Myanmar Health Sciences Research Journal

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MATERIALS AND METHODS

 

Study design and study population

A community-based, pre- and post-inter-vention study was conducted applying both quantitative and qualitative methods at Kanpetlet Township and Paletwa Township, Southern Chin State. Baseline assessment was carried out in 2015 and end-line assess-ment was conducted during September-December 2017. Study population included mothers of less than 2 years old children and health care providers.

Inclusion criteria

Mothers of under 2 years old children who are staying at least 2 years at the study township

Exclusion criteria

Mothers of under 2 years old children who were moving into the study township after delivery of the index child. Participants included in the qualitative assessment were responsible providers from public sector, focal persons from international and local non-governmental organizations, volunteers and VHC members.

Intervention components and process

Program intervention activities were supporting BHS for MNCH activities such as providing travel expenses to attend monthly meeting, financial support for meeting with VHC, outreach and supervision support; revitalizing village health committee, and training of CHWs, AMWs and VHC for raising awareness of community and emergency referral. In particular, CHWs, AMWs and VHCs were trained under the leadership of Township Health Officer and BHS regarding the danger signs and need of emergency referral to implement community health prevention and behavior change communication (BCC) activities in colla-boration with BHS.

A process called Accountability, Equity, and Inclusion (AEI) practice cycle was also conducted as a series of meetings between BHS, VHC and local NGO. It is applied to identify the gaps in MNCH care after discussions have been made between local NGO, BHS and VHC thereby aiming for improving MNCH care. AEI cycle was carried out as the step-by-step approach aiming to recognize challenges, search for the solutions and make final decision after discussion with focal person from public sector.

Sample size and sampling

Sample size was calculated considering
a difference in proportions of mothers on knowledge about danger signs before and after the intervention as 25% (50% before intervention and 75% after intervention). Therefore, total number of mothers needed in each township would become 140 for 95% confidence level, power of 80%, design effect of 2, and non-response rate 5%. Cluster sampling was applied to recruit the required sample size. At each township, seven villages were randomly chosen considering to include from different geographical areas and after excluding the no-go zones and conflict areas. At each selected village, a total of 20-25 eligible participants were recruited. A total of 12 qualitative interviews were done by using purposive sampling.

Data collection

Training of interviewers was done at Department of Medical Research before field data collection. Using a pre-tested, structured questionnaire, face-to-face interviews were conducted with mothers of under two years old children by well-trained interviewers.
In some villages, interviews were done with the help of trained translators.
Outcome measures for quantitative assessment were knowledge and practice of mothers on antenatal, delivery and post-natal period. Key informant interviews (KIIs) with responsible service providers and in-depth interviews (IDIs) with volunteers and VHC members were also carried out using the guidelines. Confidentiality of the participants’ information was ensured.

Data management and analysis

Data entry was done using EpiData-3.1 and analyses were conducted using SPSS version 20. Descriptive statistics were shown as frequency and percentage for categorical variables and as mean or median for continuous variables. Comparison of out- come measures was done using Chi square test. Manual thematic analysis was applied for qualitative information. Triangulation of the research results was done from both quantitative and qualitative information to capture the comprehensive understanding of the program.

Ethical consideration

Verbal informed consent was taken from all the participants after thorough explanation about the assessment. Anonymity and confi-dentiality of the information were ensured using the code numbers and only inves-tigators have accessed to the information.
The study was approved by the Ethics Review Committee of Department of Medical Research, Myanmar (Ethics/DMR/ 2017/ 159).

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