INSTITUTE OF CHILD HEALTH
Maternal and newborn care practices
among disabled women, and their
attendance in community groups in rural
Makwanpur, Nepal
Aman Sen, Joanna Morrison, JF Trani, Dhruba Adhikari, Kirti
Tumbahangphe Tim Colbourn, Bharat Budhathoki, Machhindra
Basnet, DS Manandhar, Anthony Costello, Nora Groce,
Trial design
24 clusters
in 12 matched pairs
1600 sq km
population 170,000
Surveillance of pregnancies
28,931 women
Supply side
Health service activities
12 intervention clusters
12 control clusters
Women’s groups
No women’s groups
Demand side
Primary outcome
Neonatal mortality rate
Secondary outcomes
Stillbirth rate
Maternal mortality ratio
Home care practices
Health care seeking
Women’s group
Community action
cycle
Problem
identification
Participatory
Evaluation
Strategy dev.
and planning
together
Implementation
30% reduction in neonatal mortality!
Major impact on maternal mortality!
Lancet 2005
Surveillance system
VDC=
Ward
Married women
of Reproductive
Age
Sector
Ward Enumerator
VDC Interviewer
Field supervisor
General objective
To find out prevalence of different types of
disability, severity of disability and its effect on
child birth, care practice and care seeking
behavior.
Specific objectives
To identify women with disabilities among
the cohort of over 13687 Married Women
of Reproductive Age who have given birth
in the last 10 years
To provide data to the researchers around
the world with significant insight into the
maternal and child health needs of disabled
women as part of the emerging discourse
on disability at local, national and global
level
Continue
To create maternal health and child surviving
programming and policy of women with
disabilities
To know the accessibility of services for
women with disabilities
To generate hypothesis and develop the
community based intervention (policy
relevant) for improving health of women with
disabilities and their children
Method
Our sample is women with disabilities that were
identified from a cohort of 13,687 married women
of reproductive age from 30 Village Development
Committees of Makwanpur District, that we (MIRA)
have studied since 2001.They were identified
using a screening tool and 100 questionnaires
were piloted and modified accordingly.
44 interviewers were used to collect data after
providing training
Cont….
• Cross sectional descriptive
• 30 VDCs mainly hill and
inner terai
• Married Women of
Reproductive Age who
gave birth in last10 years
• Women's relatives were
interviewed for additional
information
Conti…
Conducted semi-Structured
Interview (SSI) with women
with disability and women
without disability using
checklist
Focus Group Discussion
(FGD) with Female
Community Health
Volunteers (FCHV) and field
supervisors using topic guide
Screening tools
• functioning, disability and health questionnaire ,we
adopted ,was developed and used in a National
Disability Survey in Afghanistan.
• Questionnaire screens for type and severity of
disability .
• The questionnaire has 34 questions and modules
contain questions to detect epilepsy ,physical,
sensory, learning, behavioural and social disabilities.
• It uses the definition of disability used by the
International Classification of Functioning, Disability
and Health, ICF, WHO 2001)
Research for Development
Thank you