|
The Health
and Nutrition Situation
of the Mother
and Child
in Banswara
Introduction
Dear
Supervisor,
Very often, data is
collected, compiled sent up for reporting and the exercise is finished there.
However, there is a need to use the data collected at your level for
improving the service delivery and improving the use of services by the
community for whom it is meant.
This is a booklet which
sums up nine key indicators which are crucial in realizing Hajo Soru in the
district of Banswara. Each of the indicators are explained and the data that
you collected during the base line survey last year is explained.
This booklet has been
prepared for your use. You can and must use this as a programme planning
tool.
Go through it carefully
and use the information provided in your sector level meetings, to make your
AWWs and ANMs understand what the situation is and to discuss what needs to
be done to improve the situation in your block. Many of the indicators are
linked. For example, weighing and feeding during illness or diarrhoea.
To assess how well your
block is functioning against each of the indicator look at Pg.31. The score
given in the 2nd column shows how well each block has done against each
indicator. If any of the indicator has a score less than 50% then it is time
to act. You must decide which problem should be given priority and discuss
with your workers as to how the problem can be addressed.
You can use your AWC/SHC
records (Monthly reports) and see which sectors and which centres are showing
improvement with regard to each of these indicators. Discuss what brought
about this improvement and encourage your workers on the good work that they
have done. In sectors and centres which are not showing improvement, spend
more time with those workers and assist them.
You can also use this in
the community, to explain to mothers, the importance of ANC, regularly
weighing, feeding during illness, etc., along with the AWW booklet and
posters that have been provided to each of AWCs and SHCs.
Facilitators Team
Hajo Soru Project
Only a Healthy Mother can have a
Healthy Baby
Indicator 1 -
Pregnancy at Risk
Among
others, there, are two conditions that are crucial to reduce risk at birth
which will also protect the mother from putting herself at risk. These
are: age of the mother and time interval between two consecutive deliveries.
Condition
1 - The Right Age
If a
woman has a baby when she is over 18 years and below 35 years of age, there
are more chances that she would have an easier pregnancy and delivery.
What did the baseline
survey show?
From the above, it is clear that in both Anandpuri (27 out of 82) and Garhi
(26 out of 80) blocks, there were a greater number of pregnant women who were
either under age or over age.
Table 1: No. of Pregnant women at risk due
to age
|
Blocks
|
Below 18 years
|
In the safe age group (18 - 35 years)
|
Above 35 years
|
Total number of Respondents
|
Total number of women at risk
|
|
Anandpuri
|
8
|
55
|
19
|
82
|
27
|
|
Bagidora
|
9
|
62
|
13
|
84
|
22
|
|
Ghatol
|
6
|
62
|
11
|
79
|
17
|
|
Garhi
|
10
|
54
|
16
|
80
|
26
|
|
Kushalgarh
|
8
|
58
|
14
|
80
|
22
|
|
Pipalkhunt
|
3
|
56
|
14
|
73
|
17
|
|
Sajjangarh
|
4
|
65
|
12
|
81
|
16
|
|
Talwara
|
5
|
57
|
15
|
77
|
20
|
Condition
2 - Interval between two births
If a
woman has another baby after a two year interval, then she would have
recovered from her previous delivery and thus is stronger to cope with the
next pregnancy and birth.
What did the baseline
survey show?
The above shows that in both Bagidora (37 out of 84) and Talwara (33
out of 77), there were a large number of pregnant women who had two children
within 2 years.
Table 2: No. of Pregnant women having 2 babies within 2 years
|
Blocks
|
Pregnant Women having child <2
years and thus at risk
|
Total Pregnant women
|
|
Anandpuri
|
21
|
82
|
|
Bagidora
|
37
|
84
|
|
Ghatol
|
17
|
79
|
|
Garhi
|
21
|
80
|
|
Kushalgarh
|
10
|
80
|
|
Pipalkhunt
|
10
|
73
|
|
Sajjangarh
|
14
|
81
|
|
Talwara
|
33
|
77
|
To sum up:
ICDS and Health
functionaries must counsel and talk to women, adolescents and families about
family planning methods that are available and appropriate with respect to
each case. They must also discuss with the family the importance of
taking the at risk mother for check-up and that special care must be taken
during the entire period of the pregnancy. Finally the family and the
concern women must be prepared for safe delivery and arrangement must be made
for transportation in case of need for emergency obstetric care. Timely
and appropriate counseling and along with building of trust can the problem
of at risk be minimised in the future. While all blocks need attention,
specific attention must be paid to Anandpuri, Garhi, Bagidora and Talwara.
Indicator 2 - Ante-
natal care
As soon
as a woman knows that she is pregnant, both she and her family are vested
with certain responsibilities. Safe motherhood is also a right and she has to
be taken care of in an appropriate and fitting manner, by the service
delivery system and by society.
Step 1
- Registration
All pregnant women must be registered at the AWC or the
SHC. Registration helps her to seek the care she deserves and assists the
functionary to provide her the services.
