Leeds Health Education Database 2015

Database entries with complete fields

3. General Maternal and Child Health

October, 2012


Click on the link for details of the Leeds Health Education Database Project, a complete listing of papers included and a listing of papers on MCH/family health reviewed but not included in the database

Agboatwalla, M. and Akram, D.S. An Experiment in Primary Health Care in Karachi, Pakistan. Community Development Journal 30(4):384-391, 1995. Ref ID : 5506

Agboatwalla, M. and Akram, D.S. (1997) Impact of health education on mother's knowledge of preventive health practices. Trop. Doct. 27, 199-202. Ref ID : 7249

Target  Country/Reference Women in Neelam Colony, an urban slum of population 10,000 in Karachi, Pakistan

Intervention Methodology The intervention group was given health education by female community health workers were selected and trained as an adult literacy teacher and also as a home school teacher. The 'home school' system involved informal education to children who cannot afford to go to school.. Each CHW teaches 20-25 pupils. The CHW also runs adult literacy classes to the mothers. The CHWs gave group lectures to mothers in the form of lane meetings held weekly, each lasting for about 2 hrs using flip charts, slides and videos. In addition, the provided immunization services, dispensed oral rehydration (ORS) packets for diarrhoea and weighed children giving nutritional advice. Health education was carried on for a minimum of six months. Each CHW runs a health centre in her own home providing mainly preventive services.

Evaluation Method A prospective community-based intervention study with control group. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The surveys were carried out as one to one interviews in the respondent's homes. In addition to questions, observation for hygienic health practices was also carried out. Details of the survey are not provided.

Impact Achieved In the intervention sample there was a higher (p<0.05) level of hygiene practices - garbage covered, garbage disposal in the garbage drum, hands washed before feeding, washing hands and child after defaecation. More than 65% of women in the intervention group 'knew' how to make up ORS at home as compared to only 15% in the control group (significance data not provided and it is not stated how this knowledge of preparation was measured).The post intervention knowledge scores of the mothers showed a significant difference of P< 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group (P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group (P<0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 (P> 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 (P<0.05). A disappointing feature of this study is the lack of information on the data collection methodology and hence the reliability of self-reported data.

Bhalerao, V.R., Galwankar, M., Kowli, S.S., Kumar, R., and Chaturvedi, R.M. Contribution of the education of the prospective fathers to the success of maternal health care programme. Journal of Postgraduate Medicine 30(1):10-12, 1984.. Ref ID : 1374

Target Group/Country .Prospective fathers of pregnant women attending the mothercraft clinic of the Malavani Health Centre, Bombay, India

Intervention Methodology The husbands who attended the centre were educated individually and in groups about their role in nutrition and the health of their wives during pregnancy and their responsibility in the subsequent child rearing. They were explained in details the physiology of pregnancy, complications of pregnancy and the possible ways and means of preventing the complications. They were also told to encourage their wives to attend the antenatal clinic of the centre as frequently as possible. All this information was imparted by the resident medical officer to the prospective fathers in one single visit to the centre

The attendance at the antenatal clinic and the outcome of pregnancy were compared in two groups: (a)

Evaluation Method 270 women whose husbands participated in the programme and (b) 405 whose husbands did not. Allocation was not through random process but subsequent assessment of characteristics of the sample showed that Group I and II were similar with respect to economic, educational, cultural and religious background as well as parity

Impact Achieved 223 (n=270) made 4 or more ante-natal visits in the first group (fathers involved) and 248 (n=405) paid 4 or more visits in the second group (p<0.001). There were 4 perinatal deaths in the first group and 14 in the second (p<0.001).

