Baseline Findings(21st November 2004 to 30th July 2005)

The System

• A monitoring system has been developed to cover all 36 control and intervention clusters for the duration of the project.

• The intention is to create a monitoring system that can be easily replicated, at low cost, elsewhere.

• The system comprises of two stages.

Stage One

1). The Identification Stage

The system aims to identify:

1. All births to women who permanently reside in the study area

AND

2. All deaths to women of reproductive age (15-49) in the study area

Key Informants• Key informants are either traditional birth attendants (TBAs),

relatives of TBAs or active village members.

• 1 key informant is responsible for covering a logical geographic area of approximately 250 households

• Their role is to identify all eligible births and deaths within this area irrespective of whether they attended the birth.

• They are paid an incentive of 30 rupees for every accurate identification.

• The key informants meet with interviewers once a month. The interviewers visit the identified households to verify the births and deaths before paying incentives

Stage Two

• One interviewer is recruited for each cluster as a full-time salaried member of staff.

• Their role is to verify the information provided to them by key informants, and where a birth has occurred, to interview the mother once, at around 6 weeks after delivery.

• Detailed information is collected on the antenatal, delivery and the postnatal periods for all births in the study area, as well as background information on the mother and household characteristics.

Verbal Autopsies

• In the event of a stillbirth or neonatal death the interviewer conducts a verbal autopsy with the mother.

• In the event of a maternal death, pregnancy related death or late maternal death the interviewer conducts a verbal autopsy with family members who were present at the time of death

• Verbal autopsies are also completed with the care provider, if one was present at the time of death. This includes informal health care providers such as TBAs, village doctors and traditional healers as well as formal health care providers.

Additional Checks

• All deaths to WRA are identified and maternal, pregnancy late maternal deaths are identified through a process of elimination

• All women identified are ‘snowballed’ to see if they can identify any other women of reproductive age in the study area who have given birth recently or died.

• 14% of interviews cross-checked by supervisors.

The Monitoring System

Select one key informant per 25O households

Pay informant incentive to identify births and deaths to women of reproductive age

Interviewer visits informant monthly to collect list of identifications

Interviewer verifies identifications and pays informant

Interviewer interviews once at six weeksafter delivery

Women who are interviewed are ‘snowballed’ for other identifications

Interviewer collects identifications fromgovernment records every month

The Findings

Births

Number of births 4672

Number of singletons 4584

Number of twins 44

Number of live births 4495

Number of infants alive at one month 4236

Crude Birth Rate 30

Neonatal Outcomes

Stillbirth rate per 1000 births (n) 38 (177)

Neonatal mortality rate per 1000 live births (n) 58 (259)

Early neonatal mortality rate per 1000 live births (n) 39 (175)

Late neonatal mortality rate per 1000 live births (n) 19 (85)

Perinatal mortality rate per 1000 births (n) 75 (352)

Cause of Death

Asphyxia24%

Sepsis19%

Premature18%

Other12%

Pneumonia10%

Congenital5%

Diarrhoea5%

Birth Injury4%

Tetanus3%

Background Characteristics

Age

0

10

20

30

40

<20 20-24 25-29 30-34 35+ Don't know

%

Religion

0

10

20

30

40

50

60

Hindu Sarna Christian Other

%

Tribe / Caste

0

20

40

60

80

Tribal Non-tribal

%

Other Backward

HO

Scheduled

Santhal

Bhuiyan

Munda

Education

0

20

40

60

80

No education Primary Secondary Higher secondary

%

Number of Pregnancies

0

10

20

30

40

1 2 3 4+ Don't Know

%

Antenatal

Number of Antenatal Visits

0

10

20

30

40

0 1 2 3 4 5+

Number of visits

%

Timing of 1st Visit

0

10

20

30

40

No ANC 1-3 4-6 7-9

Trimester

%

Services Received

0 20 40 60 80 100

Vaginal Examination

Danger signs Info

Contraceptive Info

Height

Recommend PNC visit

Breastfeeding Info

Urine

Blood Test

Blood Pressure

Abdominal Exam

Weight

%

Yes

No

0

20

40

60

80

Iron TT

%

Received Iron and TT

Delivery

Place of Delivery

0

20

40

60

80

100

Home Facility Other

%

Husband's

Parent's

GovernmentPrivateCharity

Other

Delivery Attendant

0

10

20

30

40

Friend /Relative

TBA Husband Doctor Nurse Self VillageDoctor

Outreachworker

%

Use of Items During Delivery

0

20

40

60

80

100

Safe Delivery Kit Disposable Gloves Plastic Sheet

%

Don't Know

No

Yes

Newborn and Postnatal Care

Instrument to Cut Cord

0

20

40

60

80

New Blade Scissor Old Blade Other Don't know

%

Don't know

Not Boiled

Boiled

Wiping and Wrapping

0

5

10

15

20

25

30

35

40

Never Immediately 10-30minutes

30 minutes –1 hour

1-4 hours > 4 hours Don't Know

%

Wiped

Wrapped

Bathing

0

10

20

30

40

50

Never Immediately Within 6 hours 7-24 hours > 24hours Don't know

%

First Breastfed

0

5

10

15

20

25

30

Never Immediately 10-30 mins 30 mins – 1 hr

1-4 hrs 4-24 hrs > 24 hrs Don't know

%

Breastfeeding Practices

0

10

20

30

40

50

60

70

80

First feed - breast milk Exclusively breastfed Mixed Feeding Never breastfed

%

Newborn Check-upYes - Problem

7%

Yes - Check-up3%

No90%

Maternal Postnatal Check-upYes - Problem

8%

Yes - Check-up2%

No90%

Population characteristics …

• Predominantly tribal (HO, Santhal, Bhuiyan, Munda)

• Non-tribal are predominantly OBC

• Sarna and Hindu

• Low education

• High number of pregnancies

Conclusion

• Very high newborn mortality

• Low uptake of ANC

• ANC not offering full range of services – especially advice

• Uptake of iron and TT better

• Most delivered at home with assistance of friend / relative or TBA

Conclusion

• Many cut cord with new blade, but very few boiled

• Very few used SDK, gloves, plastic sheet

• Most wiped and wrapped in first hour, but few immediately – especially wrapping

• Most infants bathed in first 6 hours – very few wait 24 hours

• Very few mothers / infants had postnatal check-up. Those who did - mainly for problem

• Most infants were breastfed, need to increase exclusive breastfeeding, and resist attempts to increase use of formula milk

Conclusion