|Year : 2021 | Volume
| Issue : 1 | Page : 49-54
Coverage assessment of maternal and child health services provided at Urban Health and Nutrition Day in urban slums of Jamnagar Municipal Corporation area
Mubashshera Firdous Khan1, Ilesh S Kotecha2
1 Department of Community Medicine, AIIMS, Nagpur, Maharashtra, India
2 Department of Community Medicine, M P Shah Government Medical College, Jamnagar, Gujarat, India
|Date of Submission||14-Apr-2020|
|Date of Decision||18-Jul-2020|
|Date of Acceptance||03-Apr-2021|
|Date of Web Publication||29-Jun-2021|
Dr. Ilesh S Kotecha
M P Shah Government Medical College, C-29/A-Doctors Quarters, M P Shah Medical College Campus, P N Marg, Jamnagar - 361 008, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: Urban Health and Nutrition Day (UHND) is an initiative to provide preventive, promotive, and curative maternal and child health services monthly on fixed day. It is mainly designed to reach out to those who are living in urban slums and for serving vulnerable. The study was conducted to assess the utilization of services provided to mother and child at Mamta session.
Materials and Methods: A cross-sectional study was conducted in urban slums of Jamnagar. In the first stage, 30 Anganwadi centers were chosen by systematic random sampling, and in the second stage, 8 postnatal women with 8 children were included.
Results: Out of 240 participants, 80% of women registered their pregnancy at Mamta session and 86% were having Mother and Child Protection Card at the time of visit. Basic health checkups containing blood pressure and weight were measured for around 90%, three-fourth of women were checked for hemoglobin % and urine for albumin, and only 29% were done with abdominal examination. Health education component was found to be much-sidelined portion of UHND session in both mother and child care in this study. From surveyed children, 81.6% were registered at session site; from those registered, 62% attend the session regularly; 80% of children were weighed; only 12% of children's weight was recorded in Mamta card; and 50% of mothers were explained about weight and its interpretation. Fifty-four percent of women had given colostrum to their babies, and the same proportion of mother gave prelacteal feed to their children.
Conclusion: There is a need to sensitize health workers about the importance of giving health education to mothers which is found to be the most poorly executed component of the study.
Keywords: Anganwadi center, Mamta session, maternal and child health services
|How to cite this article:|
Khan MF, Kotecha IS. Coverage assessment of maternal and child health services provided at Urban Health and Nutrition Day in urban slums of Jamnagar Municipal Corporation area. Indian J Community Fam Med 2021;7:49-54
|How to cite this URL:|
Khan MF, Kotecha IS. Coverage assessment of maternal and child health services provided at Urban Health and Nutrition Day in urban slums of Jamnagar Municipal Corporation area. Indian J Community Fam Med [serial online] 2021 [cited 2021 Jul 25];7:49-54. Available from: https://www.ijcfm.org/text.asp?2021/7/1/49/319935
| Introduction|| |
National Urban Health Mission (NUHM) had been launched in 2013 for providing primary health services to an urban vulnerable population. The framework of the NUHM envisages the provision of outreach services targeted to slum dwellers and other vulnerable groups.
The monthly outreach sessions/Urban Health and Nutrition Days (UHNDs) are organized along the line of the Village Health and Nutrition Day under the National Rural Health Mission. These are organized to cater population living in slums/vulnerable within the catchment area of an urban primary health center to ensure universal coverage for a set of basic curative and large basket of preventive and promotive services. The UHND is also an occasion for health communication on a number of key health issues; it is usually observed once a month at Anganwadi center (AWC) or school or any other available space for community work. The primary focus of organizing UHND session is to provide health services to the urban poor and address the disparity of health services in an urban part. UHND sessions also known as Mamta divas had been initiated under the umbrella of Mamta Abhiyan since 2006 in Gujarat to reach population mostly residing in urban slums.
The key beneficiaries of Mamta day are women of reproductive age group, pregnant women, postnatal women, and children under 5 years.
Maternal and child health (MCH) indicator among slum people shows that their health is 2–3 times worse than in urban areas. Drawing upon the findings of the National Family Health Survey (NFHS), it was concluded in many studies, that although health indicators in urban areas are better than rural population, there is vast disparity in these indicators if we compare between urban poor and nonpoor populations in terms of status of MCH care indicator in all over India as well as in all states. WHO report published for SEAR (South East Asian Region countries) found the utilization of Antenatal, Postnatal, skilled birth attendant and family planning services low in slum setting as compared to non slum area; the same scenario is of high infant mortality rate, under-five mortality, and low utilization of child health services.
Various studies have shown that inadequate utilization of MCH services among the urban poor, particularly the slum dwellers, leads to high MMR, undernutrition, poor immunization, and infant morbidity and mortality.,,, The study was conducted with an objective to assess the utilization of services provided to mother and child at UHND sessions.
| Materials and Methods|| |
Jamnagar city is situated in Saurashtra region of Gujarat, being known as oil city of India; it has witnessed a lot of industrialization, and due to this, a large number of people are migrated from all over India, leading to increased slum population. A cross-sectional study was conducted in urban slums located in Jamnagar Municipal Corporation area to see the utilization of MCH services provided at UHND sessions. The study is a part of another big study to evaluate the utilization of UHND services among all beneficiaries, conducted for 1 year in 2016.
