Final Report_MaMoni Evaluation_Habiganj_Maternal & Newborn health 2010 Final Report Study Title: Evaluation of the ACCESS/Bangladesh and MaMoni Programs: Population-Based Surveys in the Sylhet Division of Bangladesh Baseline Evaluation on Maternal & Newborn Health, 2010 Habiganj Report prepared by: Child Health Unit of Public Health Sciences Division ICDDR,B 1 | Page Final Report_MaMoni Evaluation_Habiganj_Maternal & Newborn health 2010 Acknowledgements We would like to acknowledge the large number of people and organizations that provided support in the completion of baseline evaluation survey on the maternal and newborn health indicators of the ‘MaMoni’ project in Habiganj. To begin with, we express our profound appreciation to the women and household members who took time out of their busy daily routines to answer the survey questions. We thank them for their patience and willingness to respond to questions of a sensitive nature. We would also like to thank the many community leaders and health facility workers who provided information to the survey team. Save the Children, USA provided financial support and substantive technical advice concerning the design, field work and preparation of this report. We extend our appreciation and gratitude to the members of MaMoni team, Save the Children USA in Bangladesh. We would like to acknowledge the tremendous support provided by the district and upazila GoB officials like; Civil Surgeon, Deputy Director-Family Planning, Upazila Health and Family Planning Officers, Upazila Nirbahi Officers, Upazila Family Planning officers. We also express our deep gratitude to the members of the local NGOs (Shimantik and FIVDB). Associates for Community and Population Research (ACPR), was the data collection and research partner in this survey. The technical requirements of this activity were many, and they handled them in an efficient and professional fashion. We would particularly like to thank Dr.M Sekander Hayat Khan, APM Shafiur Rahman and Tauhida Nasrin for their effort and dedication. We also thank Prof.Nitai Chakraborty for his valuable technical assistance in the process of MaMoni baseline evaluation. 2 | Page Final Report_MaMoni Evaluation_Habiganj_Maternal & Newborn health 2010 Contents Page # List of tables ............................................................................................................... 5 List of figures ............................................................................................................... 10 Summary findings ............................................................................................................... 13 Chapter-1: Background ................................................................................... 16 1.1 Maternal & Newborn health situation ................................................... 16 1.2 Neonatal health interventions in Bangladesh ......................................... 18 1.3 ACCESS/MaMoni project in Habiganj ................................................. 20 1.4 Chapter References ............................................................................... 21 Chapter-2: Methodology of the survey ........................................................... 23 2.1 Respondent ............................................................................................ 23 2.2 Midline Survey Design ......................................................................... 24 2.3 Sample size calculation .......................................................................... 24 2.4 Household census & Mapping of villages ............................................ 26 2.5 Household survey (data collection) ....................................................... 26 2.5.1 Recruitment and training of field staff ................................................... 27 2.6 Survey instrument (Questionnaire) ........................................................ 28 2.7 Survey implementation .......................................................................... 29 2.8 Quality assurance (QA) ......................................................................... 30 2.9 Data management and analysis .............................................................. 31 Chapter-3: Demographic & Socio-economic status ....................................... 32 3.1 Demographic Characteristics of Households ......................................... 32 3.2 Pregnancy outcome ................................................................................ 34 3.3 Parity ...................................................................................................... 35 3.4 Educational Attainment of RDW ........................................................... 35 3.5 Household characteristics ...................................................................... 37 3.6 Household Possessions .......................................................................... 39 3.7 Land ownership ..................................................................................... 40 3.8 Religion.................................................................................................. 41 3.9 Relatives/Family members living abroad .............................................. 41 Chapter-4: Knowledge of Mother on Maternal and Neonatal Health ............ 42 4.1 Key components of birth plan ................................................................ 42 4.4 Knowledge of Complications during Pregnancy ................................... 43 4.5 Knowledge of Complications during Delivery ...................................... 44 4.6 Knowledge of Complications during Postpartum Period ...................... 45 4.7 Knowledge of Neonatal Health Problems ............................................. 46 Chapter-5 Maternal Health ........................................................................... 48 5.1 Antenatal Care ....................................................................................... 48 5.2 Components of Antenatal Care Checkup ............................................... 54 5.3 Information Received during Antenatal Care ........................................ 57 5.4 Birth Plan & Delivery ............................................................................ 60 3 | Page Final Report_MaMoni Evaluation_Habiganj_Maternal & Newborn health 2010 5.5 Post Partum ............................................................................................ 65 Chapter-6: Maternal Health Problems & Treatment Seeking Behavior ......... 68 6 Women’s Reporting of Maternal Complications ................................... 68 6.1 Complications during Pregnancy ........................................................... 68 6.2 Complications during delivery ............................................................... 72 6.3 Complication during Postpartum ........................................................... 76 Chapter-7 Newborn Health ............................................................................ 80 7.1 Prevention of Hypothermia .................................................................... 80 7.2 Umbilical Cord Care .............................................................................. 84 7.3 Breast Feeding ....................................................................................... 86 7.4 Bathing ................................................................................................... 89 7.5 Postnatal Care (PNC) ............................................................................. 90 7.6 Newborn complication and care seeking ............................................... 93 Chapter-8: Birth Interval and Contraception .................................................. 99 8.1 Birth Interval .......................................................................................... 99 8.2 Family Planning ..................................................................................... 100 Chapter-9: Community Action Group (CAG) ................................................ 105 9.1 Existence of CAG and Membership ...................................................... 105 Chapter-10: Hand washing ............................................................................... 107 Chapter-11: Neonatal Mortality ........................................................................ 113 Chapter-12: Discussion ..................................................................................... 120 Chapter-13: Appendix 123 Appendix-A RDW listing form .................................................................................. 123 Appendix-B Evaluation indicators for midline survey .............................................. 124 Appendix-C Baseline questionnaire on maternal and newborn health ....................... 126 4 | Page Final Report_MaMoni Evaluation_Habiganj_Maternal & Newborn health 2010 List of Tables Page # Chapter-2: Methodology of the survey ............................................................................. 23 Table 2.3.1 Calculation of sample size of RDW for KPC estimate ..................................... 24 Table 2.3.2 Calculation of sample size for NMR ................................................................. 25 Table 2.3.3 Sample size & required number of clusters by upazila ..................................... 25 Table 2.5.1 Completion date of data collection by upazila .................................................. 27 Table 2.7.1 Sample implementation status .........................................................................