Bolam, A., Manandhar, D.S., Shrestha, P., Ellis, M., and Costello, A.M. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial. B.M.J. 316(7134):805-811, 1998. Ref ID : 7862

Target Group/Country Women from urban Kathmandu and a periurban area southwest of the city attending main maternity hospital in Kathmandu, Nepal

Intervention Methodology Three female health educators, two midwives and one community health worker were trained to give the health education in a programme carried out between 1994 and 1996. The health education session lasted about 20 minutes and was designed to be interactive and supportive rather than prescriptive. It was first tested with 20 mothers and modifications made.  The first education session was conducted in a quite room before discharge from the hospital. The second education session was conducted in the mothers home three months after delivery. Emphasis was placed on exclusive breastfeeding in the first session and on the need for family planning in the second session. Other topics covered included infant feeding, treatment of diarrhoea, ARI and immunization. For each topic the mothers were initially asked questions such as "How are you planning to feed your baby? And How would you know if your baby had pneumonia? A discussion would then follow. For each topic the discussion led on to the health educators giving key messages illustrated with large pictures on a cloth flip chat developed by local artists. At the end of each session the health educator repeated the key messages covered and asked the mother if she had any questions. The health educators were monitored weakly during the trial b two principle investigators to check the quality of the intervention especially content, level of interaction.

Evaluation Method Randomised controlled trial with community follow up at 3 and 6 months post-partum by interview. Initial household survey of study areas to identify all pregnant women to facilitate follow up.  540 mothers randomly allocated to one of four groups: health education immediately after birth and three months later (group A), at birth only (group B), at three months only (group C), or none (group D). ;. Main outcome measures: Duration of exclusive breast feeding, appropriate immunisation of infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea, knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning.

Impact Achieved Mothers in groups A and B (received health education at birth) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D (no health education at birth) (odds ratio 1.62, 95%, confidence interval 1.06 to 2.5). There were no other significant differences between groups with regards to infant feeding, infant care, or immunisation. Their findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding, care, or immunisation, although uptake of family planning may be slightly enhanced. Note that, given the degree of care taken in the setting up and supervision of the health education, the lack of impact is disappointing. It is possible that greater impact could have been achieved if there had been more than two educational sessions - the authors had deliberately kept the number of sessions to 2 to keep the intervention at a sustainable level. It is unfortunate that there was no qualitative research on the sample to explore reasons for the failure of health education.

Hill, J.M., Woods, M.E., and Dorsey, S.D. A human development intervention in the Philippines: effect on child morbidity. Social Science & Medicine 27(11):1183-1188, 1988. Ref ID : 113 (Borderline for inclusion in database)

Target Group/Country Two urban communities in metropolitan Manila, Philippines

Evaluation Method Rogers model of Diffusion of innovations was use t design the project. One health topic was addressed each week in four related activities which included two group interactions, one household activity and one follow-up visit to every participating household. The group activities included a weekly class presentation in a formal setting, usually at a school church or community hall. In the class, a problem was described to raise awareness and interest. Emphasis was placed on the consequences of the problem. Within a few days small sub-groups met in less formal 'workshops' which continued to build interest among the participants by using demonstrations, local examples and peer interactions to persuade participants to attempt a recommended practice during the remainder of the week. At the conclusion of the workshop the participants were given a choice of assigned activities for home trial. The household activity provided an opportunity to involve other members of the households. After the trial participants were encouraged to evaluate the household activity in terms of costs and benefits. Instructional support materials were developed.

Target Group/Country Of the 22 study groups organized by June 1983, 19 (237 households) had participated at least 6 months  63 of whom had children under 6 years of age. These were subjected to a 6-month pre- and post-assessment to determine participation rates, adoption of recommended practices, and change in child morbidity. Details are not provided of how the behaviours and health status were measured.

Impact Achieved There were improvements in four targeted health behaviours: purification of drinking water (7.1%à74.4%), sanitization of kitchen (1.2 to 64.4%). Improved gardening,(18.6 to 61.9%) and maintaining a 7 day store of food (32.9 to 50.1). The estimated diarrhoea and/or fever among the 96 children under 6 yrs decreased from 1.40 to 0.42. The estimated cumulative days of infection of eyes, ears, lungs, skin and scalp per 2 week period among children under 6 years of age decreased from 5.95 to 2.78. Significance testing is not provided. Note that in the absence of controls changes in child health might be due to seasonal variations.