A cross-sectional study was conducted in urban slums located in Jamnagar Municipal Corporation area to see the utilization of MCH services provided at UHND sessions.
The research study includes mothers who had delivered child within 1 year at the time of data collection and children in the age group of 0–6 years. Only those participants who were residing in catchment area of chosen AWC and beneficiary of AWC were included in this study.
Two-stage sampling methodology was adopted. A complete list of Anganwadi centers of Jamnagar urban area was taken from Integrated Child Development Services (ICDS) office; there were around 297 Anganwadi centers in the study area. For sampling purpose, a ward wise alphabetically listing of all the 297 AWCs was arranged; then, in the first stage, 30 AWCs were chosen from 297 AWCs by using systematic random sampling, and in the second stage from each chosen AWC, 8 mothers and 8 children (0–6 years) were chosen randomly in the study. The participants were included at household level in this study.
Sample size was calculated by using standard formula n = 4pq/l2 where n is required sample size and P is proportion of interest that we considered 50% for evaluating coverage of both MCH services separately, with 10% absolute precision, so minimum estimated sample size was 100. Design effect of 2 is taken; a 20% safety margin was added to allow for a maximum estimated nonresponse; it gave a sample size of about 240. Because we considered evaluation of mother and child services separately, we chose 8 postnatal mothers and 8 children from each selected AWC.
For including the required number of participants in the study, first house in selected AWC was chosen by randomly considering last two digits from currency note present with investigator as proxy for household number and the household having that number was taken as first household for including mother and child. Starting from that house every eligible mother and child were included from subsequent houses till required number of participants found. In case Anganwadi. Participants were inquired about their sociodemographic characteristics; assessed for utilization of maternal and child health services provided at Mamta Divas with emphasize being given to assess the counseling component of UHND sessions.
Ethical clearance and data collection
The study proposal was approved by the institutional ethics committee. A house-to-house survey was done to collect the data using a predesigned and pretested semi-structured questionnaire for 1 year. Before starting actual study, a pilot testing was conducted to see the comprehension of questionnaire among beneficiaries and refining them for easy administration. Informed consent was taken from each participant before administering questionnaire.
Data entry and analysis were done using Epi Info version 3.5.4 CDC (Center for Disease Prevention & Control) Atlanta, Georgia, US. Results were expressed in terms of percentages and proportion.
| Results|| |
[Table 1] shows the sociodemographic characteristics of 240 postnatal women surveyed in this study. Majority of the women were in the age group of 20–29 years, and 2.9% of pregnancies were found to be in adolescent age. The proportion of illiteracy was found to be as high as 25%. Majority of the women (94.2%) were homemakers and economically dependent which may reflect adversely on their health-seeking behavior. Majority of the women were belonging to Hindu religion (63.3%) and living in joint family system (59.6%). It was observed that majority of women, i.e., 79.6%, belong to lower socioeconomic class (class III, IV, and V) and 20% of women were belonged to higher socioeconomic class (class I and II) by using BG Prasad classification. The study revealed that around 23% of women in the study area had their first child before the attainment of legal age of marriage and around one-fourth of the study population had a family size more than 2.
[Table 2] shows the utilization of maternal health services provided at AWC on Mamta divas. Eighty-six percent of women had Mamta card during visit, and the most commonplace (80%) of registering pregnancy in slum was found to be Mamta session. After assessing Antenatal services that include weight and blood pressure measurement, hemoglobin estimation(Hb%) and abdominal examination; it was found that only weight and BP measurement was carried out in most of the AWCs; only weight and BP measurement services are provided in most of AWC; three-fourth of women were checked for Hb%, urine for albumin, and sugar; abdominal examination was conducted on 30% of women. We also assessed about getting benefits of supplementary nutrition to beneficiaries (ANC, PNC, children and adolescents) that is provided at AWCs under ICDS programme. In this study, we found that only 62% were provided with take-home ration (THR) at least once in their ANC period, and out of them, only 24% had been provided with adequate number of packets. The coverage of early registration was only 60% in the study area, and around 10% of pregnancies were not at all registered in any facility. Around 30% of women registered pregnancy either in the second or third trimester. Less than 50% of women had the desired number of ANC visits which show the weakness in reaching beneficiaries.
|Table 2: Coverage of maternal health services provided at Anganwadi center on Mamta session (village health and nutrition day)|
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Out of 190 women who registered in Mamta session at AWC, around 60% of women had been provided with 100 or more iron and folic acid (IFA) tablets; it could be due to their infrequent visit to sessions. For ascertaining the services provided to mother, we recorded most of the findings from Mamta card only. Coverage of complete immunization in pregnancy was 90%; 60% of women got the full ANC care (≥4 antenatal visit, consumption of 100 or more IFA tablets, and at least one doses of tetanus toxoid injection) in the study area; around 88.88% of women were delivered in health-care facility. 11.3% of women were delivered at home of which 67% were conducted by trained Dai and 33% of home delivery was conducted by untrained Dai.
