Background
Methods
Study setting
The better health outcome through mentorship and assessment project: BHOMA II
Community conversations
Target communities
Data collection process
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General concerns regarding reproductive health in the community;
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Challenges in accessing family planning services;
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Challenges in attending ANC;
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Challenges in facility-based delivery;
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Risk factors associated with pregnancies; and
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Perceived causes of maternal and neonatal mortality within the community.
Data management and analysis
Selection of projects for consideration
Ethical consideration
Results
Demographic characteristics of participants
Step | Date of Implementation | District | Health facility | No. of females | No. of males | Total |
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Step 1 | Jun-14 | Kafue | Kambale | 12 | 16 | 30 |
Kafue | Kazimva | 23 | 22 | 45 | ||
Chongwe | Lwiimba | 9 | 11 | 20 | ||
Chongwe | Mwalumina | 13 | 7 | 20 | ||
Luangwa | Luangwa Boma | 12 | 13 | 25 | ||
Step 2 | Jul-14 | Kafue | Railways | 24 | 21 | 45 |
Kafue | Kris Katumba | 17 | 8 | 25 | ||
Chongwe | Kasisi | 13 | 17 | 30 | ||
Chongwe | Zasti | 11 | 14 | 25 | ||
Luangwa | Chitope | 10 | 15 | 25 | ||
Step 3 | Sep-14 | Kafue | Chilanga | 24 | 26 | 50 |
Chongwe | Mpango | 18 | 22 | 40 | ||
Chongwe | Chinyunyu | 21 | 19 | 40 | ||
Chongwe | Nyangwena | 16 | 14 | 30 | ||
Luangwa | Mphuka | 9 | 16 | 25 | ||
Step 4 | Oct-14 | Kafue | Mwembeshi | 17 | 13 | 30 |
Chongwe | Rufunsa | 9 | 11 | 20 | ||
Chongwe | Chainda | 22 | 18 | 40 | ||
Chongwe | Ngwerere HP | 8 | 7 | 15 | ||
Luangwa | Kasinsa | 10 | 15 | 25 | ||
Total | 298 | 305 | 605 |
Geographical access
“Because labour starts all of a sudden, we see women giving birth on the way, as the labour ward is very far. If we had anything nearer, we wouldn’t have been experiencing such challenges.”
Male participant, Luangwa
“The other reason that women give birth from homes and on the way to the hospital is because we do not have transport. The ambulance that has been provided for Luangwa does not get to us, we just see it from a distance.”
Female participant, Luangwa
“Yes, the problem is really big here, as the majority of the villages are very far away from the health facility … How do you honestly expect a pregnant woman in labour to use an oxcart with the rough roads? I have my own experience with transport; my own wife was due for delivery, and she asked me to take her to the centre; due to the unavailability of transport, I straddled her onto my farm tractor and started heading to the clinic. On our way, the child dropped from her as I sped on the bad road. And when I stopped, I found that the child was still attached to the mother, and I managed to wrap it, and we managed to get to the centre.”
Male participant, Kafue
Infrastructural challenges
“Pregnant women need to move close to the clinic before it is too late … if there was a shelter, it could have been much easier for them to sleep and even prepare some food for themselves.”
Male participant, Kafue
“ … sometimes women are afraid because the facility is small and the people will hear you when you start crying. Sometimes men are passing [by], so it is embarrassing. There is also no toilet, no shower, It is embarrassing for everyone to be looking at you. To avoid this embarrassment, it [is] better to deliver from home.”
Female participant, Chongwe
Availability of essential commodities
“I had a case like that. One mother came at night and did not have anything for a safe delivery. No gloves, no razor, no blanket; she was unprepared. So most women decline [to go] to the clinic when they realise they are not prepared.”
Traditional birth attendant, Chongwe
“The problem is that the delivery requirements are expensive. So many who cannot afford [them] stay home.”
Headman, Kafue
“I want to talk about Jadelle [a long-acting reversible contraceptive implant]; it is not in stock most of the time. A person could want to change from oral contraceptive because it causes side effects, but when you come here, you are only told that it is not available.”