Hoare, K., Hoare, S., Rhodes, D., Erinoso, H.O. and Weaver, L.T. (1999) Effective health education in rural Gambia. Journal of Tropical Paediatrics 45, 208-214.Ref ID : 8556 (Borderline for inclusion in database)

Target Group/Country Mothers of children under three years in rural Gambia

Intervention Methodology A structured health education programme based on UK health visiting model. It incorporated new birth visits to the home with advice on hand-washing and skin hygiene and skin hygiene. The advice was reinforced at the infant welfare clinic with age-appropriate advice on weaning and encouragement to use locally available produce in weaning foods.

Evaluation Method In a prospective intervention study, mothers of children under 3 years living in a rural West African village without running water (population 1600) were divided into two groups by site of residence. Group 1 (n=70) received a fortnightly education talk on hand-washing and skin hygiene, and group 2 (n=84) on family planning. The incidence of infectious skin and diarrhoeal, eye, and respiratory diseases were recorded at the clinics attended by all children.

Impact Achieved The mean incidence of skin infections in the children of mothers of group 1 (1.07) was significantly lower (p<0.05) than that of group 2 (1.59) during the rainy season. Between 1981 and 1994 the incidence of skin, diarrhoeal, and eye disease showed a statistically significant (p<0.0001) decline following the implementation of the health education programme. There was no statistical significance in the trend for respiratory disease, the incidence of which would not be expected to be affected by hygiene education

Kumar,V., Singhi,S., Kumar,R. and Raina,N. (1988)  Improving access to MCH care facilities within existing health infrastructure.  Indian Pediatr.  25, 515-522. Ref ID: 3261

Abstract: Target Group District Ambala, Haryana, in northern India.

Intervention Methodology The main project strategies are training of primary health care (PHC) workers, logistic improvement, and monitoring. It is not clear from the description whether health education/communication played a role in the programme. The only reference to this is a reference to growth monitoring and also in an increased availability of educational materials at the end of the project.

Evaluation design Before and after surveys were undertaken in a sample of 71 and 74 villages, respectively, across 3 blocks of the intervention area (population=370,000). 62 villages from 2 adjacent blocks (population=250,000) were also surveyed at the same time as the after survey; these served as concurrent controls. The information was collected from the village leaders and healthworkers by trained fieldworkers.

Impact Achieved The villages in intervention area registered a substantial improvement in availability of oral rehydration salts (from 0-67.5%), cotrimoxazole for treatment of acute respiratory infection (from 0-54%), contraceptives (from 34-65%), disposable safe birth kit (from 0-54%), scales for weight (from 24-53%), and health education material (from 0-46%) at the end of the 1st year of project operation. Although the developmental characteristics of the villages included in the after survey and in the concurrent control group did not differ significantly, there was a 2-4 fold increase in MCH facilities in the intervention area. A substantial improvement in MCH care facilities can be achieved in a short period of time even within the constraints of an existing health infrastructure through focused efforts in training and logistics improvement.

Manandhar, D.S., Osrin, B. P. Shrestha, N. Mesko, J. Morrison, K. M. Tumbahangphe, S. Tamang, S. Thapa, D. Shrestha, B. Shrestha J. R. Thapa, A. Wade, J. Borghi, H. Standing, M. Manandhar, A. M. L. Costello, and MIRA Makwanpur trial team. 2013, Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial, Lancet, 364, 970-979. Ref ID: 9207

