Annex 3 Frequencies of qualitative survey information
Review of health facilities
Focus group discussion
TBA interview
1. Review of Govt Health Facility
Note: some questions allowed multiple responses.
1. Type of health facility
1 Sub Health Post
2 Health Post
3 Primary Health Care Center
4 District hospital
5 Family Planning clinic
6 Missing70
35
7
14
2
453.0%
26.5%
5.3%
10.6%
1.5%
3.0%
2. Proportion of health facilities with certain types of staff
1 Untrained TBAs 0% 2 Trained TBAs 0% 3 FCHV 6.1% 4 AHW 87.1% 5 VHW 75.0% 6 MCHW 48.5% 7 ANW 37.1% 8 Nurse 14.4% 9 Doctor 15.2%
3. Which staff are concerned with pregnancy and delivery?
1 Trained TBAs 0.8% 2 FCHVs 43.0% 3 AHW 35.9% 4 VHW 6.3% 5 ANM 35.9% 6 Doctor 8.6%
4. Do you have scales for weighing adults? And if the scales work?
Scales Scales work Yes 98(74.2%) 85 (64.4%) No 31 (23.5%) 14 (10.6%) Missing 3 (2.3%) 33(25.0%)
5. Do you have a sphygmomanometer? And does the sphygmomanometer work?
Sphygmo Work
Yes 117 (88.6%) 85 (78.8%) No 12 ( 9.1%) 14 (6.8%) Missing 3 ( 2.3%) 33 (4.1%)
6. Do you have a foetal stethoscope?
Yes 79 (59.8%) No 50 (37.9%) Missing 3 (2.3%)
7. Do you supply pregnant women with iron/folate tablets?
Yes 115 (87.1%) No 14 (10.6%) Missing 3 ( 2.3%)
8. Do you give pregnant women injections of TT as required?
Yes 122 (92.4%) No 7 (5.3%) Missing 3 (2.3%)
8.1 Are sterile syringes supplied with the vaccine?
Yes 119 (90.2%) No 10 (7.6%) Missing 3 ( 2.3%)
8.2 Do you have money for kerosene to sterilize syringes?
Yes 77 (58.3%) No 52 (39.4%) Missing 3 (2.3%)
9. What advise about nutrition during pregnancy and breast-feeding?
1 eat beans 99 (79.2%) 2 eat vegetables/fruit 117 (93.6%) 3 eat eggs/protein 88 (70.4%) 4 drink milk 62 (49.6%) 5 take liquid foods 22 (17.6%) 6 eat more 13 (10.4%)
10. What advise about the place to deliver babies?
1 Clean/dry place 94 (75.2%) 2 well ventilated/open 90 (72.0%) 3 well lit place 54 (43.2%) 4 no dust/smoke 15 (12.0%) 5 lined with cowdung 7 ( 5.6%) 6 go to a health facility 28 (22.4%) 7 Missing 1 (0.8%)
11. What advise pregnant women about breast feeding?
1 use colostrum 91 (72.8%) 2 prepare nipples 13 (10.4%) 3 clean nipples 64 (51.2%) 4 feed frequently 46 (36.8%) 5 start BF immediately 43(34.4%)
12. What advise pregnant women about Home Delivery Kits?
Use HDK 124 (99.2%) Keep HDK Safe 30 (24.0%) Keep HDK clean 7 (5.6%)
13. How much do you charge women:
Median Rupees for initial registration: 2.0 for subsequent visits: 0
14. How many pregnant women attended in the last 12 months?
Median 35 pregnancies
15. What health problems during pregnancy have you seen in the last 12 months?
Problems Cases (%)1 Vomiting 17 (4.0%) 2 High blood pressure 30 (7.2%) 3 Urine infection 9 (2.1%) 4 Pain in stomach 25 (5.9%) 5 Weakness 55 (13.0%) 6 Fever 3 (0.7%) 7 Pain in body 40 (9.5%) 8 Foetal death 1 (0.2%) 9 Oedema 34 (8.1%) 10 Bleeding 41 (9.7%) 11 Infection 40 (9.5%) 12 Difficulty in breathing 16 (3.8%) 13 Loss appetite 8 (1.9%) 14 Anemia 102 (24.2%) 15 Missing 1 (0.2%) Total 422 (100%)
