Myanmar Health Sciences Research Journal
Original Article:
The Korean Journal of Parasitology 2020; 58(3): 217-227.
Published online: June 26, 2020
DOI: https://doi.org/10.3347/kjp.2020.58.3.217

Enhancing Changes in Undesirable Practices and Health Sector Response Related to Maternal, Newborn and Child Health in Paletwa Township: A Qualitative Approach

Yadanar Aung, Kyaw Thu Soe & Kyaw Oo

Myanmar Health Sciences Research Journal, Vol. 32, No. 1, 2020

Abstract

The project on strengthening local capacities to improve Maternal, Newborn and Child Health (MNCH) interventions has been launched in 100 villages of Paletwa Township, Chin State since 2010,. This cross-sectional study using qualitative methods aimed to assess the knowledge, perceptions, and practices related to MNCH and health sector response in rural setting. The research team used a multistage sampling procedure to select 9 villages from December 2015 to February 2016. In each selected village, the eligible women with under 2 years old children (n=72) were purposively selected to join 9 focus group discussions and 9 mothers participated in in-depth interviews. Moreover, the team recruited 9 midwives and 9 auxiliary midwives for key informant interviews using pre-tested guidelines. All sessions were audio-recorded and supplemented by manual note-taking. Village women revealed good knowledge of care during pregnancy, delivery, post-natal and newborn care. However, some risky traditional practices for both mothers and newborns remained such as food taboos and cord care. Focus group discussants reported home deliveries either on their own or assisted by untrained traditional birth attendants (TBA) rather than choosing skilled birth attendants or hospital delivery due to spreading myths and misconceptions. Health care providers reached a consensus for improving awareness of the consequences of home deliveries assisted by unskilled TBAs/none, not using contraception and improper newborn/ infant feeding practices. Developing information, education and communication materials in a simple language inclusive of the needs to change undesirable practices and to promote the use of quality services is critical in a remote setting.

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INTRODUCTION

INTRODUCTION

 

Myanmar has made significant progress in improving maternal, newborn and child health (MNCH), but in remote areas still remarkable gap between health sector response and strongly needed to enhance changes of undesirable practices among Chin ethnic minority women. Although Myanmar’s overall maternal mortality rate is 282 per thousand live births, Chin State figured out that ethnic minority people have higher maternal mortality (MMR : 357 per thousand live births), infant  and  under five mortality rates in 2014.1 The project on strengthening local capacities to improve MNCH inter-ventions has been launched since 2010 in 100 villages of Paletwa Township, Chin State. The International Rescue Committee (IRC) has worked with local Non-Governmental Organizations (NGOs) in Paletwa Township, Chin State in past 6 years to implement the project interventions.2

The project trained community health workers (CHW), auxiliary midwives (AMW),  and Village Health Committees (VHC) to imple- ment community health prevention and behaviour change communication (BCC) activities in collaboration with Basic Health Staff (BHS) including midwives (MW). Baseline and midterm surveys on Knowledge, Practice and Coverage (KPC) concerning reproductive health interventions were completed.3 More mothers in project villages were aimed to be able to identify warning signs of childhood diseases and to seek timely care from trained health care providers mainly CHWs. During the years of inter- vention, the project led to more positive deviants than negative in terms of knowledge, practices and coverage of MNCH services.3 However, sustainability issues should be put forward for changes in breast feeding, postpartum care, child care, immunization and sanitation practices that require more external resources. To evaluate the impact of previous project implementation and to address the gaps in health sector response, this research aimed to identify the know- ledge, perceptions, and practices related to MNCH and health sector response in rural setting in Paletwa Township, Southern Chin State.

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MATERIALS AND METHODS

MATERIALS AND METHODS

 

A cross-sectional study using a qualitative approach was conducted in Paletwa township from December 2015 to February 2016. Among those areas which had granted to secure, good communication skills, and responsiveness of village women, nine clusters with similar travel route were included. After assembling the village based on transportation ability, village (easy to reach and not easy to reach) was selected by random. The research team used a multistage sampling procedure to select 9 villages in Paletwa township. In each selected village, the eligible women with under 2 years old children (n=72) were purposively selected to join 9 focus group discussions and      9 mothers participated in-depth interviews. Each FGD lasted one and a half hour conducted by one trained moderator/ facilitator and two note-takers. At each and every village, focus groups were scheduled to encompass all work shifts. One trained local interpreter attended the FGDs to minimize the language barrier. Moreover, the team recruited 9 midwives and 9 auxiliary midwives for key informant interviews using pre-tested guidelines which lasted 45 minutes to one hour. Guidelines covered knowledge, perception and practices related to MNCH care. Participants were assured anonymity and confidentiality of their responses. All sessions were audio-recorded supplemented by manual note-taking. After transcribing, coding was done by using ATLAS.Ti software. Two researchers reviewed the trans- cripts and identified themes and subthemes. Triangulation was done for meaningful interpretations of findings from FGDs and KIIs.

Ethical consideration

The Ethics Review Committee of Department of Medical Research approved this study. All interviews were done following the written and informed consent.

DISCUSSION

DISCUSSION

 

The study highlighted the traditional practices related to MNCH in a remote rural setting that required intensive BCC and other support for BHS and volunteers amidst of project interventions that aimed to promote an access to health information and quality care.

