Targeted approach needed for better maternal and child health outcomes: CBTS
Article132.png”” alt=””Article132″” />A rolling short sample survey on mother and child health in 25 districts of Uttar Pradesh where health indicators are poor has suggested that it is important to strengthen the specific health promotion interactions between frontline health workers, women and their families on issues related to family planning, breastfeeding, complementary feedings, and immunization. “”Overall, from an equity perspective, it may also be important to target specific population groups abd blocks that may be experiencing the greatest need and may be the most vulnerable to poor outcomes due to social and supply factors,”” says the Community Behaviour Tracking Survey (first round) conducted by the Uttar Pradesh Technical Support Unit.
According to the survey, only 4% of the women who delivered in the past 2 months had received all three components of recommended antenatal care (ANC) or more ANC check-ups, 2 TT injections, and 100 iron folic tablets. While most (71%) pregnant women received 2 TT injections, only 13% received 3 of more ANC check-ups. The ANC check-ups often did not include critical elements for detecting high risk pregnancies like 37% of the recently delivered had an ANC done in their 3rd trimester of pregnancy, but only 24% had their blood pressured assessed and 26% had their haemoglobin level checked.
Women contacted by an Accredited Social Health Activist (ASHA) during pregnancy were more likely to plan facility deliveries, and a greater proportion of women who planned to deliver in a facility had an institutional delivery. Yet, only 57% of the mothers who had delivered in the past 2 months reported that an ASHA visited them at home during pregnancy. “”It may be important for the TSU Community Resource Persons (CRPs) to focus greater attention on strengthening the quantity and quality of ASHA visits in order to influence institutional delivery rates in the focus blocks. 63% of the women who delivered had an institutional delivery (52% in government facilities and 11% in private facilities) while 37% still reported home deliveries.
The CBTS included five demographic groups which are relevant for RMNCH+A (reproductive, Maternal, Newborn, Child and Adolescent health) programming: women who had delivered in the past 2 months of the survey (done in February 2015), mothers with children aged 3-5 months, mothers with children aged 6-11 months, mothers with children aged 12-23 months, and adolescents aged 13-19 years.
Since its establishment in November 2013, UPTSU has been providing an integrated techno-managerial support to improve the planning, implementation and monitoring of health programmes in 25 high priority districts (HPDs) in the State. The TSU is providing implementation support at the community and facility levels through its Community Resource Persons and Block Community Supervisors and Nurse Mentors, respectively. The State monitoring systems are being strengthened with the TSUâ€™s support in improving the quality and use of HMIS/MCTS data. This data from the TSUâ€™s CBTS will further help in validating the service coverage data from HMIS and making mid-course corrections in the programme implementation at the district and block levels. The data is available for the first time from Block levels for the 100 of the 294 blocks in 25 HPDs.
Postnatal and newborn care is poor regardless of settings. Only 37% reported that an ASHA visited them at home within 24 hours of delivery or discharge from facility. The neonatal mortaliy rate estimated in the 100 TSU focus blocks was 29.9 per 1,000 live births. Improvements in postnatal care provide an incredible opportunity to decrease childhood mortality as more than 50% of child deaths occur in the first month of life, the survey says.
Of mothers delivered in the past 2 months, only 22% initiated breastfeeding within one hour of birth. When women with children aged 3-5 months were asked if the child was given anything other than breastmilk in he past 24 hours, 53% responded in the negative. Only 16% of the children aged 6-11 months were both breastfed and given complementary feedings.
Overall, 54% of the children aged 12-23 months were fully immunized (BCG, 3 doses of DPT and measles vaccine) and 12% have not received any primary vaccines. Only 4 TSU focus blocks had achieved a full immunization rate of more than 80% and for the remaining 20 blocks, the full immunization rate was less than 40%.
During the last episode of diarrhoea for children, one third had received rehydration oral solution (ORS), 19% had received zinc, and only 10% received both zinc and ORS. Overall, 73% children (up to 2 years) were treated with an antibiotic when they had symptoms of pneumonia.
On the family planning front the Survey says the prevalence of modern contraceptive use among women interviewed was 14% (0.3% IUCD, 1% female sterilization and 12% other methods). Unmet need for spacing (wanting another child after 3 years) was 19% and unmet need for limiting (not wanting more children) was 28%. In 25 TSU focus blocks, the proportion with unmet need for family planning (spacing and limiting) was over 60%. Counselling for family planning was poor with only 15% of women delivered in the last 2 months and 20% of women with children aged 3-5 months reporting having received any counseling or advice on family planning during their pregnancy.
Currently, 55% of adolescent girls (13-19 years) attend school, college or university and the coverage of Centreâ€™s Weekly Iron Folic Supplementation (WIFS) programme is very low, with less than 3% girls having received weekly IFA tablets in the month prior to the survey. Only 3% of adolescent girls reported that hey had bought sanitary napkins from ASHA/AWW/ANM in the 6 months.”