Annex 3 Frequencies of qualitative survey information

 

  1. Review of health facilities

  2. Focus group discussion

  3. 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 Missing 

70
35
7
14
2
53.0%
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
   
     Median:  10 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

 


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