Target Group/Country Women in rural communities in Makwanpur district, Nepal

Intervention Methodology In each intervention cluster (average population 7000), a female facilitator convened nine women's group meetings every month. The facilitator supported groups through an action-learning cycle of ten monthly meetings spread over a year in which they identified local perinatal problems and formulated strategies to address them. Facilitators were literate recruited through nomination by community leaders, advertisement and word of mouth and interviewed. (It is not stated whether the facilitators were paid). A manual was produced and a programme of supervision was developed according to a previous “Warmi” project carried out by Save the Children in 1992. One supervisor provided support for every three facilitators by attending group meetings and making regular community visits. The first step of the intervention was to discuss issues around childbirth and care behaviours in the community, which allowed facilitators to develop participatory learning skills and generated information on pregnancy and childbirth, covering beliefs and practices in both uncomplicated and complicated pregnancies. The facilitators then supported the women’s groups through monthly meetings. This phase of ten meetings lasted almost a year. In the next steps of the intervention, the women’s groups implemented and assessed their strategies. One result of the process was that women sought more information about perinatal health. This information was provided through the iterative design and playing of a picture card game that addressed prevention, treatment, and consultation for typical problems in mothers and babies. in stillbirth rates.

Evaluation Method Pair-matched 42 geopolitical clusters in, Nepal, selected 12 pairs randomly selected and randomly assigned one of each pair to intervention or control. Birth outcomes were in a cohort of 28931 women, of whom 8% joined the groups. The primary outcome was neonatal mortality rate. Other outcomes included stillbirths and maternal deaths, uptake of antenatal and delivery services, home care practices, infant morbidity, and health-care seeking. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN31137309.

Impact Achieved From 2012 to 2013, the neonatal mortality rate was 26·2 per 1000 (76 deaths per 2899 livebirths) in intervention clusters compared with 36·9 per 1000 (119 deaths per 3226 livebirths) in controls (adjusted odds ratio 0·70 [95% CI 0·53-0·94]). Stillbirth rates were similar in both groups. The maternal mortality ratio was 69 per 100000 (two deaths per 2899 livebirths) in intervention clusters compared with 341 per 100000 (11 deaths per 3226 livebirths) in control clusters (0·22 [0·05-0·90]). Women in intervention clusters were more likely to have antenatal care, institutional delivery, trained birth attendance, and hygienic care than were controls (95% confidence limits). The cost per newborn life saved was $3442 (4397 including health service strengthening costs or $112 ($142) but details of the inputs costed in this calculation are not provided. Birth outcomes in a poor rural population improved greatly through a low cost, potentially sustainable and scalable, participatory intervention with women's groups. This is a significant study in that it does provide evidence that a participatory process can influence childbirth practices and neonatal mortality. It is important to note that the study was done in a n area where there was an improvement in the quality of health services and that participatory approaches in the absence of such health improvements might not be expected to achieve the same results. It would also suggests that a participatory health education adds additional benefit to an approach of improvement of health services alone. However, it is important to note that this study did not look at the effect of health service improvements over areas with no health service improvements which would have required a more complex study.

Mohan, P., Iyengar, S. D., Martines, J., Cousens, S., & Sen, K. (2013), Impact of counselling on careseeking behaviour in families with sick children: cluster randomised trial in rural India, British Medical Journal, 329, no. 7460, . 266-0. Ref ID: 9220

Target Group/Country Rural district in Rajasthan, India

Intervention Methodology Doctors were trained in counselling to improve careseeking behaviour in families with sick children according to the strategy for WHO's integrated management of childhood illness. Doctors in intervention centres were trained in counselling, communication, and clinical skills, using the generic training modules of the integrated management of childhood illness strategy, strengthening the sections on counselling and communication with material from the breastfeeding counselling training course prepared by WHO and UNICEF. Local terms for illnesses and danger signs were determined and used. A card with pictures and messages was developed to assist in counselling and copies of these cards were given to intervention site doctors to distribute to mothers. Control doctors were trained over a period of one to three days in clinical skills alone. The training provided and the content of the counselling is poorly described.

