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Similar to Quality of care in obstetric services in rural South India-evidence from two studies in a ten year period-Asha kilaru
Similar to Quality of care in obstetric services in rural South India-evidence from two studies in a ten year period-Asha kilaru (20)
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More from IPHIndia (20)
Quality of care in obstetric services in rural South India-evidence from two studies in a ten year period-Asha kilaru
- 1. UTILIZATION AND QUALITY OF OBSTETRIC CARE IN RAMNAGARAM DISTRICT: CHANGES OVER A DECADE BELAKU TRUST
- 3. Findings Antenatal Study 1 1996-98 Study 2 2007 - 09 Contact in 1st trimester 56% 83% > 4 antenatal visits 6% 64% Quality of care at antenatal visit BP measured 57% At most recent visit - Abdomen palpated: 88% BP: 66% IFA: 64% Blood test: 13% urine test: 8% advice on signs or problems: 23% Bf advice: 5% postnatal visit advice: 2% Planned to deliver at home 87% 10%
- 4. Findings (2) Study 1 1996-98 Study 2 2007 - 09 Planning for problems and for response to onset of labour Not available, but low according to our observation Not available, but low according to our observation Switching place of del (planned/anticipated to actual) 30% 33% Switched for reasons other than referral by provider
- 5. Findings (3) Study 1 1996-98 Study 2 2007 - 09 Institutional deliveries 35% 82% ANM in attendance at home delivery 34% 17% Oxytocin administered at home delivery 53% 17% Oxytocin administered intramuscular at inst delivery Not available 23% Birth weight recorded <25% 76%
- 6. Findings (4) Study 1 1996-98 Study 2 2007 - 09 Length of stay Usually few hours 62% <6hrs (even with LBW infants) Postpartum/ newborn advice given Rarely given 55-60% (62% of women w/o LBW infant and 56% of those w/ LBW received advice) Perinatal deaths 11 stillbirths 15 nn deaths (26/355 live births) 13 stillbirths 14 nn deaths (27/581 live births)
- 7. Findings (5) Study 1 1996-98 Study 2 2007 - 09 Postpartum visits 58% with some postpartum contact, most with only 1 93%(565) at least 1 contact with HCP Of these, 94% said it was only for baby Most of the visits (68%) reported routine visits for immunization
- 9. Findings (7) SC % (n) Others %(n) Mean ANC visits 5.3 6.1 Timing of 1 st ANC 1 st or 2 nd month 14.3 (21) 27.7 (128) Place of ANC Only government 68.5 (100) 40.7 (188) Only private 9.6 (14) 37.9 (175) Place of birth Home 24.0 (35) 14.7 (68) Sub-centre/PHC 24.7 (36) 18.4 (85) Taluk hospital 34.9 (51) 34.6 (160) Private hospital 5.5 (8) 18.8 (87) **Other govt hospital 9.6 (14) 11.9 (55) En-route 1.4 (2) 1.5 (7) Total sample size 146 462
- 10. Findings (8) SC % (n) Others % (n) Provider spoke with respect 63.0 (92) 70.3 (325) I felt comfortable to ask questions 58.2 (85) 66.9 (265) Other staff were helpful 37% (54) 47.6% (220) Told about postpartum signs needing consultation 50.7% (74) 57.1% (264) LBW 25% 15% Total 146 462
Editor's Notes
- Planned to deliver at home – study 2 - 14% would like home del next time
- Poor Planning - Feeling that childbirth is “normal”. Little understanding of urgency of intrapartum problems. Fear of planning being prophetic. Switching reasons 2 nd study - include onset of unexpected problem, lack of time to reach planned facility, anticipating or finding that a provider or facility would not be open, transport difficulties
- Distribution of inst deliveries - QoC: Significant load on taluk hospital; only 20% delivered at peripheral centres Active mgmt of III stage poor: only 78 women of 501 delivering in institution report any sort of injection in III stage. Very low, even if all these were oxytocin
- Postpartum contact - Counselling low except for contraception An additional 1.3% said PP visit only for mother, and 4.3% said for both
- Study 2 data All of these results are statistically significant In timing of first visit, it seems important to look at early care, even before month 3. Women often say they wait until month 3 before they feel it is a pregnancy, and then they go see a provider. So a reporting of month 3 for a consultation may actually be later.
- 1. women usually do not make decisions about the care they receive
- The recommendations we have put down are specific to our findings. since a significant number of women switched because facilities were closed. during antenatal check-ups, delivery and discharge (e.g., birth planning during antenatal visits, postpartum and neonatal advice before discharge)
- for women with uncomplicated normal births and neonates ≥ 2500 gms after observation of breastfeeding; longer for women with complications and/or low birth weight infants.