Maternal, Neonatal and Child Health

Robust situation assessment to identify gaps, designing pilot programmes, testing innovations, and scaling up of effective interventions constitute our programme components in maternal, neonatal and child health (MNCH). Along with our affiliate organisations, the Centre for Global Public Health, University of Manitoba and Indian Health Action Trust, we provide technical assistance, since 2009, to the National Rural Health Mission of Government of Karnataka to improve MNCH outcomes in the state.


Current Projects

Kangaroo Mother Care

Increase KMC practice of prolonged duration to reduce mortality due to low birth weight.

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Concluded Projects

  • Sukshema
    • Sukshema-Improving facility and community level care of new mothers, infants and children

      In India, while the maternal and newborn deaths have been declining over the past two decades, the pace has been slow. In particular, progress among the poorest and most marginalised populations in the country continues to lag, with continued disparities in health outcomes. Combination of complex multi-level factors increase vulnerability of this segment to poor health outcomes.Closer home in Karnataka, the state average for infant mortality rate (IMR) is 35 and maternal mortality rate (MMR) is 144. Many of the less developed northern districts in Karnataka with weaker health infrastructure lag in improvements in Maternal Neonatal Child Health (MNCH) outcomes. Nearly half of the maternal deaths and many more neonatal deaths occur at the time of delivery and first week postpartum. In north Karnataka, IMR and MMR are the above state average. In district Raichur, IMR is 67 and MMR is 244 and in Koppal, IMR is 58 and MMR is 236.

    • Implementation

      The programme was implemented from 2009 – 2015 in eight priority districts in north Karnataka – Bagalkot, Bellary, Bijapur, Gulbarga, Koppal, Raichur and Yadgir. The project supported the National Rural Health Mission to improve the functioning of programmes and resources directed primarily at the interactions between health workers and families/ communities at the home, community and first level health facilities (i.e. up to First Referral Units) to provide a focused set of critical interventions during pregnancy, around birth and during the neonatal period.

      Bill and Melinda Gates Foundation funded the programme. KHPT partnered with University of Manitoba, Canada, St. John’s Academy of Health Sciences, Karnataka, Karuna Trust, and Intra Health to implement the programme.

    • Impact

      The project resulted in considerable improvement in quality of maternal and newborn care at the facility level.

      • Arogya Mantapa, formed at the community level, promoted collaborative action at the sub centre level among all front line health workers, Anganwadi workers, junior health assistants as well as community representatives from the Village Sanitation Health and Nutrition Committees
      • The ANC check-up rates increased substantially in all project districts
      • Proportion of women who stayed for 48 hours after delivery and proportion of women who received all services across continuum gradually improved
    • Innovations

      Several innovative approaches to tackling the problem evolved from the project.

      • ASHA Diary, a simple enumeration and tracking tool to assist ASHAs in population level planning and tracking of beneficiaries across MNCH care continuum
      • Home based maternal and newborn care tool to provide high quality service during home visits including screening and referral of complications
      • Family focused communication for facilitating behaviour change within the families
      • Onsite mentoring, using a new cadre of nurse mentors, to improve the quality of institutional deliveries in the primary health centres
      • Simplified case sheet and other tools and aids to help providers adhere to clinical standards, assist in screening, managing and referral complications in timely manner in addition to being a quality monitoring and improving tool by itself
      • Skills and drills intervention to improve quality of emergency obstetric and newborn care at the first referral units

      Supportive community monitoring tools and processes to strengthen community accountability at the grass root level

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  • Strengthening First Referral Units
    • Strengthening First Referral Units-Improving emergency obstetric and newborn care

      An intervention research project,  implemented from 2013 to 2014, chose four First Referral Units (FRUs) facilities, each from two districts, Bagalkot and Koppal, in northern Karnataka, India as intervention and control facilities to evaluate the diagnosis and management of select maternal and newborn complications.

    • Context

      The likelihood of girls from scheduled castes and tribe (SC/ST) families in northern Karnataka completing secondary school is sharply diminished by family poverty, gender discrimination, the traditions of early marriage and devadasi dedication, boys’ actions and attitudes towards girls, inadequate measures to meet girls’ needs at schools and by community authorities and education officials to enforce girls’ right to education. The rates of underage marriage are over 30% among girls from SC/ST communities in Bijapur and Bagalkot districts. Girls who drop out of school are more vulnerable to HIV infection and other health problems, will have a larger, less healthy family, earn less than their better educated peers, and lack voice, agency and are disengaged from larger community issues.

    • Implementation

      The intervention was a composite of the below activities.

      • Skills building through refresher training for medical providers
      • Emergency drills to strengthen team and system preparedness in handling select obstetric and newborn emergencies
      • Supportive supervision provided by obstetric and pediatric specialists along with drills improvement of referral networks.

       

      The intervention focused on strengthening providers’ skills and team work along with documentation.

      A formative research collected information related to the facility infrastructure, human resource and supplies. This was followed by visits by experts to ensure adherence to some basic infection control practices at all study facilities. Data collection was completed in October 2014.

      Bill and Melinda Gates Foundation funded the project from 2014 – 2016. KHPT implemented it with support from IECS, Argentina and University of Manitoba, Canada.

    • Impact

      A study, based on a mixed methods approach, evaluated the effectiveness and impact of ‘skills and drills’ intervention on such complications. It showed that the ‘skills and drills’ intervention, a relatively new mode of facility-based intervention was well accepted and appreciated by the providers, especially by the nursing staff of these facilities.

      The delivery record, a new documentation format was highly valued, and used for almost all deliveries in both intervention and control facilities.

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