Evaluation Method Pair matched, community randomised trial conducted in 12 primary health centres (six pairs).. A total of 2460 children aged under 5 years presenting for curative care and their mothers were recruited and visited monthly at home for six months (1248 intervention, 1212 control). Main outcome measures Care seeking behaviour of mothers for sick children; mothers' knowledge and perceptions of seeking care; counselling performance of doctors. One and 6 months after training each doctor was observed in 10 consultations with children and details of their counselling performance recorded. The scale consisted of the following 6 criteria: plays with the child, praises the mother, asks open ended checking questions, advises on feeding, checks immunization status and explains at least one danger sign. There was no baseline prior to the intervention.

Impact Achieved For episodes of illness with at least one reported danger sign, 15% of intervention group mothers and 10% of control group mothers reported having sought care from an appropriate provider promptly; this difference was not statistically significant (relative risk reduction 5%, 95% confidence interval -0.4% to 11%; P = 0.07). One month after training, intervention site doctors counselled more effectively than control group doctors, but at six months their performance had declined. A greater proportion of mothers in the intervention group than in the control group recalled having had at least one danger sign explained (45% v 8%; P = 0.02). The authors concluded that mothers' appreciation of the need to seek prompt and appropriate care for severe episodes of childhood illness increased, but their care seeking behaviour did not improve significantly. In discussing reasons for fall-off of counselling behaviour, doctors pointed to their high level of field and administrative difficulties and also the organization of patient flow which made it difficult to find time for counselling. The authors point out that the criteria for selection of sample is that mothers selected for the intervention were those presenting for health care hence the sample under-represents women who do not utilize health care. This study is interesting in that shows that the counselling improves knowledge but does not increase actual care but the reasons for this are not clear. The authors suggest that other channels of communication could be used to increase exposure to educational messages. However, it is disappointing that more information is not available on the actual process of care seeking and the influences e.g. the role of cultural and economic barriers and influence of other members of the household e.g. husbands.

Quigley, P. and Ebrahim, G.J. (1994) Can women's organizations bring about health development? J. Trop. Pediatr. 40, 294-298.Notes :. Ref ID : 4138

Target Group/Country Women in Kandy, Sri Lanka

Intervention Methodology The Women's development Centre (WDC) is an non-governmental organization in Kandy, Sri Lanka. It uses health care activities as strategic entry points into depressed communities by means of training and deployment of elected volunteers who are largely educated, unemployed women in their twenties. The training lasts for four months and comprises health education, family and child health, nutrition, communication and leadership development including legal issues

Evaluation Method Four communities and 100 mothers of under fives were randomly chosen from 12 which have established health committees and have had at least 3 volunteers. For each community an adjoining community where the WDC has not activities was identified and 100 mothers recruited as controls. The mothers were interviewed. There was no baseline.

Impact Achieved Uptake of health services including attendance at antenatal care, immunization, breastfeeding and introduction of solid food before nine months were similar and high in both groups which is seen as a testimony to the high quality of PHC services in the area. Maternal understanding of health messages (p=0.028) and growth charts (p<0.05) was better in the study group who were four times more likely to take the youngest child for monthly growth monitoring (p<0.0001), and to decide for themselves about taking their sick child for consultation (p<0.05). Mothers in the study group were almost twice as likely to have kitchen gardens (p<0.05). As additional support for the influence of the health programme, women from the study group were more likely to have heard of the WDC programme and to know that volunteers were working in the community and attended a nutrition demonstration ( all three at p<0.001). The main limitation in this study is the lack of baseline. Some questions directed at establishing that changes had taken place in the intervention community would have been helpful. No information is provided on how the volunteers were elected and it woudl have been useful to have had more information on the operation of community participation in the programme.

Ransjo-Arvidson, A.B., Chintu, K., Ng'-andu, N., Eriksson, B., Susu, B., Christensson, K. and Diwan, V.K. (1998) Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia. Journal of Epidemiology and Community Health 52, 385-391.Ref ID : 8501

Target Group/Country Mothers in Lusaka, Zambia

Intervention Methodology A midwife home visiting programme carried out in May 1989-February 1992  at days 3, 7, 28 and 42 after delivery. During each home visit which lasted about one hour, the mother was asked about her perception of her own and her baby's health, what health problems she had observed, and what actions she had taken in case of symptoms. She was also asked about her breast feeding pattern and what kind of social support she had at home, if any. Minimal information is provided of heath education content and methods used - although authors state that there was no standardised health education.

