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Day 2 panel 3 video edutainment ng 108039
- 1. Yagana Gidado Anne Cockcroft Adamu Ibrahim Gamawa : Khalid Omer Umaira Ansari Amar Aziz Neil Andersson Implementation Research Team
- 3. Background • Very high maternal mortality in Nigeria, and in Bauchi State • In Bauchi: • 16% of deliveries had skilled attendant • 40% had 4+ antenatal visits • But only 20% attenders had minimum functional level of care • 82% did not reduce heavy work in pregnancy • 17% experienced IPV in pregnancy • MoH, SPHCDA identify maternal morbidity & mortality as priority
- 4. Objectives • Implement universal home visits to pregnant women and their spouses • Assess acceptability and impact of visits (maternal & infant outcomes) • Assess added value of video edutainment • Assess mechanisms of impact and implementation costs • Disseminate findings, institutionalize, and plan scale up • Strengthen local health systems, build skills in evidence based planning
- 5. Methods Antenatal care and safe pregnancy behaviours Distance Costs Poor access to care in facilities Poor quality of facilities Bypass structural obstacles to care Universal home visits (every 2 months) to all pregnant women and their spouses
- 6. Methods Factors related to maternal morbidity in Bauchi • Experience of IPV in pregnancy • Lack of discussion with spouse • Continued heavy work in pregnancy • Lack of awareness of danger signs Improvement requires male involvement Home visits include male spouses
- 8. Sep15-Feb16 Mar16-Feb17 Mar17-Feb18 Mar18-Feb19 Mar19-Feb20
- 9. The two first wave wards: Up to 31 March 2017 Video ward Non-video ward Households 4274 2313 Women of childbearing age 6643 3714 Pregnant women (& spouses) 2518 1464 Completed pregnancies 1175 460 Results to date
- 10. The two first wave wards: Up to 31 March 2017 Video ward N (%) Non-video ward N (%) “High risk pregnancies” 469 (19) 153 (10) Recurrent severe headache 314 (67) 70 (46) Dizziness 140 (30) 52 (34) High blood pressure* 91/331(27) 23/94 (24) Swelling of hands or face 85 (18) 17 (11) Something wrong with urine** 52/328 (16) 23/90 (26) Vaginal bleeding 59 (13) 7 (5) Fits 42 (9) 11 (7) Results to date *among those who had BP checked; **among those who had urine tested
- 11. The two first wave wards: Up to 31 March 2017 Video ward N (%) Non-video ward N (%) “High risk pregnancies” 469 (18) 153 (10) Referrals to a health facility 404 (86) 135 (88) Referral advice on previous visit 111 62 Attended the facility 79 (71) 32 (52) Results to date
- 16. IRT and capacity strengthening Capacities in govt structures: Capacities in IRT members: • Management of programme • Data quality monitoring • Basic analysis of results • Evidence-based planning • As trainers • In educational technologies • In research methods • In KTE approaches
- 17. Plan for 2017 Sep15-Feb16 Mar16-Feb17 Mar17-Feb18 Mar18-Feb19 Mar19-Feb20
- 18. Areas for collaboration State and wards State Steering Group Ward stakeholders WAHO KT Workshop, Bauchi, Nov 2016 BORN project Other stakeholders in Bauchi
- 19. Areas for collaboration National and regional Federal Ministry of Health WAHO-facilitated regional workshops Any pictures for this?
- 21. Synergy background • Bauchi State government wants to expand scope of home visits • Geographically: across LGAs in Bauchi • Content: include child-spacing to protect maternal health • High maternal parity – kunika – viewed differently for women & men • Contraception culturally sensitive and often badly handled • Need to build capacities for sustainable home visits program
- 22. Synergy objectives • Explore how to include issues about child-spacing in the home visits program • Develop, pilot, and refine materials for training • Develop high level (PhD) research skills
- 23. Synergy methods Stakeholder perceptions about kunika (fuzzy cognitive mapping) Stakeholder dialogue groups to co-design actions Evidence-based content for home visits Develop blended learning training program for home visits, including kunika issues Implement and institutionalise the training program In parallel
- 24. Synergy focus Opportunities for collaboration Synergy project Bauchi govt MoH; SPHCDA; LGAs CNM, CHT Bauchi non-govt CSOs, CBOs, BORN Federal govt MoH Regional,internatl WAHO, conferences
Notas do Editor
- This is a google earth image of a remote village in one of the wards. Such remote villages in particular raise problems of transport costs, recruiting fieldworkers, security concerns, and home visitors not spending much time in the community. In the second wave wards, we are making efforts to recruit fieldworkers from within the communities or nearby areas. They may not have the same level of education, but we will adapt the training as necessary.
- This first image shows the locations of household interviews (based on the handset GPS readings). Each yellow pin represents one interview location. As you would expect, they are scattered across the community. The second image shows a different picture, with the interviews all clustered in one small area – suggesting the interviewer may well have fabricated some records. The third image is a close up view, and you can see a whole host of interviews apparently conducted in one compound (the home of the interviewer). Sometimes the interviews are located on the road nowhere near a community. These GPS records are able to identify this form of fraud. But even more importantly, they can be preventive. When interviewers know that the fraud can easily be detected and they don’t get paid for such interviews, it reduces the rates of invalid interviews dramatically.