Female participant, Kafue
“There are times that when a woman comes to access family planning, it is discovered that there is nothing available, and so they are advised to go and buy from a private chemist. But that woman has no money, and she will end up going back home and conceiving. So we are requesting that these drugs be readily available at all times.”
Female participant, Chongwe
Human resource shortages
“We have also noticed that sometimes only one nurse is on duty, and she cannot handle all the cases. So some mothers simply end up going home. When these women have to wait long, they get discouraged.”
Male participant, Chongwe
“I think a lack of man power at the clinic is a major problem. When you go to the clinic, you find one doctor, and when an emergency happens, he is going to rush for the emergency, leaving you waiting; as you know, he can’t handle two cases at once.”
Female participant, Luangwa
“ …. the problem is that even if they deliver at the clinic, they are helped to deliver by the TBAs, not the nurses.”
Male participant, Kafue
“For those who come from afar, they wait for the nurses to go there for outreach services because they cannot manage to come here. It’s very far. At times the nurse doesn’t go to the monthly outreach. So on the month that the nurse doesn’t go for the meeting, [mothers] don’t register until the nurses go to the outreach. That is why others register when they are 6 or 7 months pregnant.”
Female participant, Chongwe
“The problem is that the clinic is understaffed; the clinical officer is the one always on duty … and the clinical officer is our friend. So the mothers don’t want to be handled by the person who happens to know them. They prefer someone they totally don’t know or a fellow woman.”
Male participant, Chongwe
“One of the problems that I have seen is that some of the nurses don’t know how to help women deliver. They are just nurses, but they are not trained to deliver. So we only have one nurse who knows how to deliver [babies from] pregnant mothers.”
Female participant, Kafue
“Some women do not go to the clinic because they are more comfortable in the hands of the TBA than at the clinic. They fear being shouted at and sometimes insulted during delivery.”
Male participant, Chongwe
“Sometimes some women say that they can’t go for fear of being rebuked for being dirty by some nurses. Some are even rebuked for coming with unclean children or wearing the same clothes all the time.”
Female participant, Luangwa
“I also just wanted to echo the sentiments expressed by the previous speaker that women would rather give birth from home for fear of being shouted at here at the health centre by staff for not having all the requirements needed for labour. And so I would like to urge the nurses to be compassionate and understanding; it is not everyone that comes from a family that can afford what is needed.”
Female participant, Kafue
Knowledge gap and misconceptions
“I used the pills at first and had side effects, and then I got injectables. But they too gave me problems, and so I reverted to pills. But the problem is that I can’t conceive now when I want to.”
Female participant, Kafue
“We know for a fact that when a woman takes these tablets for a long time, she fails to conceive. These things block her completely with little or no chance of ever conceiving.”
Male participant, Kafue
“We hide [our use of] family planning, [because] we fear arguments in the home and the little children in the home, so we hide [them] so that they are not found.”
Female participant, Kafue
“I also found the same problem of my wife hiding the pills from me when we had agreed to stop using family planning methods, having spaced our previous children; but I was surprised that she was still taking the pills secretly.”
Male participant, Luangwa
“I think that if a couple starts using condoms in the house, it means that there is one or both of you who is promiscuous and [that] you don’t trust each other”
Male participant, Kafue
“ … the other thing is that churches don’t allow church members to use family planning, for example, Catholics.”
Male participant, Chongwe
“I want to find out at what age a woman is supposed to access family planning. I say so because some women are allowing their children to start contraceptives so that they finish their education, and I think that is one reason that is causing all of these pregnancy complications.”
Male participant, Chongwe
“If you allow them [young people] to use family planning methods, that means they will have freedom and they will be having sex freely without even a worry; let’s just teach them what’s bad so that even when they are doing it, they are scared of the consequences.”