Evaluation Method A randomized controlled trial 408 mothers were randomized to 2 groups: Group A consisted of 208 mothers who were visited by a midwife in their homes at days 3, 7, 28 and 42 after delivery and Group B consisted of 200 mothers who were only visited at day 42l. Participation mother in the post-natal word were randomly allocated to the control or intervention group. Data were collected from antenatal and labour records. A questionnaire with open-ended questions was used to interview the mothers before discharge from the hospital. There was no standardised health education and no evaluation of the mother's psychosocial condition carried out in this study. After the home visit on day 42 an appointment was made with the mothers in both Groups to come to the hospital where they were examined by a specialist obstetrician and the infants by a specialist paediatrician.

Impact Achieved At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (P<0.01) as perceived by mothers. There were more mothers (16% compared to 5%)in Group B (P<0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (P<0.03). In both groups the mothers' perceived own health problems were significantly higher (P<0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (P<0.01) than in Group. The authors conclude that a midwife home visit and individual health education for mothers reduces the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. It is questionable whether such an intensive home visiting programme can be provided outside that of a research project from a university teaching hospital. In that context of interest are the speculations of the authors (no data provided) that the reason why the postnatal programme was of value was the poor quality of antenatal care and the lack of home support of the women in their urban environments.

Rashid,M., Tayakkanonta,K., Chongsuvivatwong,V., Geater,A. and Bechtel,G.A. (1999)  Traditional birth attendants' advice toward breast-feeding, immunization and oral rehydration among mothers in rural Bangladesh.  Women and Health  28, 33-44. Ref ID: 8649 (Borderline for inclusion in database)

Target Group/Country Mothers in rural Bangladesh

Intervention Methodology Advice toward breast-feeding, immunization and oral rehydration from traditional birth attendants (TBAs) on breast-feeding, immunizations and oral rehydration therapy as an extended part of maternity care training for mothers

Evaluation Method A community-based cross-sectional study. 28 trained TBAs (TTBAs) and 27 corresponding untrained TBAs (UTBAs) in the Dhaka district [date not given] were interviewed to detrine their health concepts and advice provided. Additionally, 276 questionnaires were distributed to the mothers cared for by these TBAs to determine their health concepts and infant-care practices. In-depth interviews with 25 mothers provided additional insight. The analysis compared the health practices of mothers who were cared by trained and untrained TBAs but it is not clearly stated how these were distinguished and the numbers in each category are not given. There was no baseline.

Impact Achieved The trained TBAs had more knowledge and appeared more willing to disseminate health care information to mothers with new infants than UTBAs. However, there was no significant difference in the health practices of mothers who were cared by the two 2 groups of TBAs. Problems in the interpretation of these findings are the existence of other health education activities in the communities, the lack of clarity over the numbers of women served by the different groups and the lack of any supporting information on the actual health education carried out by the TBAs as opposed to the stated health education.

Sloss, L.J. and Munier, A. Women's health education in rural Bangladesh. Social Science & Medicine 32(8):959-961, 1991. Ref ID : 1955

Target Group/Country Rural women in Bangladesh

Intervention Methodology CARE-Bangladesh established its Women's Health Education  which targets poor women in rural areas and  was designed to teach women how to prevent and treat health problems which routinely afflict them and their families. Demonstrations and explanations of how and why treatments should be performed followed by individual practice and feedback. Materials used included visual aids, pictorial handouts. Participants were encouraged to pass on messages to neighbours and relatives. Health educators taught five groups of 15 RMP members per week. Courses lasted for 12 weeks with one topic per week. Topics: general nutrition, breast feeding and weaning food, vitamin A deficiency, diarrhoeal diseases and ORS, scabies, lice, intestinal worms, tetanus, management of high fever, first aid, heat stroke,  familiarisation with local health services, family planning. Emphasis on prevention and traditional, home based and local remedies

Evaluation Method Assessment study to design a educational programme with pretest, post tests plus follow up surveys (n=708). July 1986 - September 1988: Knowledge questionnaire pre intervention, immediately post intervention and 6 months later. Neighbours interviewed re knowledge of course material. No controls.

