Leeds Health Education Database 2015

Database entries with complete fields

4. Childbirth/safe motherhood

September 2015


Click on link for background information on Leeds Database Project, a list of all entries and details of childbirth/safe motherhood interventions reviewed but not considered suitable for inclusion database

Belizan,J.M., Barros,F., Langer,A., Farnot,U., Victora,C. and Villar,J. (1995)  Impact of health education during pregnancy on behavior and utilization of health resources. Latin American Network for Perinatal and Reproductive Research.  Am. J. Obstet. Gynecol.  173, 894-899.Ref ID: 4177
Langer,A., Farnot,U., Garcia,C., Barros,F., Victora,C., Belizan,J.M. and Villar,J. (1996)  The Latin American trial of psychosocial support during pregnancy: effects on mother's wellbeing and satisfaction.  Social Science and Medicine  42, 1589-1597.Ref ID: 5284

Target Group/Country
Pregnant women at risk in Rosario, Argentina; Pelotas, Brazil; Havana, Cuba; and Mexico City, Mexico

Intervention Methodology Following an ethnographic study to assess women's needs a  home intervention was designed dealing with psychosocial support and education about health-related habits, alarm signs, hospital facilities, antismoking and anti-alcohol programs, and a reinforcement of adequate health services utilization for the pregnant woman. Home visits were carried out by specially trained female social workers (Argentina, Brazil, Mexico) or obstetric nurses (Cuba) at the 22, 26, 30 and 34 weeks gestation with two more optional visits if needed. Each visit lasted between 1-2 hours and involved the partner. The initial part of the visit was devoted to encouraging the pregnant woman and her support person to discuss the pregnancy situation, change, worries and doubts, This information guided the subsequent session. A special patient support office that did not require a previous appointment was set up with a hot line. Education activities conducted during the home visit were reinforced with a poster simulating a path for a healthy pregnancy and booklet.

Evaluation Method A randomized, controlled trial was conducted in four cities of Latin America on pregnant women at risk of low birth weight. Criteria for inclusion included at least one of the following characteristics. Previous low birth weight or pre-term infants, previous foetal, neonatal or infant data, aged 17 years or less, body weight 50kg or less, height 1.5 m or less, low family income, less than 3 years of schooling, smoking or heavy alcohol consumption or single/separated/divorced or widowed. Half of them (n = 1115) received the intervention The control group (n = 1120) received routine prenatal care. Clinic personnel were not informed who were in the intervention and control groups. Interviewers met all participating women at home during the 36th week of gestation and at the hospital immediately after delivery. At 36 weeks information was obtained on social support activities, knowledge about pregnancy and delivery and health related behaviour and psychosocial distress levels. Post partum data were obtained from medical records and complemented by the mother on antenatal care, labour and delivery experience and newborn status. The 40 day post-partum obtained information on maternal-infant morbidity and feeding practices.

Impact Achieved Women in the intervention group showed a statistically significant better knowledge of seven of the nine alarm signs considered and of two of the three labour-onset signs required. No differences between groups were observed in improvement on diet, cigarette and alcohol consumption, maternal physical strain, lactation at 40 days postpartum, and utilization of health facilities. The intervention of psychosocial support and health education during pregnancy therefore failed to show any benefit on perinatal outcome, health-related behaviour, or utilization of health facilities. The intervention was not successful in either altering women's perception of social support and satisfaction with the reproductive experience, as well as maternal and newborn's health care. Given the intensive nature of the intervention the lack of impact is a matter of concern and it would appear that the intervention was certainly not cost-effective. Note that a publication in press cited by the authors includes the claim that there was also no impact on maternal distress and anxiety - it has not been possible to trace this publication in either Popline or Medline (cited as Farnot,U., Langer,A., Barros,F, Victora,C., Belizán,J.M., Villar ,J. Psychosocial outcomes in a ranzomized trial of psychosocial support during high-risk pregnancies.