16. How many deliveries attended in the last 12 months? Median 9.5 deliveries
17. What do you use to cut the cord of newborn babies?
Instrument % of facilities
1 New blade 96 (72.7%) 2 Old blade boiled 2 (1.5%) 3 Scissors boiled 19 (14.4%) 4 Missing 15 (11.4%)
18. What do you apply to the stump of the cord after cutting it?
Materials % of facilities
Nothing 24 (18.2%) Antiseptic 94 (71.2%) Missing 14 (10.6%)
19. Emergency health problems during pregnancy/delivery in the last 12 months?
Problems Cases (%)Eclampsia 10 (10.8%) High blood pressure 7 (7.5%) Bleeding 53 (57%) Obstructed/prolonged labour 20 (21.5%) Miscarriage 2 (2.2%) Infection 27 (29.0%) Baby upside down 16 (17.2%) Retained placenta 28 (30.1%)
20. How many of these emergency cases were referred by family members and TBAs?
By family members: 597 cases By TBAs: 478 cases
21. Which of these problems did you manage here?
Problem % managed
1 Eclampsia 6.0% 2 High blood pressure 7.1% 3 Bleeding 45.2% 4 Obstructed/prolonged labour 14.3% 5 Miscarriage 1.2% 6 Infection 17.9% 7 Baby upside down 14.3% 8 Retained placenta 27.4% 9 Missing 14.3%
22. Where did you refer the others for help?
1 Nowhere 11 (8.3%) 2 SHP 1 (0.8%) 3 HP 4 (3.0%) 4 PHCC 1 (0.8%) 5 District hospital 74 (56.1%) 6 Nursing home 1( 0.8%) 7 Private clinic 2 ( 1.5%) 8 Missing 38 (28.8%)
23. How many pregnancy or postpartum deaths in the last 3 years?
256 cases of deaths were reported by the facilities visited.
Death reported No. of facility (%) yes 43.2% No 49.2% Missing 7.6%
24. What was the cause of death in each case?
Causes Cases Case could have been prevented (%)Bleeding 49 28 Eclampsia 11 2 Obstructed/ prolonged labour 38 17 Infection 50 15 Missing 5 4 Total 153 66
25. What could be done to improve services of pregnancy/delivery?
|
Suggestions | % facilities |
1 More funds |
11 | (9.0%) |
2 More facilities |
72 | (59.0%) |
3 More hospitals |
35 | (28.7%) |
4 More drug |
41 | (33.6%) |
5 More staff |
29 | (23.8%) |
6 Staff training |
55 | (45.1%) |
7 Better home care |
19 | (15.6%) |
8 Early referral |
6 | ( 4.9%) |
9 Regular check up |
21 | (17.2%) |
10 TT immunization |
5 | ( 4.1%) |
2. Results of Focus Group Discussion
Note: some questions allowed more than one answer.
1. Do women in this community usually go for antenatal visits?
1 Yes 58 40.8% 2 No 39 27.5% 3 Sometimes 40 28.2% 9 Missing 5 3.5%
2. Where do they go for antenatal visits?
1 Sub Health Post 24 23.3% 2 Health Post 37 35.9% 3 PHCC 8 7.8% 4 District Hospital 59 57.3% 5 Nursing home 5 4.9% 6 Private clinic 9 8.7% 9 Missing 7 6.8%
3. If they do not go for antenatal care, why not?
1 Too far away 29 20.4% 2 Too expensive 39 27.5% 3 No medicine 3 2.1% 4 No staff 6 4.2% 5 Bad attitude 13 9.2% 6 Poor condition 12 8.5% 7 Old tradition 112 78.9% 8 Not allowed 18 12.7% 9 10 Missing 15 10.5%
4. What problems are there with the available antenatal care here?
1 Too far away 35 24.6% 2 Lack of staff 41 28.9% 3 Lack of medicine 54 38.0% 4 Poor service 62 43.7% 5 Too expensive 20 14.1% 6 Wait for long time 13 9.2% 7 Poor facility 27 19.0% 8 No health education 8 5.6% 9 Missing 6 4.2%
5. How could the antenatal care services be improved?
1 Set up mobile clinics 17 12.0% 2 Make doctors available 31 21.8% 3 Provide female doctor 42 29.6% 4 Provide free medicine 58 40.8% 5 Set up more clinic 38 26.8% 6 Train TBAs 14 9.9% 7 Free medical care 28 19.7% 9 Missing 32 22.5%
6. How much help do pregnant women here get from their families and the community?
0 No help 4 2.8% 1 Help emergency 3 2.1% 2 Help household work 22 15.5% 3 Help transport 5 3.5% 4 Help finance 8 5.6% 9 Missing 100 70.4%
