Community motivators promote use of emergency obstetric services in rural Sierra Leone

Kandeh, H.B.S; Leigh, Bailah; Kanu, Mohamed; Kuteh, Mabel; Bangura, James; Seisay, Alhassan L.

doi:10.1016/s0020-7292(97)00167-7

Cited by 12 publications

(19 citation statements)

References 4 publications

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“…The use of community health volunteers as agents of health promotion has been a classical approach in community health and other development programs [21,23,32]. In line with findings from Sierra Leone, Nigeria and Bolivia [33-36], our study shows the potential of community change agents - in our case SMPs - to increase utilization of obstetric care and other maternal health services such as early ANC booking and increased number of ANC visits.…”

Section: Discussionsupporting

confidence: 80%

Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Mushi

Mpembeni

Jahn

2010

BMC Pregnancy Childbirth

126

155

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BackgroundIn Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania.MethodThis community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues.ResultsDeliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (ρ < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues.ConclusionThe study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

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Section: Discussionsupporting

confidence: 80%

Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Mushi

Mpembeni

Jahn

2010

BMC Pregnancy Childbirth

126

155

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“…Likewise, the National Perinatality Program of Mali was conceived in 1994 and organised the referral system to improve the environment of perinatal care. Reported interventions at the community level focused on (1) educational activities to raise awareness of danger signs and encourage the use of obstetric services; (2) reducing geographical and financial barriers through emergency loan schemes / subvention and (3) improving transport and communication [Kandeh et al, 1997;Nwakoby et al 1997]. This policy led to an increase in cesarean delivery rates in rural district hospitals [De Brouwere, 1997], but it was very difficult to implement in large cities like Bamako.…”

Section: Referral System and Cesarean Deliverymentioning

confidence: 99%

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

Teguété¹,

Traoré²,

Sissoko³

et al. 2012

Cesarean Delivery

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“…These community-based interventions are referred to as community participation, community empowerment or social mobilisation and aim to increase the use of maternal health services (2–4), and to reduce maternal and perinatal mortality (1). Most community-based interventions involve the use of lay people referred to as community motivators, community health agents, community health workers among others (5, 6). Although the requirement for both supply and demand side interventions are implicit and acknowledged in maternal mortality reduction frameworks, in practice, most maternal and perinatal reduction strategies have mainly focused on the supply side and more tangible interventions (such as buildings, equipments, vehicles, staffing, training and supervision among others).…”

mentioning

confidence: 99%

Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels

Hounton

Byass

Bassane

2009

Global Health Action

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BackgroundReducing maternal and perinatal mortality in sub Saharan Africa remains challenging and requires effective and context specific interventions.ObjectiveThe aims of this paper were to demonstrate the impact of the community mobilisation of the Skilled Care Initiative (SCI) in reducing maternal and perinatal mortality and to describe the concept and implementation in order to guide replication and scaling up.DesignsA quasi experimental design was used to assess the extent to which the SCI was associated with increased institutional births, maternal and perinatal mortality reduction in an intervention (Ouargaye) versus a comparison (Diapaga) district. A geo-referenced census was conducted to retrospectively assess changes in outcomes and process measures. A detailed description of activities, rationale and timing of implementation were gathered from the SCI project officers and summarised. Data analyses included descriptive statistics and multivariate analyses.ResultsAt macro level, the main significant difference between Ouargaye and Diapaga districts was the scope and intensity of the community-based interventions implemented in Ouargaye. There was a temporal association relationship before and after the implementation of the demand-driven interventions and a remarkable 30% increase in institutional births in the intervention district compared to 10% increase in comparison district. There was a significant reduction of perinatal mortality rates (OR =0.75, CI 0.70–0.80) in intervention district and a larger decrease in maternal mortality ratios in intervention district, although statistical significance was not reached. A comprehensive framework of community mobilisation strategy is proposed to improve maternal and child health in poorest communities.ConclusionControlling for the availability and quality of health services, working in partnership and effectively with communities, and not for them – hence characterising communities as not being empty vessels – can have impacts on outcomes. Here, in the district with a community mobilisation programme, there was a marked increase in institutional births and reductions in maternal and perinatal deaths.

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Community motivators promote use of emergency obstetric services in rural Sierra Leone

Abstract: The project improved utilization of the PHUs by women with complications, indicating that once services are of acceptable quality, many women will use them. The contribution of the motivators was positive, though smaller than expected.

Cited by 12 publications

References 4 publications

Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels

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