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Abdul Wajid, Gul Rashida Shaikh,
Zeba Sathar,
and Peter Miller. "Addressing the three delays in Pakistan."
ABSTRACT
Learning objectives
By the end of this presentation, participants will be able to:
describe the problem of maternal and neonatal mortality in Pakistan;
understand the three-delays model as it applies to a rural and
socially conservative setting in Pakistan; and be familiar with
specific community-based interventions and health services
interventions to address the three delays in Pakistan.
Background
The Safe Motherhood Applied Research and Training (SMART) project is
a three-year operations research project designed by the Population
Council, Pakistan, to develop and test interventions to reduce
maternal and neonatal mortality in Dera Ghazi Khan District, Punjab, a
predominantly rural and socially conservative setting in Pakistan.
The principal objective was to test the hypothesis that reducing all
three delays in obtaining care in the case of obstetric emergency as
described in the three-delays model (first delay at household level
to seek care; second delay at community level to transport mother;
and third delay at facility level) is significantly more effective
than reducing the third delay alone.
Design/methods
The SMART project was implemented in three sites. Two intervention
strategies, one involving a community-based intervention plus a health
services intervention (“site 1”) and the other involving the health
services intervention only (“site 2”), were compared against a
control site (“site 3”) with no intervention. The community based-interventions included community organization, education for women
and men, and training of community health workers and traditional
birth attendants (dais). The health services interventions included
technical and counseling training for relevant public-sector
physicians and paramedics. For the interventions, 120 villages with
a total population of approximately 630,000 were randomly divided
into equal numbers of 60 communities. Sixty control villages were
selected in a similar adjacent district of Layyah.
Results/outcomes
The findings from this project are encouraging in terms of improving
understanding about the interventions that might improve the three
delays that women facing obstetric emergencies experience in
Pakistan. The data show a statistically significant decline in the perinatal mortality rate (PNMR) in a short period of 18 months. PNMR
declined by 22 percent (p = .017) in site 1, with no decline in
sites 2 or 3. Analysis of effects of specific interventions
suggests that community education through women’s group sessions and training
of dais may have been primarily responsible for the mortality
decline.
Conclusions
In the relatively short period of time of three years, the project
results suggest that community-level interventions to address the
first two delays can have a significant effect independent of
improvements in health facilities. Also, the project shows that
declines in perinatal mortality are possible in a short period of
time and in a challenging setting.
Panel Session H2—A Strong Start: Mobilizing Communities for Safe
Delivery
Saturday, 31 May 2008,
9:30–11:30
am
2008
International Conference on Global Health Web site
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