Bello Gummi,F., Hassan,M., Shehu,D. and Audu,L. (1997)  Community education to encourage use of emergency obstetric services, Kebbi State, Nigeria.  International Journal of Gynecology and Obstetrics.  59, S191-S200 Ref ID 7879: (Borderline for inclusion in database)

Abstract: Target Group/Country Catchment population of a hospital, health centre and maternity centre  in Sokoto State, Nigeria

Intervention Methodology Sokoto Prevention of Maternal Mortality (PMM) team, instituted the following interventions to reduce maternal mortalityi: 1)mprovements in the health facilities, 2) staffing improvements, 3) community education activities, and 4) improving transport mechanisms. The community education activities involved creation of a safe motherhood committee composed of local leaders, development of key messages and educational materials, creation of a videotaped docu-drama of the maternal death of a 17-year-old, and development of a project logo.

Evaluation Method Survey of 821 women and 1101 men in 1992  as baseline. A survey after the intervention in 1995 of 870 women and 1020 men. These were supplemented by focus group discussions and records from health facilities. There were no controls.

Impact Achieved  The intervention increased the community's awareness of the causes of maternal death, nature of obstructed labour, signs of pre-eclampsia, need for prompt treatment, and importance of delaying marriage (increase by 34-35% points - no significance testing). However utilization of obstetric emergency services did not increase. The authors suggest three reasons for this: 1) the prevailing civil unrest, 2)lack of confidence by the community in health care facilities, 3) the economic decline and the higher cost of obstetric emergency services. Lack of significance testing on the increases in knowledge observed and lack of controls are limitations to this study. The cost of the intervention was relatively low at $9500.

Garner,P., Lai,D., Baea,M., Edwards,K. and Heywood,P. (1994)  Avoiding neonatal death: an intervention study of umbilical cord care.  Journal of Tropical Paediatrics  40, 24-28.Ref ID: 7854

Abstract: Target Group/Country Women in the area of Wosera, Papua New Guinea.

Intervention Methodology Women in the area had been receiving tetanus toxoid vaccinations, this offered a high degree of protection against neonatal tetanus but  the traditional practices of cord care had not changed. Neonates were still at risk of infection other than that caused by Clostridium tetani. Women supplied with an umbilical care pack and health education through the antenatal clinics: The health education covered the use of blade and acroflavine was demonstrated to individual women with the message: "apply acriflavine once daily for three days".

Evaluation Method This was an intervention study with a cohort of women (n=126) and babies (n=131) from 20 of the villages in the study area.
"Control group" (n=64): no pack supplied
"Razor group"   (n=33): razor blade and acriflavine 10% in spirit with swab sticks.
"Clamp Group"  (n=34): razor blade, acriflavine 10% in spirit with swab sticks and a cord clamp
Neonatal outcomes relevant to morbidity collected from newborns in the 20 villages e.g. birth weight, gestational age assessment, clinical exam for raised body temperature and signs of umbilical cord infection.  There was postnatal follow-up for 1) Compliance (package usage), 2) Neonatal outcomes from standard infant books and clinic records. There was no baseline.

Impact Achieved   "Razor group": 22/33 (66.6%) used the whole pack, 1 unknown). "Clamp group": 17/34 (50%) used whole pack, 12/34(44%) not all components used.  There was significantly less sepsis in intervention than control groups, P<0.02.  There was: significantly less fever  (axillary temp equal or > 37.4C) in intervention than control groups, P<0.0003.

Murira,N., Munjanja,S.P., Zhanda,I., Lindmark,G. and Nystrom,L. (1996)  Health education for pregnancy care in Harare.  Central African Journal of Medicine  42, 297-301.Ref ID: 6872 (Borderline for inclusion in database)

Abstract: Target Group/Country Women at pre-natal clinics in Harare, Zimbabwe

Intervention Methodology Routine prenatal education within clinics. Health education was provided only once during pregnancy, generally at the end of the day of the first visit. The education usually took the form of a group lecture without visual aids or written handouts. The lecture covered nutrition and hygiene recommendations, pregnancy risk factors, and sexually transmitted diseases.