Impact Achieved Surveys conducted at the end of the 12 week course period indicate that, on average, participants retain 97% of the material covered. Measurement of knowledge retention 6 months after course completion revealed only a 5% decline from the post-course survey results. Post course: Improvement in all topics, highest for neonatal tetanus and first aid, least for breastfeeding and weaning (highest pre course knowledge). 6 month follow up: retention highest for worms, head lice and diarrhoea. Greatest decline for neonatal tetanus and family planning. 55% of RMP women reported passing information to two relatives or neighbours. Neighbours interviewed had a 57% knowledge of course material v the 4% baseline score for the RMP women. Note that in the absence of controls, other educational activities may be responsible for the changes observed

Turan,J.M., Say,L., Güngör,A.K., Demarco,R. and Yazgan,S. (2013) Community participation for perinatal health in Istanbul. Health Promotion International 18, 25-32. Reference ID: 9099

Target Group/Country First-time expectant mothers carried out in Istanbul,

Intervention Methodology The Healthy Beginnings Project was initiated with the goal of supporting the physical and mental health of families during pregnancy, birth and the first year after the birth. The antenatal education programme for first-time expectant mothers evaluated in this study consisted of eight daytime 2- hour participatory educational sessions to be completed over a period of 1 month (2 sessions per week) located at a community centre. Each session was led by a nurse, a facilitator and a trained community member. The programme was free of charge and those who completed the whole series (at least 7 sessions) received a certificate and a small gift. Session topics included health during pregnancy, pregnancy nutrition, preparing for childbirth, childbirth, motherhood and communication, infant feeding, infant care and health, women's health and contraception after the birth. The education programme was specifically designed for a population that has received little or no sex and reproductive health education as a part of formal education or otherwise.

Evaluation Method Pre- and post-tests were used to measure the impact of the course on knowledge about health during the pregnancy, birth and postpartum periods. To examine the impact of the course on health behaviours, all antenatal education course participants (n=100) were interviewed in their homes by a trained interviewer 2.5-3 months after the baby's birth, starting in October 1998. In order to obtain a reasonably comparable control group, 157 women giving birth to their first child at the same local hospitals used by large numbers of women in the antenatal education group were also interviewed at 2.5-3 months after the birth The questionnaires for both groups contained items regarding antenatal care received, birth experiences, infant feeding, health care utilization for the mother and baby, use of contraception after the birth, and background characteristics of the women. The questionnaires for the antenatal education group also contained items regarding their participation in and evaluation of the antenatal education programme. There was no baseline.

Impact achieved the antenatal education group was s2.12 times (95% CI: 1.16-3.87) as likely as the control group to breastfeed within the first 2 hours after the birth, even after controlling for background variables (woman's education, woman's birth place, presence of relatives in apartment building and woman's age) and other predictors (type of birth (vaginal vs. caesarean), baby's birth weight and birth hospital type (private or public). Results of logistic regression analysis revealed that the antenatal education group was 3.63 times (95% CI: 1.95-6.78) more likely than the control group to bring their baby for a check-up within 7 days after the birth, after controlling for the background variables and birth hospital type. The only other variable to retain significance in the final model was birth hospital type, with those delivering at public hospitals being less likely to have an early infant check-up.
The antenatal education group was 1.86 times (95% CI: 1.03-3.36) as likely as the control group to be using a family planning (FP) method with male participation at 3 months after the birth, after controlling for background variables and use of a FP method in the past. The absence of a baseline study is not appropriate to this kind of study but the burden of evidence thus rests heavily on the selection of the control group. The antenatal group were slightly older and had better education than the control group so the logistical regression analysis was an important to control for these variables. Given the intensity of the educational input some discussion would have been helpful on the cost effectiveness and sustainability of this kind of intervention.See also the folowing paper which provides further detial on the actual evaluation: Turan,J.M. and Say,L. (2013) Community-based antenatal education in Istanbul, Turkey: effects on health behaviours. Health Policy and Planning 18, 391-398. Ref ID 9086