Male participant, Kafue
Summary of major problems across all study sites
Site | Proposed interventions | Community Contributions | Project contribution |
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Lwimba | Build outreach post at Ndapula (11 km) and Lukoshi (15 km).construction of mothers shelter at the clinic | Support outreach health services. (NHCs, CHWs, TBAs).Provide sand, bricks, stones and labour towards the construction of mothers shelter | Material support toward construction of mother’s shelter (Not more than allocated amount to site) |
Mwalumina | Construction of bathroom for mothers at the health centre | Provide bricks, sand stones and labour | Provide building materials for incomplete mother’s shelter |
ZASTI | Community Sensitisations on safe motherhood issues | -Conduct continuous health education on safe motherhood issues during community meetings and drama performances | Sensitization on information of SMH |
Kasisi | Community sensitisation on importance of safe motherhood health services | Form community groups in each zone for sensitization. Form drama group. Sensitization through door to door, vilage meetings and outreach services by CHWs, TBAs and NHCs | Sensitization on information of SMH |
Ngwerere HP | Conduct community sensitization through community meetings, churches, door to door and Drama performances. Community members to also form drama group | Conduct Health Education on importance of ANC, HIV testing, Clinic delivery, postnatal care and family planning with emphasis on long term contraception during village meetings, farm meetings and NHCs meetings. Conduct drama performances | Cooperatives approach (ride on existing cooperative initiatives and include sensitization on SMH) |
Sensitization on dangers of teenage pregnancies in schools and communities through drama performances. Conduct health education in communities and schools. Sensitization and counseling of parents at community level on benefits of FP to teenagers and dangers of Teenage pregnancies | Drama groups to perform in schools and market places to sensitize teenagers on the dangers of abortions, HIV and importance of contraception. | Engage with SFH to provide training and LARC for use at clinic | |
Chainda | Carry out Drama performances in community on importance of males to support their wives. Use village headmen during community meetings to allow TBAs, NHCs CHWs provide health education and carry out community sensitization on importance of male involvement, and the benefits of utilization of ANC, facility delivery and family planning services.- equip knowledge to headmen and NHCs by carrying out trainings and skills on issues of safe motherhood in order to assist in dissemination of right information in communities | provide local drama group to carry out drama performances in all the zones.- Support the mobilization of people for the drama performances through NHCs, Headmen and health centre staff. HCC and health staff to identify community leaders and members to be trained on safe motherhood. HCC together with health staff to plan and monitor action schedule for the activities. HCC and heath staff to arrange a meeting with apostolic church leaders in chimbali area on issues of health in order to allow their members access health services. | Purchase marquee and put slab |
HCC to be holding meetings with health center staff to discuss best way forward to avoid misunderstandings. | HCC through the HCC chairperson to provide platform for dialogue on behalf of the community. TBAs to continue assisting the health staff in providing knowledge to mothers for clinic deliveries, and early ANC bookings. | ||
Rufunsa | To construct mothers shelter at the clinic for use by expectant mothers and their relatives | Mold bricks, provide sand,stones and Labour toward s the construction of the mothers shelter. Prepare the BOQ for other required building materials such as Cement, planks, roofing sheets,etc. | Material support toward construction of mother’s shelter (and provide sensitization in SMH to expectant mothers) |
Mpango | Conduct community sensitization on safe motherhood issues | Sensitize community members through village meetings and NHCs. Conduct Drama performances | Sensitization in SMH issues |
Conduct community sensitization on importance of Birth preparedness and Male involvement | Teach community members through village meetings and NHCs on importance of birth preparedness and male involvement. Conduct Drama performances | ||
Nyangwena | Carry out drama performances in community on importance of males to support their wives | provide local drama group. Mobilize people for the performances through NHCs, Headmen and health centre staff. | Provide a marquee at site for venue for health talks |
Chinyunyu | Community sensitization on importance of male involvement in safe mother hood issues | NHCs, CHWs, TBAs and community leaders to sensitize males during village meetings as well as drama performances | Provide a marquee at site for venue for health talks |
