MCH-FPMaternal and Child Health/Family Planning
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Most women in Matlab deliver at home with the help of a traditional birth attendant, although institutional deliveries, which were rare as recently as the early 1990s, have increased sharply in the MCH-FP area in recent years (14) Both areas of Matlab have access to Chandpur government district hospital and to some private clinics that provide emergency and intensive-care services, including caesarean delivery and blood transfusion.
The MCH-FP project--a series of carefully designed reproductive health interventions that may directly and indirectly affect maternal health and mortality--was implemented in Matlab in 1977.
In 1996 and 1999, the discrepancies between MCH-FP and DHS data are similarly large: 21-25% versus 11% of births in 1996 and 23-24% versus 14% of births in 1999 were classified as unwanted via prospective and retrospective measurements respectively.
For all four calculated indicators of maternal mortality the value for the MCH-FP area was significantly lower than the comparison area (p<0.
Overall, quantitative data indicated a generally low availability of STI services at MCH-FP facilities in Ghana, Kenya, and Zambia: Only 28 percent to 46 percent of the facilities surveyed offered any form of STI diagnosis or treatment, even in areas with resources to do so.
We examined these trends separately for the MCH-FP and comparison areas and used t tests to assess whether differences between areas are statistically significant.
At primary health care level, it was proposed to add STI/HIV prevention activities to MCH-FP services, and a number of papers have been published in the past few years which analyse the advantages and disadvantage of this form of integration in depth.
METHODS: Data from the Matlab Demographic Surveillance System on 165,894 pregnancies over the period 1982-2005 were used to calculate four measures of maternal mortality for the MCH-FP and comparison areas.
Previously, programme activities at district level relied heavily on vertical donor funding that came earmarked for STI/HIV or MCH-FP activities.
Informal interviews of the service providers were conducted, and the activities at the government facilities were observed by three male and three female community organizers, two male researchers, and one male and one female community health educators who, as part of their job, had day-today interactions with the village women and MCH-FP programme personnel.
Figure 2 shows the IMR in the MCH-FP intervention and comparison areas.