Population Council Knowledge Commons Reproductive Health Social and Behavioral Science Research (SBSR) 2006 Safe Motherhood Applied Research and Training (SMART) Report 1: Project overview Gul Rashida Population Council Peter C. Miller Population Council Follow this and additional works at: https://knowledgecommons.popcouncil.org/departments_sbsr-rh Part of the Demography, Population, and Ecology Commons, Family, Life Course, and Society Commons, Gender and Sexuality Commons, International Public Health Commons, Maternal and Child Health Commons, and the Medicine and Health Commons How does access to this work benefit ou?y Let us know! Recommended Citation Rashida, Gul and Peter C. Miller. 2006. "Safe Motherhood Applied Research and Training (SMART) Report 1: Project overview." Islamabad: Population Council. This Report is brought to you for free and open access by the Population Council. Safe Motherhood Applied Research & Training SMART1 Project Overview European Union Safe Motherhood Applied Research & Training Project SMART SMART Report 1. Project Overview Gul Rashida Peter C. Miller The Population Council, an international, non-profit, nongovernmental organization established in 1952, seeks to improve the well-being and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council analyzes population issues and trends; conducts research in the reproductive sciences; develops new contraceptives; works with public and private agencies to improve the quality and outreach of family planning and reproductive health services; helps governments design and implement effective population policies; communicates the results of research in the population field to diverse audiences; and helps strengthen professional resources in developing countries through collaborative research and programs, technical exchanges, awards, and fellowships. For inquiries, please contact: Population Council House #7, Street 62, F-6/3, Islamabad, Pakistan Tel: 92 51 2277439 Fax: 92 51 2821401 Email: [email protected] Web: http://www.popcouncil.org Layout & Design: Mehmood Asghar & Ali Ammad Printed by: Crystal Printers Published: October 2006 The Population Council reserves all rights of ownership of this document. No part of this publication may be reproduced, stored or transmitted in any form by any means – electronic, photocopying, recording or otherwise – without the permission of the Population Council. Table of Contents Executive Summary.............................................................................. xi Introduction ........................................................................................ 1 Rationale and aims ....................................................................................... 1 Goal and objectives ...................................................................................... 1 Study design ............................................................................................... 3 Site Selection and District Profiles ............................................................ 5 Site selection .............................................................................................. 5 District profiles............................................................................................ 6 Interventions ....................................................................................... 9 Community-based interventions.......................................................................10 Health services intervention ...........................................................................18 Project implementation ................................................................................20 Dissemination and Replication................................................................ 23 Dissemination of SMART activities ....................................................................23 Replication activities....................................................................................24 Research .......................................................................................... 27 Household survey ........................................................................................27 Knowledge, attitude and behavior....................................................................29 Verbal autopsy ...........................................................................................29 Health services assessment ............................................................................30 Results ............................................................................................. 31 Status at baseline........................................................................................32 Changes in health services, knowledge and behavior..............................................34 Mortality...................................................................................................40 Discussion .................................................................................................41 Conclusions ....................................................................................... 45 Limitations and constraints ............................................................................45 Recommendations............................................................................... 49 MNH program design ....................................................................................49 Project implementation ................................................................................50 iii Annexes Appendix 1. List of 120 Clusters for District Dera Ghazi Khan ................................... 52 Appendix 2. List of 60 Clusters for District Layyah ................................................ 53 Appedix 3. Timeline of SMART Project, DG . Khan (October 2003 to September 2006) ........................................................................................ 54 Appendix 4 Formative research ...................................................................... 55 Appendix 5. Alternate community mobilization strategies used................................. 57 iv List of Tables Table 1. Expected results from project interventions (CBI + HSI areas) ..................... 2 Table 2. Selected indicators for DG Khan and Layyah districts, 1998 Census............... 6 Table 3. Community-level training, by type of trainees and content ....................... 20 Table 4. Numbers of activities implemented in support of community mobilization in the CBI area ............................................................ 21 Table 5. Training for health services improvement ............................................ 21 Table 6. Coverage of household baseline survey ............................................... 28 Table 7. Coverage of household endline survey ................................................ 28 Table 8. Knowledge, attitude and behavior (KAB) ............................................. 29 Table 9. Health facilities visited at baseline .................................................... 30 Table 10. Health facilities visited at endline ..................................................... 30 Table 11. Selected development indicators, by site, 2004..................................... 32 Table 12. Selected maternal and neonatal health indicators by project site, 2004 ......................................................................................... 33 Table 13. Percentage of women identifying three or more danger signs at baseline and endline, by childbirth period and site................................. 36 Table 14. MNH-related behaviors, by survey round and study site............................ 37 Table 15. Proportions seeking care in case of potentially serious complication, by childbearing cycle, site and round ................................................. 40 Table 16. Vital events recorded by household survey in previous 12 months at baseline and endline, by study site .................................................... 40 Table 17. Vital rates and selected 95% confidence intervals at baseline and endline, by study site .................................................................... 40 Table 18. Project results compared with initial expectations* ................................ 41 v List of Figures Figure 1. Study design ................................................................................ 3 Figure 2. Timeline of SMART activities............................................................. 4 Figure 3. Administrative and health infrastructure and map of Layyah ...................... 7 Figure 4. Administrative and health infrastructure and map of DG Khan .................... 8 Figure 5. Three delay model......................................................................... 9 Figure 6. Intervention activities..................................................................... 9 Figure 7. Training given to community-based service providers .............................. 14 Figure 8. Health services training.................................................................. 18 Figure 10. Difference in increase of knowledge of pregnancy, delivery, postpartum period and newborn danger signs, in sites 1 and 2 compared with 3 .......................................................................... 37 Figure 11. Proportion of women who know at least