Improved vs. unimproved practices and associated factors

After project interventions over a six-year period, PN care practices including proper cord care, and early breast feeding were improved. But some traditional behaviours remained like nutrition for pregnant mothers and cord care that were risky for both women and newborn. There were some barriers such as lack of local adaptability of IEC materials and health information given by health staff. Nonetheless, findings indicated good knowledge of mothers, satisfaction of services provided by BHS, and compliance to referral due to good system support. However, they still practiced home delivery and use of TBA due to some limitations related to choose SBA and hospital delivery.4 In most of the RHCs, BHS were not available because they had to attend training and/or meeting at Paletwa township hospital. Accessibility/ availability of skilled providers and lack of consciousness on risk during delivery were main factors that influenced utilization of skilled birth attendants which was consistent to other studies.5, 6

The number of healthcare providers and midwives required strengthening in the study sites according to the geographical landscape and population expansion. Major constraints in access to the health center for delivery in this study encompassed socio-economic hardship, and cultural barriers. Better knowledge and good education
were main factors influencing the utilization of quality services.7
Pictorial cards have been used in resource-poor settings in rural Nepal to educate women on pregnancy danger signs, birth-preparedness, and maternal nutrition.8

Focused BCC using pictorial cards during AN visit in study sites or similar remote rural areas might improve knowledge regarding five danger sings in pregnancy with clear implications for improving institutional delivery rates. Moreover, educational cam- paigns and behaviour change activities should modify both modern and traditional beliefs and practices to help women be better able to access safe motherhood, delivery and child cares.3 Maternal nutritional practices need to be changed and educated well not to follow traditional eating habits during post-partum period (42 days after delivery). Like previous study9, continuation of exclusive breast feeding practices should be encouraged.

Health sector response, challenges encoun- tered and potential solutions

In this study, production of adequate numbers of AMWs, capacity building of  local volunteers and village health committee members, and existing fund-pooling mechanisms were noted as good opportunities for sustainable BCC interventions.7, 8 Further- more, motivation and incentives for local volunteers to prevent attrition is essential for the community on the changes they want to get while making significant behavioural changes. Increasing coverage of local volunteers and their capacity is the most possible, practical and effective implement-ation. There is a need to promote community awareness in existence of fund-pooling mechanisms and support functions of VHCs. The training for VHWs should include how to provide effective health education messages for clients especially about danger signs in pregnancy, life-threatening compli-cations in delivery as well as danger signs of newborn/childhood illnesses and untoward consequences related to lack of childhood immunization. The formal and sustained IEC channels should be considered. Developing information education, and communication materials in a sample language inclusive of the needs to change undesirable practices and to promote the use of quality services is critical in a remote setting.

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ACKNOWLEDGMENT

ACKNOWLEDGEMENTS

 

We would like to extend our words of thanks to the International Rescue Committee (IRC) for financial support to conduct this study. Our heartfelt gratitude goes to Township Medical Officer, local authorities and administers of Paletwa Township for their
contributions in conducting research and security concerns. Last but not the least, we owe our gratitude to research assistants from DMR (POLB) for their kind assistance and our deep respect to Dr. Kyaw Oo for overall technical guidance during this study.
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CONFLICT OF INTEREST
CONFLICT OF INTEREST

Competing interests

The authors declare that they have no competing interests.

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REFERENCES

REFERENCES

 

1.    Department of Population. The 2014 Myanmar Population and Housing Census. Naypyitaw, Ministry of Immigration and Population, 2015.

2.    3MDG Fund. Supporting Implementing Mater- nal Newborn and Child Health Services (MNCH) in Chin State. [Internet]. 2013. Available from [https:// www. 3mdg. org/ en/ what-we-do/ maternal-newborn-and-child-health/ partners-projects/ item/ 438-save-the-children-township-health-plan-chin-state]

3.   International Rescue Committee. Report of Knowledge, Practice and Coverage (KPC) Survey for Maternal and Child Health, Paletwa Township, Southern Chin State. IRC, Myanmar, 2012.

4.     Ministry of Health and Sports & ICF. Myanmar Demographic and Health Survey 2015-16. Naypyiptaw, MoHS and ICF, 2017.

5.     Sollom R, Richards AK, Parmar P, Mullany LC, Lian SB, Iacopino V, et al. Health and human rights in Chin State, Western Burma: A population-based assessment using multistaged household cluster sampling. PLoS Medicine 2011; 8(2): e1001007.

6.    Diamond-Smith N, Thet MM, Khaing EE & Sudhinaraset MJC. Delivery and postpartum practices among new mothers in Laputta,  Myanmar: Intersecting traditional and modern practices and beliefs. Culture, Health & Sexuality 2016;18(9): 1054-1066.

7.    Wanjira C, Mwangi M, Mathenge E & Mbugua G. Delivery practices and associated factors among mothers seeking child

welfare  services  in  selected health facilities in Nyandarua  South  District,  Kenya.  BMC Public Health 2011; 11(1): 360.

8.    McPherson RA, Tamang J, Hodgins S, Pathak LR,  Silwal  RC,  Baqui  AH,   et al. Process evaluation of a community-based             

       intervention promoting multiple maternal and neonatal care practices in rural Nepal. BMC Pre- gnancy Childbirth  2010; 10(1): 31.

9.     Hmone MP, Dibley MJ, Li M & Alam A. A formative study to inform Health-based randomized controlled trial inter-
vention to promote exclusive breast-feeding practices in Myanmar: Incorporating qualitative study findings. BMC Medical Informatics and Decision Making 2016; 60(16): 1-10.

Vision : Achieving a healthier nation through application of research findings          Mission Statement : To Develop and promote solutions to the major health problems of Myanmar