBORN DANGER SIGNS AMONG THE RECENTLY DELIVERED WOMEN IN SUB-DISTRICT HOSPITALS OF BANGLADESH

Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal mortality. While, most of the neonatal deaths are preventable; health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges.Objective: 1) to determine the level of knowledge among the recently delivered women (RDW) about newborn danger signs and 2) to distinguish the factors associated with ability of identifying the danger signs.Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015. Seven key danger signs were identified, and responses were categorized accordingly. Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification.Results: About 51% of RDW could identify one key danger sign. Knowledge on “fever’’ was the most commonly known danger sign (65%). Middle age (OR 1.67, 95% CI: 1.09 - 2.18), high education (OR 2.37, 95% CI: 1.46 - 2.77), increased parity (OR 1.91, 95% CI: 1.17 - 2.89), and previous hospital delivery (OR 1.79, 95% CI: 1.14 - 2.68) were found associated with the knowl­edge of the danger signs.Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge. Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.

A study on postnatal care and its correlates among recently delivered women visiting to BRD medical college Gorakhpur

Background: Postnatal care is crucial in maintaining and promoting the health of the woman and the newborn baby. Despite the known benefits of the postnatal care, there are many access and utilization barriers to care. The present study was conducted on postnatal care and its correlates among recently delivered women visiting to BRD Medical College Gorakhpur. Methods: For present cross-sectional study recently delivered women (RDW) defined as a post natal woman who had a baby between two months to six months of age at the time of data collection were taken as the study subjects. Complete post natal care was considered if RDWs had received post natal check-up (Post natal day -1, day-3, day-7,) along with immunization of child with BCG, OPV and three doses of DPT/Pentavalent vaccine. Sample size was calculated as 275 by using the formula 4PQ/L2 with an allowable error (L) of 20% including 10% extra for non/incomplete responders. The proportion of women receiving postnatal care was considered as 50.0% as by this proportion maximum sample size is arrived. Results: A total of 269 recently delivered women (RDW) were taken as the study subjects. They belonged to age group 19-29 year (Mean age 23.7±6.7 year), either educated up to 12th standard and only few were graduate or post graduate. Majority of them belonged to middle or lower middle class. Conclusions: Postpartum care utilization was associated with socioeconomic status, antenatal care received or not, planned pregnancy or not. Interestingly, access to care was not perceived as a top reason for not obtaining PPC.

Postnatal Care Experiences and Barriers to Care Utilization for Home- and Facility-Delivered Newborns in Uganda and Zambia.

Objectives The objective of this study was to examine experiences with, and barriers to, accessing postnatal care services, in the context of a maternal health initiative. Methods As part of a larger evaluation of an initiative to promote facility deliveries in 8 rural districts in Uganda and Zambia, 48 focus groups were held with recently-delivered women with previous home and facility deliveries (6 per district). Data on postnatal care experiences were translated, coded and analyzed using thematic content analysis techniques. Results were categorized into: positive postnatal care experiences, barriers to postnatal care utilization, and negative postnatal care experiences. Results Women who accessed care largely reported positive experiences, with Zambian women generally reporting more positive interactions than Ugandan women. The main reasons given for low postnatal care utilization were low awareness about the need, fear of mistreatment by clinic staff, cost and distance. In half of the focus groups, women described personal experience or knowledge of denial or threatened denial of postnatal care due to the birth location. Although outright denial of care was not common, women frequently described various types of actual or presumed discrimination because of having a home birth. Conclusions for Practice While many women reported positive experiences with postnatal care utilization, cases of delay or denial of postnatal care exist. As programs incentivize facility deliveries, the lack of focus on postnatal support may place home-delivered newborns in "double jeopardy" due to poor quality intra-partum care and reduced access to postnatal care.

Skin, thermal and umbilical cord care practices for neonates in southern, rural Zambia: a qualitative study.

