Academic journal article Contributions to Nepalese Studies

A Qualitative Description of Perinatal Care Practices in Makwanpur District, Nepal

Academic journal article Contributions to Nepalese Studies

A Qualitative Description of Perinatal Care Practices in Makwanpur District, Nepal

Article excerpt

Introduction

Perinatal mortality remains high throughout south Asia. Deaths in the perinatal period are intimately linked to the health of the mother and her newborn. Despite their public health importance interventions to address perinatal deaths have tended to focus upon managing complications and service provision. There is, however, a wealth of health-seeking behaviour literature documenting that access alone does not increase health service utilisation. A combination of socio-economic and cultural factors contribute to seeking and receiving health care (Hotchkiss 2001:44) (Devkota 1984:11) (Erickson 1995:11) (Justice 1983:96) (Reissland and Burghart 1989:17) (Thapa 1996:871). With the majority of births in south Asia taking place at home, it is here that illness is recognised as such, and here that preventative measures to avoid illness are practised. An appreciation of care practices and health-seeking behaviour for the population at risk is essential to define the thrust of health education, so that care providers respond appropriately when a problem arises.

Background

We are presently conducting a study on the impact of a community-based participatory intervention to improve essential newborn care (ENC). The study is a cluster randomised controlled trial involving 12 pairs of Village Development Committees (VDCs)in Makwanpur District, Nepal (1). The study has three major areas of activity:

1. The intervention: this is a participatory intervention based on a model used in Bolivia (Howard-Grabman n.d:105). A VDC Facilitator is placed in each intervention VDC with a brief to work with women's groups in an action learning process to address problems in pregnancy and care of the newborn infant. The VDC Facilitator is a local woman who attempts to broker change in care practices. 12 VDCs will receive the intervention over three years. 12 matched VDCs will serve as controls during this period, after which they will receive the intervention in a form that will have been modified on the basis of the findings of the initial study.

2. Health service strengthening: this is carried out across the entire district in co-operation with His Majesty's Government of Nepal District health services. It comprises audit, training of personnel and supply of essential equipment and medications for care of the newborn infant. The health service strengthening team are also involved in the technical training of programme staff.

3. Surveillance: in the 24 study VDCs, a cohort of married women of reproductive age (15-49 years) have been enumerated and are followed prospectively every month, to identify pregnancies and determine the outcomes of births.

The aim of the overall programme is to bring about sustainable improvement in the care of mothers and their newborn infants, an improvement that should benefit morbidity and mortality. Improvements in care would ideally take place in the home, within the lay referral network and within the health service system. It is towards the first of these that the facilitation team is working.

Objectives

The first phase of the programme involved community entry and a period of qualitative data collection. To design an effective community intervention targeted at improving perinatal and neonatal outcome, current perinatal care practices, problems and health seeking behaviour need to be understood and located within the social context. Perinatal problems and health seeking behaviour have been documented elsewhere. This part of the study aims to document the language used for perinatal health and current practices during normal pregnancy, birth and post-partum.

Methods

Setting: Makwanpur District occupies 2426 sq km and lies to the south of Kathmandu in the Central Region, Narayani Zone. It has a population of 395 889, the vast majority of whom are employed in agriculture. Topographically, Makwanpur includes both hill (pahaad) and plains (terai) areas. …

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