Indian experience of home based mothers card: ICMR task force study

Autor: S. Joshi, A. Pratinidhi, A. Patwary, K. Maitra, B. N. Saxena, Vijay Kumar, S. Abraham, N.C. Saxena, Khub Singh, V. B. Saxena
Rok vydání: 1991
Předmět:
Zdroj: The Indian Journal of Pediatrics. 58:795-804
ISSN: 0973-7693
0019-5456
DOI: 10.1007/bf02825437
Popis: To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre.Health workers at 6 primary health centers in different areas of India introduced the home-based mothers card (HBMC) to 2446 pregnant and mostly illiterate women in November 1984-October 1985 and followed them for 2 years to evaluate the acceptability and feasibility of the HBMC among rural women. Overall retrieval of the HBMCs after 18 months was 89.2%. 66.9% had at least 1 maternal risk factor. The most common risk factors were previous abortions (7.8%), neonatal deaths (5.9%), and fetal deaths (5%). The risk factors associated with the highest perinatal mortality rates were eclampsia (133.3) and fetal deaths (118.2). The researchers learned that they needed to revise the criteria for identifying at-risk mothers by using risk factors associated with the higher risk of perinatal mortality. Women with 3-4 risk factors were more likely to experience perinatal mortality than those with 1-2 risk factors (39.7 and 56.5 vs. 122.5 and 105). Health workers should refer women at highest risk (3-4 risk factors) to a health care facility for delivery. Of the 66.9% at-risk mothers, only 10% experienced risk factors during delivery. The risk factors during delivery were associated with a high relative risk (RR) of perinatal death, e.g., RRs ranged from 1.8 to 4.6. Prenatal care can detect the 2 delivery risk factors with the highest perinatal mortality (multiple pregnancy and abnormal presentation). Health workers should also refer mothers with these risk factors to a health care facility. 78% of at-risk mothers who had been referred to a health facility did indeed go for referral care. Health workers at the centers found the HBMC to be helpful, but it would be more so if it were to include infant health. Anganwadi workers would be more accepting of the card if it had pictorial illustrations.
Databáze: OpenAIRE
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