BackgroundIn Choma District, southern Zambia, the neonatal mortality rate is approximately 40 per 1000 live births and, although the rate is decreasing, many deliveries take place outside of formal facilities. Understanding local practices during the postnatal period is essential for optimizing newborn care programs.MethodsWe conducted 36 in-depth interviews, five focus groups and eight observational sessions with recently-delivered women, traditional birth attendants, and clinic and hospital staff from three sites, focusing on skin, thermal and cord care practices for newborns in the home.ResultsNewborns were generally kept warm by application of hats and layers of clothing. While thermal protection is provided for preterm and small newborns, the practice of nighttime bathing with cold water was common. The vernix was considered important for the preterm newborn but dangerous for HIV-exposed infants. Mothers applied various substances to the skin and umbilical cord, with special practices for preterm infants. Applied substances included petroleum jelly, commercial baby lotion, cooking oil and breastmilk. The most common substances applied to the umbilical cord were powders made of roots, burnt gourds or ash. To ward off malevolent spirits, similar powders were reportedly placed directly into dermal incisions, especially in ill children.ConclusionsThermal care for newborns is commonly practiced but co-exists with harmful practices. Locally appropriate behavior change interventions should aim to promote chlorhexidine in place of commonly-reported application of harmful substances to the skin and umbilical cord, reduce bathing of newborns at night, and address the immediate bathing of HIV-infected newborns.

Ante natal care (ANC) utilization, dietary practices and nutritional outcomes in pregnant and recently delivered women in urban slums of Delhi, India: an exploratory cross-sectional study.

BackgroundAntenatal Care (ANC) is one of the crucial factors in ensuring healthy outcomes in women and newborns. Nutrition education and counselling is an integral part of ANC that influences maternal and child health outcomes. A cross sectional study was conducted in Pregnant Women (PW) and mothers who had delivered in the past three months; Recently Delivered Women (RDW) in urban slums of North-east district of Delhi, India, to explore ANC utilization, dietary practices and nutritional outcomes.MethodsA household survey was conducted in three urban slums to identify PW and RDW. Socio-economic and demographic profile, various components of ANC received including nutrition counselling, dietary intake and nutritional outcomes based on anthropometric indices and anaemia status were assessed. Socio-demographic characteristics, nutrient intake and nutritional status were compared between those who availed ANC versus those who did not using logistic regression. Descriptive summary for services and counselling received; dietary and nutrient intake during ANC were presented.ResultsAlmost 80% (274 out of 344) women received some form of ANC but the package was inadequate. Determinants for non-utilization of ANC were poverty, literacy, migration, duration of stay in the locality and high parity. Counselling on nutrition was reported by a fourth of the population. Nutrient intake showed suboptimal consumption of protein and micronutrients like iron, calcium, vitamin A, vitamin C, thiamine, riboflavin niacin, zinc and vitamin B12 by more than half of women. A high prevalence of anaemia among PW (85%) and RDW (97.1%) was observed. There was no difference in micronutrient intake and anaemia prevalence among women who received ANC versus who did not.ConclusionsPregnant women living in urban poor settlements have poor nutritional status. This may be improved by strengthening the nutrition counselling component of ANC which was inadequate in the ANC package received. Empowering community based health workers in providing effective nutrition counselling should be explored given the overburdened public health system.

Utilization of ante natal care services and it′s determinants by women admitted in a tertiary care hospital of Kolkata

