Integrated community based maternal and new-born care learning programme

This report presents results of a field study of beliefs, behaviours and practices relating to maternal and newborn care in Malawi. The study was commissioned by the Ministry of Health in partnership with ACCESS/Malawi, and was conducted in the districts of Rumphi in the north, Nkhotakota in the centre, and Machinga in the south. The purpose of the research was to inform the implementation of an integrated facility and community-based maternal and newborn care intervention package to be delivered by facility-based nurses and midwives, and community-based Health Surveillance Assistants (HSAs) linked with the Accelerated Child Survival and Development ACSD/ Integrated Management of Childhood Illnesses IMCI and Essential Health Package (EHP) framework of Malawi.

The study’s specific objectives were to:

• Assess community-level structures in knowledge, attitudes, beliefs and practices pertaining to essential maternal and new-born care, focusing on care of pregnant women, delivery, and new-born care.
• Qualitatively assess facility-level activities related to pre-partum, intra-partum, post-partum, and new-born care.
• Determine gaps in knowledge, skills, and practices among health care providers, including HSAs on maternal and new-born health (MNH).
  
• Determine existing household to hospital continuum of care structures, including access to services, client flow, feedback mechanisms and district-level monitoring and data flow.
  

The main instrument of the paper was the focus group discussion guide on antenatal care (ANC), labour, and delivery administered to pregnant women, those with babies less than 5 years old, and grandmothers. Information was collected on the care of pregnant women and new-born babies; on delivery practices; and on attitudes and traditions relating to pregnancy and child birth.

Some of the recommendations in this report include:

• Programme interventions should target the institutions and individuals who are central to the social construction of attitudes, beliefs and practices.
• Traditional knowledge on the herbs used to prevent infections in new-born babies should be the starting point for building awareness on the immunisation of new-borns.
  
• Most of these challenges would best be solved by a periodic review of policies.