Evaluation Method An evaluation of prenatal health education in 7 primary care clinics in Harare Interviews were conducted with 65 clinic midwives and 100 randomly selected pregnant women who had made 2 or more prenatal visits. In addition, educational sessions were observed. There were no controls and no baseline.

Impact Achieved Only 33% of pregnant women indicated they would be able to follow the advice given by the midwives. Significantly more (p<001) midwives claimed to be using discussion, demonstration, role play and drama than the pregnant women stated they experienced. Midwives identified women's cultural and religious beliefs, noise and inattention during the lecture, the lack of questions from mothers, and women's scepticism about the information imparted as the main obstacles to effective health education. The pregnant women cited the inconvenient time of day the lectures were scheduled, their hurried nature, and the failure of midwives to solicit topics of interest to clients as the main obstacles. The authors considered it unlikely that a single lecture without written materials to take home can impart any meaningful new knowledge or produce behavioural change. This is a practical evaluation which, although not recording impact data on mother's performance, revealed valuable information on the quality of health education services.  Other similar studies of evaluation of health education by observation of performance of health workers in clinics have been rejected from the database. However this goes beyond observation of practice to explore the perceptions of women and health workers. Although it is disappointing that there is no measure of impact of the education it is ofconsiderable interest that health workers were under the assumption that they were using participatory methods but the women did not consider that to be the case.

Perreira,K.M., Bailey,P.E., de Bocaletti,E., Hurtado,E., Recinos,d., V and Matute,J. (2015) Increasing awareness of danger signs in pregnancy through community- and clinic-based education in Guatemala. Maternal and Child Health Journal 6, 19-28. Ref ID: 8999. (Borderline for inclusion in database)

Target Group/Country Women attending antenatal clinics in Southwestern Guatemala

Intervention Methodology Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling (with a reminder poster on "10 Golden rules of communication" and the provision of educational desk-top flip charts and educational mini-calendars to clients; (2) a community-based strategy consisting of 13 radio messages regarding obstetric complications each aired for one month; and (3) educational sessions conducted through women's groups where facilitators conducted 7 discussions sessions using a participatory process with coloring books and puzzles.

Evaluation Method Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, awareness of danger signs was investigated as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions. There were no controls.

Impact Achieved Among women using health clinics, the likelihood of having heard of danger signs nearly doubled between 1997 and 1998 (p<0.05) when the clinic interventions were fully implemented. The four danger signs that were most frequently recalled were anaemia, haemorrhage, premature labour and recognition of malpresentation. Premature labour was the only risk sign that clinic users were more likely to recognize than non-clinic users in 1999 (p<0.01). In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times (odds ratio 2.94; 95% CI: 1.68, 5.13) and 5 times ( odds ratio 5.68; 95% 1.13, 28.53) more likely to have heard of danger signs in pregnancy. The imprecise nature of the latter, though large and significant, was because only a small number (69 or 11%) of 1999 respondents had participated in women's groups. Lack of controls is a disappointing feature of this evaluation because - as the authors themselves indicated - attendance at ante-natal clinics is a self-selected sample. It is difficult too draw conclusions from this study on the relative contribution of clinic-based, radio and community-based approaches.

Verma,M., Chhatwal,J. and Varughese,P.V. (1995)  Antenatal period: an educational opportunity.  Indian Pediatr.  32, 171-177. Ref ID: 4156

Abstract: Target Group/Country Pregnant women attending the antenatal clinic at a Christian Medical College, Ludhiana, Punjab, India

Intervention Methodology Health education given by a paediatrician to pregnant women at the clinic during the antenatal period in small groups or one to one. Topics covered included: the purpose of antenatal care, diet during pregnancy, need for/ purpose of helmintic tablets, need for/ name of injection and purpose of Tetanus Toxoid, breast care during pregnancy and breastfeeding, childhood vaccinations.