7. What else could families and the community do to help?
1 Help with household work 47 33.1% 2 Help to arrange transport 17 12.0% 3 Help financial arrangement 35 24.6% 4 Balanced diet 35 24.6% 5 Create awareness 46 32.4% 6 Train TBAs 3 2.1% 9 Missing 12 8.4%
8. Where do women here usually deliver their babies?
1 Home 134 94.4% 2 Health and Sub-health post 5 3.5% 3 District hospital 48 33.8% 5 Private hospital 2 1.4% 7 Missing 2 1.4%
9. What happens if there is an emergency health problem during pregnancy or delivery or after delivery?
1 Spiritual healing 29 20.4% 2 Call a health worker 49 34.5% 3 Call an experienced woman 27 19.0% 4 Arrange transport 42 29.6% 5 Herbal/local medicine 9 6.3% 6 Oil massage 12 8.5% 7 Raise feet level 2 1.4% 9 Missing 12 8.4%
10. Where are women with these emergency health problems taken for help?
1 Sub health post 5 3.8% 2 Health post 17 13.1% 3 PHCC 4 3.1% 4 Private clinic 18 13.8% 5 Nursing home 2 1.5% 6 District hospital 104 80.0% 9 Missing 4 3.1%
11. Who decides when to seek help for such emergency health problems?
1 Household head 118 83.1% 2 TBAs 20 14.1% 3 Educated persons 41 28.9% 4 Other family members 25 17.8% 5 Women herself 3 2.1% 6 Missing 1 0.7%
12. In what ways does the community assist women with these emergency health problems?
1 Transport 51 52.6% 2 Finance 13 13.4% 3 Stretcher 42 43.3% 4 Traditional healer 6 6.2% 9 Missing 8 8.2%
13. How well does this help work?
1 Effective 27 19.0% 2 Somehow working 25 17.6% 3 Not effective 41 28.5% 9 Missing 49 34.5%
14. Have any women in this community died in pregnancy, delivery or within 6 weeks of delivery in last 3 years?
1 Yes 50.0% 2 No 47.9% 9 Missing 2.1%
15. What happened to the women who died?
1 Obstructed/prolonged labour 31 47.0% 2 Excessive bleeding 24 36.4% 3 Convulsion 2 3.0% 4 Infection/fever 10 15.2% 5 Other diseases 6 9.1% 6 Too weak 8 12.1% 9 Missing 17 25.7%
16. How do you think the deaths could have been prevented?
1 Early recognition 26 26.3% 2 Improve transport 18 23.8% 3 More health facility 20 31.7% 4 Public awareness 2 3.2% 5 Early referral 32 50.8% 9 Missing 10 15.8%
3. Interview with TBA
Some questions allowed multiple responses.
1. What is your age? Mean age = 44.5
2. Note caste / ethnicity
Brahmin
17 (9.7%) Chhetri
28 (15.9%) Newar
11 (6.3%) Gurung/Ghale
5 (2.8%) Magar
7 (4.0%) Rai/Limbu
7 (4.0%) Tamang/Sherpa
1 (0.6%) Muslim
1 (0.6%) Occupational
5 (2.8%) Tharu
19 (10.8%) Yadav
2 (1.1%) Others in Terai
63 (35.8%) Others in Hills
9 (5.1%)
3. Are you able to read and write a simple letter in any language?
Yes 54 (30.5%)
No 123 (69.5%)
Total 177 (100%)
4. How many years have you been working as a TBA?
Mean:
13 years
5. From whom did you learn your traditional skills?
1 Mothers
90 (50.8%) 2 Other family members
27 (15.3%) 3 HMG TBA programme
45 (25.4%) 4 NGO TBA programme
7 (4.0%) 5 Private sector
5 (2.8%) 6 Missing
3 (1.8%)
6. Have you had any training in antenatal and delivery care?
Yes 96 (54.2%)
No 80 (45.2%)
Missing 1 (0.6%)
7. If yes, who provided this training?
1 Government 75 (42.4%) 2 NGOS 6 (3.4%) 3 Private clinic 1 (0.6%) 4 Nurses/midwives 11 (6.2%) 5 Trained TBAs 1 (0.6%) 9 Missing 83 (47%)