Background: Poor access and utilisation of antenatal services contribute to high Maternal Mortality Rate (MMR) along with other socioeconomic factors. Objectives: To evaluates the utiliation of ante natal care (ANC) services and it's determinants among full term pregnant women and recently delivered women. Materials and Methods: A cross sectional study was conducted among 380 full-term ante natal women and recently delivered women (RDW) admitted in obstetric ward of a tertiary care hospital of Kolkata between February 2014 to July. 2014 using a predesigned pretested schedule. Results: About 47.11% of the study population were between the age of 20-30 years; 68.95% were Hindu; 55.53% belonged to nuclear family; 60.53% were from rural area; 53.42% were multipara; 89.47% were literate; 63.95% were homemakers; 28.95% belonged to class III. Cent percent registered for ANC); 91.05% took three ANC visits; 65.26% registered during the first trimester; weight and blood pressure was measured in 99.74% and 98.95% respectively; 99.2% had an abdominal examination; 100% received Tetanus Toxoid (TTTT); 43.96% consumed 100 Iron Folic Acid (IFA) tablets; 97.63% had blood test for Haemoglobin and blood typing; 92.11% had blood test for VDRL; 100% had an urine examination for albumin. All of the subjects was advised about diet and immunisation; 97.89% for rest/sleep; 82.89% for physical activity; 27.89% for personal cleanliness; 27.37% for family planning; 49.21% for breastfeeding and newborn care and 66.05% for warning signs. When comparison between women who went for at least four ANC visits and who did not significant difference was observed in terms of age, educational level, socio-economic status (SES), timing of registration and parity. Conclusion: At this stage of pregnancy, women are usually more receptive to their advices. This opportunity may be utilised today for the sake of a better maternal health tomorrow.

1108Timing of Information-Seeking about Childhood Vaccines for Pregnant and Recently-Delivered Women

1108Timing of Information-Seeking about Childhood Vaccines for Pregnant and Recently-Delivered Women

Use of job aids to improve facility-based postnatal counseling and care in rural Benin.

This study examined the effect of a job aids-focused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre-post randomized design, data were drawn from direct observations and interviews with 411 mother-newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention's relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [∆i - ∆c] +30.9, 95 % confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour (∆i - ∆c +33.7, 95 % CI 19.0, 48.4) and delayed for bathing (∆i - ∆c +23.9, 95 % CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding (∆i - ∆c +6.8, 95 % CI -2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant (∆i - ∆c +8.5, 95 % CI -2.8, 19.9). The proportion of mothers with correct knowledge of maternal (∆i - ∆c +27.8, 95 % CI 11.0, 44.6) and newborn (∆i - ∆c +40.3, 95 % CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices (∆i - ∆c +26.0, 95 % CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with community-based initiatives.

A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation

BackgroundMaternal morbidity is more common than maternal death, and population-based estimates of the burden of maternal morbidity could provide important indicators for monitoring trends, priority setting and evaluating the health impact of interventions. Methods based on lay reporting of obstetric events have been shown to lack specificity and there is a need for new approaches to measure the population burden of maternal morbidity. A computer-based probabilistic tool was developed to estimate the likelihood of maternal morbidity and its causes based on self-reported symptoms and pregnancy/delivery experiences. Development involved the use of training datasets of signs, symptoms and causes of morbidity from 1734 facility-based deliveries in Benin and Burkina Faso, as well as expert review. Preliminary evaluation of the method compared the burden of maternal morbidity and specific causes from the probabilistic tool with clinical classifications of 489 recently-delivered women from Benin, Bangladesh and India.ResultsUsing training datasets, it was possible to create a probabilistic tool that handled uncertainty of women’s self reports of pregnancy and delivery experiences in a unique way to estimate population-level burdens of maternal morbidity and specific causes that compared well with clinical classifications of the same data. When applied to test datasets, the method overestimated the burden of morbidity compared with clinical review, although possible conceptual and methodological reasons for this were identified.ConclusionThe probabilistic method shows promise and may offer opportunities for standardised measurement of maternal morbidity that allows for the uncertainty of women’s self-reported symptoms in retrospective interviews. However, important discrepancies with clinical classifications were observed and the method requires further development, refinement and evaluation in a range of settings.

