Title: Pathways to improving maternal mortality in rural Nepal
Creator: Sharma, Binod Bindu
Resource Type: thesis
Description: Research Doctorate - Doctor of Philosophy (PhD)
Worldwide maternal mortality, particularly in low-resource economies like Nepal, is unacceptably high. Lack of knowledge, lack of accessible care and unsupportive sociocultural practices are the main causes of poor maternal health outcomes. We first conducted a systematic literature review which revealed the importance of community support and cultural sensitivity in designing effective public health education programs. The results have been published in a peer reviewed journal, link: https://doi.org/10.1186/s12884-018-1964-1. As community singing and dancing play a central role in Nepalese rural life, we then designed a program to improve community knowledge of key maternal health issues through the use of songs and a wall chart illustrating key points. The population chosen for study was located in one of the remote hill districts of Nepal. One cluster of villages (the intervention cluster) received the program while another similar cluster (the control) did not. The clusters were assessed by pre- and post-intervention surveys to record the results. The key health messages were defined with expert assistance, but the program involved every section of the community, under the leadership of local people, to fine-tune it to suit the local culture and context. Together, we organised a song competition incorporating safer pregnancy and childbirth messages in songs. The winning songs were then taken to the wider community through singing and dancing. To complement these messages, and to encourage the villagers to value them, a pictorial “Holy Duty” wall chart, incorporating pictures of local gods, was also developed. Our program was designed to educate family members with limited literacy, especially mothers-in-law who are key figures in the rural Nepalese family. Male involvement was also essential for decisions related to finance and care. We found there was a significant improvement in the knowledge of the intervention population. Knowledge regarding the importance of antenatal care improved by 130.66%; knowledge of supplementary diet and rest during pregnancy improved by 84.37%; knowledge of childbirth planning improved by 95.73%; and knowledge regarding delivery care, the area with the least improvement, by 72.54%. The follow-up data demonstrated that across all ages and genders in the intervention cluster the effect of the intervention was maintained even 12 months after the intervention. There was a negligible change in the control population. The results have been published in a peer reviewed journal, link: https://doi.org/10.1016/j.ajog.2018.09.038. A video documentary has also been created on the work, link: https://youtu.be/g8z0Vujkrh4. An unexpected finding was a remarkable reversal in the community culture where, while it was once taboo for men to discuss pregnancy and childbirth before the intervention, it became uncommon for anyone not to talk about the key issues of pregnancy and childbirth afterwards. Our research demonstrates that if community education programs are designed, developed and executed properly by addressing community needs and respecting local culture and talents, then long-term positive changes in the knowledge, attitude and practices both at the community and government levels can be realised. The Government of Nepal has already taken important policy decisions to improve maternal health as a result of this project and an in-depth policy review has been presented to it.
Rights: Copyright 2019 Binod Bindu Sharma
Read more: https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:35074;jsessionid=D36D5FFF31C33348F734F1295AD3D919?view=null&f0=sm_identifier%3A%22http%3A%2F%2Fhdl.handle.net%2F1959.13%2F1402873%22&sort=null