A COMMUNITY-BASED MATERNITY CARE PROGRAM IMPROVES UTILIZATION OF ANTENATAL CARE AND REFERRAL OBSTETRIC SERVICES IN KONO DISTRICT, SIERRA LEONE: 12-MONTH OUTCOMES

M. Bailor Barrie, M.B.Ch.B.,1 J. Daniel Kelly, M.D.1,2

1 Wellbody Alliance, Koidu Town, Sierra Leone2 Baylor College of Medicine, Houston, TX, USA

Background

Why maternal deaths? Utilization of services Emergent obstetric services

Drop-offs in ANC visits Home-based deliveries Lack of referral system

Program Goal

Implement a community-based program designed to increase utilization of maternal health services.

Support PHUs Strengthen the

referral system Support Koidu

Government Hospital

Prior experience in community-based program implementation

Adapted our model to maternal health

In Kono District, we work in partnership with the Ministry of Health and Sanitation

Methods

In August 2011, WA trained 45 former traditional birth attendants and traditional health care providers to serve as community health workers.

WA launched its maternal mortality reduction program in September 2011 at three peripheral health clinics in Kono District, Sierra Leone.

They received monthly incentives for accompanying pregnant women to the clinic for their antenatal (ANC) care, delivery, and postnatal care, tracing those who missed appointments, referring women with pregnancy-related complications to the clinic, and educating them about the value of facility-based care.

Methods

Clinic staff performed deliveries and decided when to refer women with pregnancy-related complications from the clinic to the district hospital.

We analyzed data routinely collected from ANC and delivery registers to compare service utilization 12-months before and 12-months after implementation of the program.

Results

The average number of first and fourth ANC visits increased from 48.3 to 56.9 per month and from 22.5 to 30.7 per month, respectively.

*statistically significant

  1st ANC visit 4th ANC visit

Facility 2010-11 2011-12 2010-112011-

12 Manjama 183 181 141 184 Small Sefadu 142 121 84 97 Koeyer* 255 381* 45 87* Total 580 683 270 368

Our program demonstrated higher rates of women being initiated and retained in antenatal care.

Conclusion

Results

During the first year of the program, 83 women with complications were successfully referred to the district hospital compared to 27 in the preceding year.

Emergent caesarean sections decreased from 11 to 8.

No maternal deaths occurred among the women served by the program.

Referral rates to the hospital dramatically improved.

Conclusion

Results

Facility-based deliveries increased on average from 27.4 to 31.5 per month.

*statistically significant

Facility-based deliveries PHUs 2010-11 2011-12 Manjama 107 105 Small Sefadu 102 82 Koeyer* 120 191 Total 329 378

Home-based deliveries remain a common practice, and further studies need to develop an intervention that de-incentivizes them.

Conclusion

Limitations

Quality of facility-based care Strength of overall health system and

referral services Cultural barriers of home-based

deliveries Supervisor system of community-based

program Variable performance of facilities

Story of Edna

Further investigations need to be conducted to fully understand the reasons for Koeyer’s success

Why was Koeyer successful?

Way forward

Strengthening of facility-based care Essential to the development of a community-based

program Accompaniment of family members to initial ANC

visit to discuss value of facility-based delivery Incentive packages for mother and child if facility-

based delivery occurs Expansion of emergent obstetric referral services Restructuring of supervision system Integration of community health work