What did the baseline survey show?
The survey results show that in Pipalkhunt (26 out of 73), in Kushalgarh (20
out of 80), and in Anandpuri (20 out of 82), were not registered.
Table 3: No. of Registered Pregnancy
|
Blocks
|
Registered
|
Not Registered
|
No Response
|
Total number of Respondents
|
|
Anandpuri
|
61
|
20
|
1
|
82
|
|
Bagidora
|
69
|
14
|
1
|
84
|
|
Ghatol
|
63
|
8
|
8
|
79
|
|
Garhi
|
73
|
6
|
0
|
79
|
|
Kushalgarh
|
60
|
20
|
0
|
80
|
|
Pipalkhunt
|
47
|
26
|
0
|
73
|
|
Sajjangarh
|
64
|
13
|
4
|
81
|
|
Talwara
|
69
|
7
|
0
|
76
|
Step 2
- Regular check-up
During the period of pregnancy, the woman must have
atleast 3 check-ups, to know that everything is going all right with her and
her baby.
What did the baseline survey show?
The above shows that many women in the following blocks did not have
even one checkup. These were in Anandpuri (32 out of 82), Kushalgarh (29 out
of 80) and Pipalkhunt (29 out of 73). Moreover, in almost all the
blocks, there was no response (blank ) to this indicator. There were a
large number of women who received only one check-up.
Table 4: No. of Pregnant women who had at
least 3 checkups during pregnancy
|
Blocks
|
At least 3 checkups
|
Only one
|
Never
|
No Response
|
Total number Respondents
|
|
Anandpuri
|
25
|
18
|
32
|
7
|
82
|
|
Bagidora
|
40
|
22
|
8
|
14
|
84
|
|
Ghatol
|
54
|
12
|
11
|
2
|
79
|
|
Garhi
|
51
|
20
|
8
|
1
|
80
|
|
Kushalgarh
|
25
|
24
|
29
|
2
|
80
|
|
Pipalkhunt
|
28
|
14
|
29
|
2
|
73
|
|
Sajjangarh
|
28
|
15
|
15
|
23
|
81
|
|
Talwara
|
52
|
12
|
11
|
2
|
84
|
Step 3
-Protecting against Tetanus
A pregnant woman must protect herself against tetanus. She
must take two Tetanus Toxoid injections. This can be given by the ANM at the
health centre or at the AWC.
What did the Baseline survey show?
The above shows that while a large number of women had TT shots (either
one or both), many responses were blank. This could mean that many women did
not know or did not go for the TT shots. This was especially so in Anandpuri
and Sajjangarh.
Table 5: No. of Pregnant women who had TT
shots
|
Blocks
|
One Shot
|
Two Shots
|
No Response
|
Total number of Respondents
|
|
Anandpuri
|
12
|
21
|
49
|
82
|
|
Bagidora
|
29
|
30
|
25
|
84
|
|
Ghatol
|
39
|
22
|
18
|
79
|
|
Garhi
|
22
|
43
|
15
|
80
|
|
Kushalgarh
|
31
|
21
|
28
|
80
|
|
Pipalkhunt
|
22
|
24
|
27
|
73
|
|
Sajjangarh
|
24
|
16
|
41
|
81
|
|
Talwara
|
27
|
31
|
19
|
77
|
Step 4
- Combating Anemia
Most of our Indian women, especially from the poorer
strata are prone to Anaemia. Lack of iron makes the woman weak and
impacts on safe motherhood. Therefore it is necessary that she must take
atleast a 100 IFA tablets during the course of her pregnancy. These are
available at the SHC and AWC.
What did the Baseline Survey show?
The results showed that in Anandpuri (26 out of 82), in Kushalgarh (22 out of
80) and in Pipalkhunt (19 out of 73) did not take IFA tablets. Here again
there were a number of blank responses against this indicator in all the
blocks.
Table 6: No. of Pregnant women who had
taken IFA tablets
|
Blocks
|
Yes
|
No
|
No Response
|
Total number of Respondents
|
|
Anandpuri
|
33
|
26
|
23
|
82
|
|
Bagidora
|
65
|
9
|
10
|
84
|
|
Ghatol
|
60
|
4
|
15
|
79
|
|
Garhi
|
66
|
9
|
5
|
80
|
|
Kushalgarh
|
49
|
22
|
9
|
80
|
|
Pipalkhunt
|
33
|
19
|
21
|
73
|
|
Sajjangarh
|
50
|
13
|
18
|
81
|
|
Talwara
|
66
|
4
|
7
|
77
|
Step 5
- Care during Pregnancy
Together with the first four steps, the pregnant woman
must take care of her diet and food intake, and also ensure that she takes
sufficient rest (atleast two hours during the day) and not lift heavy weights
or do heavy work. Proper care during pregnancy will ensure her strength, a
healthier baby and a normal delivery.
What did the baseline survey show?