Evaluation Method The first 100 mothers who were not given health education, only routine ante natal care, served as controls. The subsequent 201 cases constituted the study group and were given health education. Women were interviewed with a pre questionnaire ( at  first antenatal visit) and post questionnaire ( after delivery)

Impact Achieved There was a significant rise in knowledge of the purpose of antenatal care: in intervention group (P<0.05). significant rise in both control and intervention group (P<0.05) in knowledge of correct diet during pregnancy: during pregnancy: There was a significant rise in knowledge for the need for Hematinics tablets during pregnancy in both control and intervention groups but only the intervention group showed a significant rise in the knowledge of the purpose of taking tablets. Knowledge of the need for tetanus toxoid for injection showed significant rise in control group (P<0.05), knowledge of the name of injection showed significant rise in both groups (P<0.05) and the knowledge of the purpose of tetanus toxoid increased significantly in the intervention group (P<0.05).There was a significant increase in knowledge that breast milk should be the first feed in both groups. (controls: group 50% to 98% and  intervention group: 45.5% to 99.5%,  P< 0.001. There was a significant increase in both groups ( controls: 29% to 78% and intervention group: 27.4% to 93%, P<0.001) in knowledge that first breastfeed should within 2-3 hours after birth. There was a significant increase in knowledge about the correct duration of breastfeeding in both groups (controls: 63% to 85% and intervention group: 59.2% to 84.1%, P<0.001). Knowledge of the advantages of breastfeeding was high in both groups at pre-test (99% controls and 98% of intervention group) but knowledge of the reasons for this (ie. bonding, less infection, right amount, more convenient and better for figure) showed a significant increase in intervention group (P< 0.05). Knowledge of vaccinations was low in in both groups on pre test re measles and DPT vaccinations. Significant increases in knowledge of BCG, OPV, DPT and Measles vaccination in intervention group (P<0.001). Note there was no evidence that these improvements in knowledge led to improved practices..

Vernon,R., Lopez Canales,J.R., Carcamo,J.A. and Galindo,J. (1993)  The impact of a perinatal reproductive health program in Honduras.  International Family Planning Perspectives  19, 103-109.Ref ID: 7857

Abstract: Target Group/Country Women attending the IHSS Materno-Infantil in Tegucigalpa, Honduras.

Intervention Methodology The perinatal reproductive health programme consisted of five separate components: a prenatal education program, a family planning and reproductive health counselling service, a wider range of contraceptive methods, a postpartum outpatients clinic women were to visit of 40th day after birth and an perinatal information system for improved data collection. The perinatal education programme began in 1991 and included 6 topics. At each educational sessions a nurse spoke on a topic, brochures ere handed out and the video was shown, From April to December 1991 two topics were presented in each daily sessions, so a woman had to attend only 3 sessions. However after January 1992 one topic was presented in each session  because a mini-survey had shown that the recall level was not very high. In May 1991 individual reproductive health counselling was offered to mothers

Evaluation Method Intervention study with data collected daily and analysed quarterly. Data were obtained in postpartum surveys: February (n=614 women), October (n=344 women) and December (n=482 women). Assessing knowledge of topics i.e. breastfeeding practices, warning signs during pregnancy, risk factors during pregnancy, cord care of infant (also acceptance of family planning methods and satisfaction with services).

Impact Achieved Significant increase in knowledge of warning signs during pregnancy (p< 0.001). e.g. contractions before the ninth month of pregnancy 25% to 41%. Significant increase in knowledge of risk factors P < 0.001. e.g. birth-spacing  less than 18 months (17% to 24%), births to women aged < 19 years or >  35 years (13% to 27%), having a low birth weight baby (1% to 8%) and previous premature birth (2% to 9%).  Significant increase in knowledge of cord care (p < 0.001) e.g. to keep the navel dry 18% to 53% and to change gauze\every day 23% to 58%. Significant decrease in number of days mothers believed should pass before starting lactation (p < 0.001). There was a significant increase  in the number of months that mothers believed should pass before the introduction of foods other than breast milk p< 0.001.  Rates of acceptance of family planning increased (9% Dec 1990 to 47% February 1992) but significance data is not provided. It is disappointing that the only dimension of the project to be evaluated with significance testing is that of knowledge change and that there were no controls.


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