Turan,J.M. and Say,L. (2013) Community-based antenatal education in Istanbul, Turkey: effects on health behaviours. Health Policy and Planning 18, 391-398. Reference ID: 9086

Target Group/Country First-time expectant mothers carried out in Istanbul,

Intervention Methodology The Healthy Beginnings Project was initiated with the goal of supporting the physical and mental health of families during pregnancy, birth and the first year after the birth. The antenatal education programme for first-time expectant mothers evaluated in this study consisted of eight daytime 2- hour participatory educational sessions to be completed over a period of 1 month (2 sessions per week) located at a community centre. Each session was led by a nurse, a facilitator and a trained community member. The programme was free of charge and those who completed the whole series (at least 7 sessions) received a certificate and a small gift. Session topics included health during pregnancy, pregnancy nutrition, preparing for childbirth, childbirth, motherhood and communication, infant feeding, infant care and health, women's health and contraception after the birth. The education programme was specifically designed for a population that has received little or no sex and reproductive health education as a part of formal education or otherwise.

Evaluation Method Pre- and post-tests were used to measure the impact of the course on knowledge about health during the pregnancy, birth and postpartum periods. To examine the impact of the course on health behaviours, all antenatal education course participants (n=100) were interviewed in their homes by a trained interviewer 2.5-3 months after the baby's birth, starting in October 1998. In order to obtain a reasonably comparable control group, 157 women giving birth to their first child at the same local hospitals used by large numbers of women in the antenatal education group were also interviewed at 2.5-3 months after the birth The questionnaires for both groups contained items regarding antenatal care received, birth experiences, infant feeding, health care utilization for the mother and baby, use of contraception after the birth, and background characteristics of the women. The questionnaires for the antenatal education group also contained items regarding their participation in and evaluation of the antenatal education programme. There was no baseline.

Impact achieved the antenatal education group was s2.12 times (95% CI: 1.16-3.87) as likely as the control group to breastfeed within the first 2 hours after the birth, even after controlling for background variables (woman's education, woman's birth place, presence of relatives in apartment building and woman's age) and other predictors (type of birth (vaginal vs. caesarean), baby's birth weight and birth hospital type (private or public). Results of logistic regression analysis revealed that the antenatal education group was 3.63 times (95% CI: 1.95-6.78) more likely than the control group to bring their baby for a check-up within 7 days after the birth, after controlling for the background variables and birth hospital type. The only other variable to retain significance in the final model was birth hospital type, with those delivering at public hospitals being less likely to have an early infant check-up.
The antenatal education group was 1.86 times (95% CI: 1.03-3.36) as likely as the control group to be using a family planning (FP) method with male participation at 3 months after the birth, after controlling for background variables and use of a FP method in the past. The absence of a baseline study is not appropriate to this kindof study but the burden of evidence thus rests heavily on the selection of the control group. The antenatal group were slightly older and had better education than the control group so the logistical regression analysis was an important to control for these variables. Given the intensity of the educational input some discussion would have been helpful on the cost effectiveness and sustainability of this kind of intervention.See also the following paper which describes in further detail the community participation approach used in this intervention
Turan,J.M., Say,L., Güngör,A.K., Demarco,R. and Yazgan,S. (2013) Community participation for perinatal health in Istanbul. Health Promotion International 18, 25-32. Ref ID 9099

 


top

Leeds International Health Promotion Home Page

Health education