The results show that in almost all the blocks, except for Pipalkhunt (35 out
of 65) and in Sajjangarh (31 out of 68) pregnant women did not
take sufficient care with regard to adequate nutrition. In four out of the
eight blocks, less attention was also being paid to taking a minimum of two
hours rest during the day and ensuring that heavy work is not done.
Table 7: No. of Pregnant women at risk due to
age
|
Blocks
|
More Nutritious Food
|
Additional rest totaling to 2
hours during the day
|
Did not take care (food, rest)
|
No Response
|
Total number of Respondents
|
|
Anandpuri
|
46
|
13
|
19
|
4
|
82
|
|
Bagidora
|
63
|
16
|
2
|
3
|
84
|
|
Ghatol
|
43
|
21
|
7
|
4
|
75
|
|
Garhi
|
61
|
6
|
2
|
10
|
79
|
|
Kushalgarh
|
64
|
10
|
4
|
0
|
78
|
|
Pipalkhunt
|
30
|
4
|
26
|
5
|
65
|
|
Sajjangarh
|
37
|
14
|
3
|
14
|
68
|
|
Talwara
|
52
|
15
|
4
|
0
|
71
|
To sum up:
ICDS and Health
functionaries must pay more attention to Ante-natal care services. They must:
- ensure that all pregnant
women are registered and that there is no duplication of registration
between departments;
- ensure that every pregnant
woman has check-up at least thrice, and gains weight regularly
- ensure that all pregnant
women receive both doses of TT
- ensure that all women receive
and consume their 100 IFA tablets
- build relationship with
pregnant women and their families and counsel them, so that the woman
has sufficient nutritious food intake during pregnancy, takes proper
rest and does not engage in heavy work. These practices be discussed and
workers must be encouraged to identify the problem and to workout
solutions along with the concerned women and her family.
Special
attention must be paid in these blocks, where the overall score for ANC is
low:
- Pipalkhunt
- Anandpuri
- Kushalgarh
- Sajjangarh
ANC
can be strengthened further in the remaining blocks of:
- Bagidora
- Garhi
- Talwara
- Ghatol
Safe Delivery Ensures Safety of Mother
and Baby
Indicator 3 - Safe
Delivery
Condition
1: Deliveries must take place at Institutions
In the earlier section, we saw the importance of
ante-natal care. Now , the mother is ready to deliver. Where she delivers
her baby and how and by whom the baby is delivered is extremely crucial
for both the safety and health of the mother and her baby. If the
delivery is carried out at a health centre or hospital, it is all the more
safer and better.
The delivery can be conducted at home as long as the place
of delivery is clean and hygienic and if the delivery is attended by a
trained person (Dai or ANM).
What did the baseline survey show?
What the above shows is that in almost all the blocks more than one third of
the deliveries take place in the home and not in institutions. In Garhi
almost all the deliveries 70 out of 80 took place at home. More than half of
the deliveries took place at home in Pipalkhunt (51 out of 73), in Ghatol (51
out of 79), in Talwara (48 out of 77), and in Anandpuri (45 out of 82).
Table 8: No. of Pregnant women planning for
Home versus Institutional Delivery
|
Blocks
|
Home
|
Institutional: PHC, Govt. Hosp. Clinic
|
No response
|
Total number of Respondents
|
|
Anandpuri
|
45
|
21
|
16
|
82
|
|
Bagidora
|
42
|
29
|
13
|
84
|
|
Ghatol
|
51
|
16
|
12
|
79
|
|
Garhi
|
70
|
9
|
1
|
80
|
|
Kushalgarh
|
41
|
32
|
7
|
80
|
|
Pipalkhunt
|
51
|
5
|
17
|
73
|
|
Sajjangarh
|
36
|
19
|
26
|
81
|
|
Talwara
|
48
|
15
|
14
|
77
|
Condition
2: Deliveries must be attended by trained attendants
Since most of the deliveries tend to take place at home,
it is important that those who attend the delivery are trained. This ensures
that the five safety measures, i.e., safe, hygienic place, soap, clean hands,
sterilized razor and clean strings are used.
What did the baseline survey show?
From the above, it is clear that except for Ghatol, all the blocks show a
high number of deliveries attended by untrained Dais or family members.
Kushalgarh, Sajjangarh and Talwara need attention in this regard.
Table
9: No. of
deliveries were conducted by trained Personnel
|
Blocks
|
Family Member/ Untrained Dai
|
Trained Personnel
|
No Response
|
Total number of Respondents
|
|
Anandpuri
|
65
|
86
|
0
|
151
|
|
Bagidora
|
70
|
71
|
16
|
157
|
|
Ghatol
|
41
|
114
|
4
|
159
|
|
Garhi
|
65
|
94
|
0
|
159
|
|
Kushalgarh
|
91
|
65
|
0
|
156
|
|
Pipalkhunt
|
74
|
77
|
8
|
159
|
|
Sajjangarh
|
77
|
78
|
6
|
161
|
|
Talwara
|
82
|
76
|
8
|
166
|
To sum up:
|