Disclaimer: “This document is an output from a project funded by the UK Department for International Development (DFID) and Australian Agency for International Development (AusAID)for the benefits of developing countries. The views expressed are not necessarily those of DFID and AusAID”. 2 Table of Contents Disclaimer. ............................................................................................................................................... 2 Preamble ................................................................................................................................................. 6 Foreword.................................................................................................................................................. 8 Message .................................................................................................................................................. 9 Message ................................................................................................................................................ 10 Acknowledgements................................................................................................................................ 11 List of abbreviations ............................................................................................................................... 13 Executive summary................................................................................................................................ 14 Introduction ............................................................................................................................................ 14 Methodology .......................................................................................................................................... 14 Conclusions and recommendations ....................................................................................................... 18 1. Introduction..................................................................................................................................... 19 1.1. Background ................................................................................................................................. 19 1.2. Situation in Sindh ........................................................................................................................ 20 1.3. Rationale for survey..................................................................................................................... 22 1.4. Goal and objectives of the study.................................................................................................. 23 2. Methodology ................................................................................................................................... 23 2.1. Study area and population........................................................................................................... 23 2.2. Study design ............................................................................................................................... 25 2.3. Sampling and selection of study population................................................................................. 25 2.4. Key variables and development of questionnaire......................................................................... 26 2.5. List of variables for constructing the study questionnaire............................................................. 27 2.6. Pilot testing.................................................................................................................................. 29 2.7. Data collection and learning from the field................................................................................... 30 2.8. Data management and analysis .................................................................................................. 31 3. Results............................................................................................................................................ 31 3.1. Socio-economic and demographic profile of study population ..................................................... 31 3.2. Eight Key Family Practices (KFP)................................................................................................ 36 4. Discussion ...................................................................................................................................... 88 5. Conclusions and the way forward ................................................................................................... 96 6. References ..................................................................................................................................... 99 7. Annexes.......................................................................................................................................... 104 7.1 Project Coordinator and Technical Advisor................................................................................ 104 7.2 Researchers.............................................................................................................................. 105 7.3. Project administrative staff......................................................................................................... 107 7.4. List of field supervisors and data collector ................................................................................. 108 7.5 Field operation plan sheet ......................................................................................................... 110 7.6 List of district codes................................................................................................................... 111 7.7 Attendance sheet ...................................................................................................................... 113 7.8. Daily log sheet........................................................................................................................... 114 7.9 Monitoring checklist................................................................................................................... 115 7.10 Some glimpses from planning to data collection in the field....................................................... 117 3 List of Tables Table 1: District-wise coverage of maternal care in Sindh province, Pakistan ...........................21 Table 2: Characteristics of household .......................................................................................33 Table 3: Age distribution of respondents ...................................................................................34 Table 4: Education level of responding mothers and their husbands.........................................35 Table 5: Monthly household income of study population ...........................................................35 Table 6: Type of care provider consulted for ANC during last pregnancy ..................................37 Table 7: Type of health care facility visited for ANC during last pregnancy................................38 Table 8: Type of examination/test done during ANC in last pregnancy......................................38 Table 9: Types of interventions reported by responding mothers to correct anaemia during their last pregnancy...........................................................................................................................40 Table 10: Reported costs incurred on doctor/hospital fee during last ANC ................................42 Table 11: Total cost incurred during last ANC ...........................................................................43 Table 12: Mode of transportation to reach to a health care facility for ANC ...............................44 Table 13: Knowledge of responding mothers about the appropriate number of ANC during a pregnancy.................................................................................................................................45 Table 14: Source of information for responding mothers regarding danger signs during pregnancy.................................................................................................................................50 Table 15: Type of health care facility visited when experienced danger sign/s in last pregnancy .................................................................................................................................................51 Table 16: Type of person who assisted last delivery .................................................................54 Table 17: Total cost incurred in last pregnancy .........................................................................54 Table 18: Type of instrument used to cut the umbilical cord when delivered at home................56 Table 19: Actions taken in case the new-born baby did not cry after birth .................................56 Table 20: Type of nutritional advice given by health care providers in last pregnancy...............59 Table 21: Type of food restricted and the person who advised to restrict food during last pregnancy.................................................................................................................................60 Table 22: Type of food and frequency of use in a week during last pregnancy..........................60 Table 23: Use of milk substitute to feed neonate.......................................................................64