8. What do you advise about the place to deliver babies?
1 Clean/dry 156 (90.2%) 2 well ventilated/open 102 (59.0%) 3 well lit 93 (53.8%) 4 no dust/smoke 8 (4.6%) 5 lined with cowdung 4 (2.3%) 6 go to a health facility 12 (6.9%) 7 missing 17 (9.8%)
9. What do you advise pregnant women about breast feeding?
1 use colostrum 105 (60.7%) 2 prepare nipples 49 (28.3%) 3 clean nipples 87 (50.3%) 4 feed frequently 65 (37.6%) 5 start immediately 10 (5.8%) 6 excl to six months 22 (12.7%) 9 missing 5 (2.9%)
10. What else do you do during antenatal visits?
1 Advice on TT immunization 30 (18.3%) 2 Advice on nutrition 125 (76.2%) 3 Advise on rest 66 (40.2%) 4 Advice on anemia/iron 4 (2.4%) 5 Advice on birth spacing 7 (4.3%) 7 Missing 28 (17.0%)
11. How many pregnant women have you attended in the last 12 months?
Mean: 15.5 Median: 10
12. What health problems during pregnancy in the last 12 months? [No. with each problem]
Problem Number % 1 Vomiting 25 4.8 2 High blood pressure 6 1.2 3 Urinary infection 3 0.6 4 Pain in stomach 88 17.0 5 Weakness 67 12.9 6 Fever 16 3.1 7 Pain in body 76 12.9 8 Foetal death 19 3.7 9 Oedema 49 9.4 10 bleeding 68 13.1 11 infection 44 8.5 12 difficulty breathing 13 2.5 13 loss appetite 5 1.0 14 anaemia 39 7.5
13. How many deliveries have you attended in the last 12 months?
Mean: 13 deliveries Median: 7 deliveries
14. How much do you normally receive for attending a delivery?
Rupees Boy Girl Mean 128 111 Median 100 50
15. What do you use to wash your hands before assisting a delivery?
0 Nothing 7 (4.0%) 1 Water only 18 (10.2%) 2 Water and soap 148 (83.6%) 3 Ash/clay 1(0.6%) 9 Missing 3 (1.7%)
16. Do you use Home Delivery Kits?
Yes 41 (23.2%) No 106 (59%) Sometimes 28 (15.8%) Missing 2 (1.2%)
17. What do you use to cut the cord of newborn babies?
1 New blade 131 (74.0%) 2 Old blade 4 (2.3%) 3 Old blade boiled 17 (9.6%) 4 Scissors boiled 1 (0.6%) 5 Scissors un-boiled 5 (2.8%) 6 Other instrument boiled 3 (1.7%) 7 Other instrument un-boiled 13 (7.3%) 8 Missing 3 (1.7%)
18. What do you apply to the stump of the cord after cutting it?
0 Nothing 62 (35%) 1 Antiseptic 88 (49.7%) 2 Ash 24 (13.6%) 9 Missing 3 (1.7%)
19. What signs during delivery would lead you to refer a woman? [Write all signs mentioned]
1 Excessive bleeding 89 (57.4%) 2 Convulsion 62 (40.0%) 3 Obstructed/prolonged labour 95 (61.3%) 4 Too much pain 97 (62.6%)
20. What health problems (including emergencies) during delivery or just after delivery in the last 12 months? [Number with each problem]
Problem No. Per cent Eclampsia 28 7.5 High blood pressure 2 0.5 Bleeding 97 26.0 Obstructed/prolonged labour 90 24.1 Miscarriage 5 1.3 Infection 75 20.1 Baby upside down 36 9.7 Retained placenta 39 10.5 Missing 1 0.3
21. To which health facility did you refer the woman in each case?
0 Nowhere 21 (11.9%) 1 SHP 8 ( 4.5%) 2 HP 28 (15.8%) 3 PHCC 2 ( 1.1%) 4 District hospital 59 (33.3%) 5 Nursing home 2 ( 1.1%) 6 Private clinic 20 (11.3%) 7 FPA clinic 8 (4.5%) 9 Missing 37 (20.9%)
22. Have you seen any women who have {died} during pregnancy or delivery or within 6 weeks of delivery in the last 3 years? [Give number]
Yes 114 (64.4%) No 48 (27.1%) Missing 15 ( 8.5%)
23. What was the cause of death in each case?
(Cause, number of that cause, number of that cause preventable)
Cause Cases Could have been prevented
1 Excessive 26 20 Bleeding 2.Eclampsia 5 2 3.Obstructed/ 33 24 prolonged labour 4.Infection 24 15 Missing 3 1 Total 91 62