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

BackgroundEthiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia.MethodsWe conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection.ResultsThe majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care.ConclusionsImproving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

Utilization of ASHA services under NRHM in relation to maternal health in rural Lucknow, India

To address poor utilization of maternal and child health services by the rural community, the National Rural Health Mission (NRHM) was launched in 2005 in India. Under NRHM, ASHA (Accredited Social Health Activist) was identified as an effective link between the government and poor pregnant women. The aim of the present study was to examine the utilization of ASHA services under NRHM in relation to maternal health by the Recently Delivered Women (RDW) in the study area. A cross-sectional study was conducted at PHC Sarojini Nagar, Lucknow and its rural field areas. A sample of 350 RDW, chosen by simple random sampling, were interviewed at bedside by a preformed schedule and then were followed up after six weeks. Antenatal registration was reported by 97% RDW of which 73% registered early. About 53% RDW had three or more antenatal care visits. Two dose Tetanus Toxoid coverage was 92.9%. Receipt and consumption of iron and folic acid was low. ASHA was the major facilitator for higher utilization of antenatal care services, except for Iron and Folic Acid receipt/consumption. Low utilization of postnatal care (21.5% RDW had at least one postnatal check-up) is a matter of concern. Knowledge and awareness of ASHA on importance of postnatal care needs to be enhanced via hands on training by specialists and regular orientation programs. Better and intense advocacy in the community regarding importance of availing services of ASHA in relation to maternal health needs to be addressed.South East Asia J Public Health | Jan-June 2012 | Vol 2 Issue 1 | 24-27 DOI: http://dx.doi.org/10.3329/seajph.v2i1.15261

Antenatal care services in rural areas of Aligarh, India: A cross-sectional study

The present study was carried out to find out the current status of antenatal care services. A cross-sectional study was carried out in rural areas of Aligarh taking WHO 30 cluster methodology. The required number of villages from each stratum was selected with probability proportional to size (PPS). There were 154 currently pregnant women (CPW) and 248 recently delivered women (RDW), of these, a majority of CPW (72.1%) and RDW (59.7%) did not have any ANC checkup. 65.1% of CPW and 40.0% of RDW had their first ANC checkup in the first trimester. Majority of CPW (53.9%) did not receive any TT vaccination. On the contrary, most of the RDW (73.0%) had two doses of TT vaccination. Similarly, large number of the CPW (75.3%) and 52.4% of RDW did not receive iron folic acid (IFA) tablets. In CPW, weight was measured only in 16.3% women. However, height was measured in 41.9%, B. P. was recorded in 46.5%, The same pattern was observed in RDW. Preferred place of delivery was home in CPW (64.9%) and RDW (81.4%) and mostly conducted by trained birth attendant (TBA). It is concluded that among the aspects ignored during antenatal period, patient education is of vast importance and even a low level of counseling can improve utilization of health services by mothers. Key words: Currently pregnant women (CPW), recently delivered women (RDW), ANC checkup, trained birth attendant (TBA).

Effect of knowledge of community health workers on essential newborn health care: a study from rural India

This study explored the relationship between the knowledge of community health workers (CHWs)-anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)-and their antenatal home visit coverage and effectiveness of the visits, in terms of essential newborn health care practices at the household level in rural India. We used data from 302 AWWs and 86 ANMs and data from recently delivered women (RDW) (n=13,023) who were residents of the CHW catchment areas and gave birth to a singleton live baby during 2004-05. Using principal component analysis, knowledge scores for preventive care and danger signs were computed separately for AWWs and ANMs and merged with RDW data. A multivariate logistic regression model was used to estimate the adjusted effect of knowledge level. A generalized estimating equation (GEE) was used to account for clustering. Coverage of antenatal home visits and newborn care practices were positively correlated with the knowledge level of AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds ratio 1.97; 95% confidence interval (CI): 1.55-2.49 for AWW, and odds ratio 1.62; 95% CI: 1.25-2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64-2.52 for AWW, and odds ratio 1.43; 95% CI: 1.17-1.75 for ANM) and thermal care (odds ratio 2.16; 95% CI: 1.64-2.85 for AWW and odds ratio 1.88; 95% CI: 1.43-2.48 for ANM) were significantly higher among women visited by AWWs or ANMs who had better knowledge compared with those with poor knowledge. CHWs' knowledge is one of the crucial aspects of health systems to improve the coverage of community-based newborn health care programmes as well as adherence to essential newborn care practices at the household level.