KAMBALE | To conduct sensitisation in safe motherhood | Community mobilization, formation of drama group | Women’s groups (ride on existing social groupings; provide logistics for social activities) |
To train and support SMAGs | Volunteers [men and women] to be trained in SMAGS | ||
To train and support youth friendly health services | Youths to be trained as peer educators | Women/youth groups (ride on existing social groupings; provide logistics for social activities) | |
KAZIMVA | To form Safe motherhood action groups. Sensitisation of the communityPromote male involvement in SMH activities | Commitment and volunteerism in terms of enrolling in SMAGs and being active, sanitization on safe motherhood | Provide a marquee at site for venue for health talks |
To train FP providers in long acting methods, | Training venue | Engage with SFH to provide training and LARC for use at clinic | |
Sensitisation of community on FP, train CBDs, SMAGs | TBAs, CBDs, SMAGs to conduct sensitisation, | ||
RAILWAY CLINIC | To sensitise the community on safe motherhood activities, To form, train and support SMAGS | Volunteers [men and women] to be trained in SMAGS | Women’s groups (ride on existing social groupings; provide logistics for social activities) |
To form,train and support youths in YFHS | Peer educators, staff, teachers to be trained, training venue | Women/youth groups (ride on existing social groupings; provide logistics for social activities) | |
To sensitise the community on safe motherhood activities and neontatal care | Community mobilization, Formation of drama group | Women’s groups (ride on existing social groupings; provide logistics for social activities) | |
KRIS KATUMBA | Mass sensitisation through local leaders, drama performances | Volunteers, drama groups | Women’s groups (ride on existing social groupings; provide logistics for social activities) |
Forming and training of Safe motherhood action groups, CBDs | Provide volunteers for training and the venue | Women’s groups (ride on existing social groupings; provide logistics for social activities) | |
To provide adequate amounts of the FP methods | Sensitisation of the mothers o the available methods | Engage with SFH to provide training and LARC for use at clinic | |
CHILANGA | To conduct regular outreach in distant zones, To include SMH activities such as ANC,PNC,FP during outreach | Provide space for outreach., Mobilise communities during outreach services | Provide Portable Tents, couch, linen |
MWEMBESHI | Create mass awareness through community sensitisation involving local leaders, SMAGs, TBAs, CBDs, NHCs and other social advocates, Promote male involvement in all SMH activities | Volunteers in form of SMAGs, TBAs, CBDs, NHCs, traditional, Church leaders etc., Community mobilisation, Use males as role models | Cooperatives approach (ride on existing cooperative initiatives and include sensitization on SMH) |
Luangwa Boma | Strengthen community health education and male involvement. | SMAGS to conduct door to door HE and follow up all males that don’t escort their wives for ANC on a monthly basis. | Provide a marquee at site for venue for health talks |
Headmen to prepare a schedule of CC/meetings which will be followed by all. | |||
Community meetings/conversations | Headmen & HC to identify and invite stakeholders to disseminate the RHS key messages. | ||
Involving churches to disseminate Reproductive Health key messages. | |||
Chitope | Massive community sensitization | SMAGs, CHWs and TBAs to intensify community sensitization through door to door visitations. | Procure motorbike ambulance |
Construction of Mangelengele community health post. | Community to provide sand, stones and mould bricks. | ||
Mphuka | Construction of a Labour ward at the health facility | 25% community contributions through moulding of blocks and provision of sand and stones | Procure bicycle ambulance |
Massive sensitizations by Safe motherhood Action Groups (SMAGs) on birth plans. | The area councilor to spearhead for the application of Constituency Development Fund | ||
The Community to lobby to DMO to send a female midwife or Nurse to the facility | HC to provide Birth plans to the SMAGS/TBAs to be used during door to door visitations. | ||
Full TBA Training to be conducted. | |||
Kasinsa | Intensify community sensitizations by Safe Motherhood Action groups, (SMAGs) Traditional birth attendants, CHWs, NHC Chairpersons and the headmen. | SMAGs to come up with an action plan of educating women on Birth Plan and continue with door to door visitations. | Procure motorbike ambulance |
Construction of a Mothers’ shelter at the health facility. | 25% community contributions through moulding of blocks and provision of sand and stones. | ||
Lobby for the purchase of Motorbike ambulances to help on transport. | The Health centre, HCC and the Councilors to work together and apply for Community Development Fund (CDF). |