Improved Accessibility of EmONC Services for Maternal and Newborn Health: a Community Based Project
Condition: Sepsis; Pneumonia; Omphalitis; Birth Asphyxia; Respiratory Distress Syndrome; Eclampsia; Postpartum Hemorrhage; Puerperal Sepsis
MeSH terms: Sepsis; Toxemia; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Postpartum Hemorrhage; Eclampsia; Hemorrhage; Asphyxia
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether an integrated EmONC package (community
      mobilization, training of community-based health care providers and a maternal and neonatal
      health pack) reduce perinatal and neonatal mortality.
    

Detailed description: 
      Deaths during birth are particularly critical to address as these occur because of
      complications during childbirth and leads to emergency situation with a slim window of time
      to intervene. Every year an estimated 3.6 million newborns and 360,000 mothers die globally.
      Of these, maternal health complication contribute to 1.5 million of neonatal deaths in the
      first week of life and 1.4 million stillborn neonates, suggesting a major gap of intervention
      subsists around childbirth and in the early postnatal period, a time when mothers and babies
      are most at risk. While many factors contribute to maternal and neonatal deaths, one of the
      most effective means of solving this problem requires effective preventive measures or
      treatment provided rapidly to women and newborns, often at home or in primary health care
      settings.

      It is often addressed that these overwhelming mortalities and morbidities are closely linked
      with a number of interrelated delays that prevent a pregnant women from accessing the health
      care she needs. Each delay is closely related to services, logistics, facilities and
      conditions, which are important elements for their health. These delays are: 1) delay in
      seeking appropriate medical help for an obstetric emergency or neonatal complication for
      reasons of cost, lack of recognition of an emergency, poor education, lack of access to
      information and gender inequality; 2) delay in reaching an appropriate facility for reasons
      of distance, infrastructure and transport; 3) delay in receiving adequate care when a
      facility is reached because there are shortages in staff, their competency, or due to
      unavailability of required medical facilities and equipment. As a result, many preventable
      maternal deaths occur, most often in resource poor settings, where births are home-based and
      in the event of complications the woman is unable to access the required care in time.

      While many proven, cost-effective ways to save the lives of mothers, and newborns exist, they
      are not always available to those who need them most. There is bulk of literature that has
      identified number of interventions that can improve maternal and newborn health. The lancet
      maternal and neonatal survival series emphasized the model of "Basic essential obstetric
      care" as one of the most feasible and effective strategies to reduce maternal mortalities.

      For the reasons above, it is essential to create demand of uptake of services and strengthen
      primary health care infrastructure at the community level, and improve the liaison of Lady
      Health Workers/Traditional Birth Attendants/Community Midwives with local and district health
      system for early and timely referral of complicated cases and sick newborns. While several
      previous studies from Pakistan have documented the beneficial impact of community-based
      interventions in improving maternal and new-born health, further evidence is required to
      assess the effectiveness of community-based interventions that can increase the uptake of
      EmONC services and reduce the delays that are responsible for poor maternal and new-born
      health. Context-specific evidence is also needed on the appropriate mix of interventions,
      their delivery strategies, task shifting and sharing options, functional link and assessment
      in the primary health care, and complementary health systems and community support and demand
      mechanisms.

      Therefore, the main target audience and beneficiary of this project is the women which
      usually do not have a say in the decision making and cannot have choices for her to opt for a
      better treatment. The women usually depend upon the decisions being made by the husbands and
      elders as the society is male dominant. We have attempted to take care of this factor to
      maximize the uptake of intervention and services by developing the community support groups.

      The specific objectives of this study are:

        1. To conduct an in-depth analysis of maternal and neonatal health seeking patterns and
           behaviors of the target population and care provision at health facilities for
           understanding the context and requirements for improved EmONC service delivery.

        2. To provide a maternal and neonatal health pack(clean delivery kit, emollient,
           chlorhexidine, sms health messages) for safe motherhood and newborn well-being.

        3. To mobilize community for creation of demand for improved MNH services and practices
           through community mobilization.

        4. To train and implement integrated EmONC package for community-level health care
           providers (Lady Health Workers, Traditional Birth Attendants, Community Midwives to
           provide antenatal, natal and postnatal care services, and recognize and refer
           complicated pregnancy and childbirth cases and sick newborns to health facilities.

        5. To strengthen and improve the quality of care at health facilities in providing EmONC
           services through capacity building of health care providers.
    

Intervention name(s): EmONC package
Intervention type(s): Behavioral
Intervention description(s): The EmONC package consists of:
Maternal and neonatal health pack(clean delivery kit, emollient, chlorhexidine, sms messages) for safe motherhood and newborn wellbeing.
Enhanced trainings of community-level health care providers to provide effective maternal and neonatal health services and referral of complicated cases to health facilities and creation of linkages amongst health care providers.
Community mobilisation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: EmONC; Neonatal mortality; Perinatal mortality