Factors influencing utilization of ASHA services under NRHM in relation to maternal health in rural Lucknow

Background:Under National Rural Health Mission (NRHM), ASHA (accredited social health activist) has been identified as an effective link to address the poor utilization of maternal and child health (MCH) services by rural pregnant women.Objective:To study the factors influencing utilization of ASHA services in relation to maternal health.Study Design:Cross-sectional.SettingPrimary Health Centre (PHC), Sarojininagar, Lucknow and its rural field area.Study Period:September 2007 to August 2008.Study Unit:RDW (recently delivered women) were considered as those who delivered a live newborn at PHC Sarojininagar, within a week of interview and belonged to villages within the confines of the PHC being served by ASHA.Materials and Methods:350 RDW were interviewed at their bedside, by a preformed and pretested schedule and then were followed-up after six weeks.Results:Utilization of ASHA services for early registration was significantly associated with age and religion of RDW. Young, educated and socio-economic class III RDW utilized ASHA services the maximum for early registration. Utilization of ASHA services for adequate ANC or antenatal care (100 iron and folic acid tablets, 2 tetanus toxoid injection and ≥3 antenatal visits) was also inversely associated with age of RDW. Young, Hindu, scheduled caste, middle school pass, Class III RDW and those with birth order one had high odds for utilization of ASHA services for adequate ANC. With regard to postnatal check-up, again young RDW with birth order one, Hindu RDW in reference to Muslim and RDW in socio-economic class III had higher likelihood for utilization of ASHA services. Caste-wise scheduled caste (SC) and other backward caste (OBC) RDW had higher odds for utilization of ASHA services. Educated RDW and those with educated husband had higher odds for utilization of ASHA services for postnatal check-up.Conclusion:Young, educated RDW with low parity, educated husband and belonging to higher socio-economic class had higher odds of utilization of ASHA services.

Community perceptions of birth weight in rural Uttar Pradesh, India: implications for care of low-birth-weight infants

Effective implementation of interventions targeting low birth weight (LBW) and preterm infants, who contribute 60 to 80% of all neonatal deaths, requires an understanding of local people's perceptions of birth weight. This study was conducted to understand how birth weight is perceived in a low-resource setting, including the etiology, signs and care given to infants of various weights. In this qualitative research study, in-depth interviews and focus group discussions were conducted with recently delivered women (RDW) and their families, as well as local health stakeholders in a rural North Indian community. Birth weight per se is not considered a determinant of newborn health. Instead, newborns are classified into types, and care is provided based on these types. Classification is based on observable criteria, including feeding, vigor and alertness, and interviewees did not always consider low weight a criterion for weak type. In communities that do not perceive birth weight to be an important determinant of health, public health programmes and practitioners must reframe messages regarding additional care for LBW infants at home and care seeking outside the home in locally relevant ways.

Trends in use of referral hospital services for care of sick newborns in a community-based intervention in Tangail District, Bangladesh.

The Projahnmo-II Project in Mirzapur upazila (sub-district), Tangail district, Bangladesh, is promoting care-seeking for sick newborns through health education of families, identification and referral of sick newborns in the community by community health workers (CHWs), and strengthening of neonatal care in Kumudini Hospital, Mirzapur. Data were drawn from records maintained by the CHWs, referral hospital registers, a baseline household survey of recently-delivered women conducted from March to June 2003, and two interim household surveys in January and September 2005. Increases were observed in self-referral of sick newborns for care, compliance after referral by the CHWs, and care-seeking from qualified providers and from the Kumudini Hospital, and decreases were observed in care-seeking from unqualified providers in the intervention arm. An active surveillance for illness by the CHWs in the home, education of families by them on recognition of danger signs and counselling to seek immediate care for serious illness, and improved linkages between the community and the hospital can produce substantial increases in care-seeking for sick newborns.