In [Table 3], apart from giving basic health services, promotive and preventive care has a special emphasis in UHND session. Hence, we also included various domains of ANC counseling in this study. Only 5% of women were aware about all three danger signs of pregnancy. Thirty percent of women got the advice regarding family planning; 70% of women had been counseled for taking adequate nutrition in pregnancy and postnatal period. Sixty-three percent of women were counseled for birth preparedness.
|Table 3: Assessment of antenatal care counseling at Urban Health and Nutrition Day sessions|
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In [Table 4] among children included in the study, around 81% were registered at Mamta session in AWC. Among registered children, only 62% had regularly attended the session every month. It was found that 80% of children were weighed in their last visit; 50% of mothers were explained by the health workers about weight and what does it mean by falling of child in a particular color zone. Mothers were also asked about feeding practices at birth; it was found that around 54% of mothers had given prelacteal feed (honey, jiggery, sugar water, and water) to child immediately after birth because some of them considered this as a ritual and others in misbelieving that there is no milk immediately after delivery. Fifty-four percent of mothers had given the first milk that is colostrum to their babies; it indicates that there is an increase in need of creating awareness among mothers about feeding of their child.
We also include the status of counseling of mothers about child care; it was checked whether mother had been counseled about nutrition, hygiene, danger sign, and knowledge about oral rehydration salt (ORS) preparation. 57% had been given nutritional advice about children related to exclusive breast feeding, correct food and timing of introduction of complementary feeding. Then, 40% had been advised about hygienic practices (nail cutting of both mother and child, handwashing of duo before feeding the child, and using clean utensil for taking food); 60% of mothers had been able to describe the correct method of preparation of ORS. Very few, i.e., 36%, were aware about the danger signs (irritable child, fast breathing, nasal flaring, yellow palm, and sole) as per Integrated Management of Neonatal and Child Health Services.
| Discussion|| |
The study included 240 mothers and 240 children to assess the utilization of MCH services provided at UHND session. The first thing that is given to mother in her first visit to avail health services is Mother and Child Protection Card and is an important card for documenting all the services utilized by mother and child and used for follow-up of services. The study found a good number of mothers (86%) who had Mamta card and registered themselves at Mamta session. It was also observed that women of study area are availing maternal services at more than one facility may be due to easy accessibility in an urban area. The finding of District Fact Sheet of Gujarat (NFHS-4) 2015–2016 shows that 93% of women had MCP card in an urban area; difference in finding could be due to the present study that was conducted only in urban slums. Pai et al. in slums of Karnataka and Neyaz et al. in slums of Aligarh found a similar proportion of women utilizing government facility for registering their pregnancy.
The proportion of women conceived before legal age of marriage was found to be as high as (23%); similar findings were found in District Fact Sheet of Jamnagar (NFHS-4); this warranted the need of proper implementation of law as well as more community outreach to create awareness among population.
The proportion of home deliveries was 11.7% in study area; among them 3.7% were conducted by untrained dais; there is a special need to map out those areas where home deliveries are high and persisting because it was observed that some selected areas were having more proportion of this practice.
It is expected that women should be provided with some basic health checkups regularly in every visit which include BP, weight measurement, and abdominal examination along with periodic Hb% estimation and urine for albumin and sugar in the last trimester. These sets of services would ensure the prevention of complication in early stage. In the present study, BP and weight were measured of more than 90% of mothers, three-fourth of mothers were checked for Hb and urine for albumin and sugar, but the abdominal examination was conducted in only 30% of mothers; it could be because of lack of required skills in auxiliary nurse midwife which indicate the need to conduct a more robust training program for health workers for effective delivery of services at primary level. In studies by Gandhi et al. in an urban slum of Surat and Pati et al. in Orissa and Mehta et al. in Vadodara, nearly all studies found good coverage of weight measurement and similarly low coverage of abdominal examination; the rest of the health services varied from study to study.
Pregnant and postnatal women are provided with supplementary nutrition in the form of THR under ICDS program. A study found that only 24% were provided with adequate number of packets. NFHS in Gujarat (2015–2016) also found that around 30%–35% of ANC and PNC mothers were provided with supplementary nutrition. Hence, the efforts of the government are not really translating into action, and in spite of functional since long, there are large lacunas in implementing the delivery of program that arise the need of interrogation at delivery level.
The coverage of IFA tablets, injection tetanus, and full ANC care was found more than NFHS-4 finding, which may be due to regional difference in coverage. An important component of UHND session is to provide preventive and promotive health services to beneficiaries; to accomplish this, there should be series of session on mother and child care in every monthly meeting. Counseling about danger sign of pregnancy, family planning, nutritional advice, and birth preparedness are some of the important ANC topics to be discussed at UHND, findings of the present study found counseling being the most neglected portion in UHND. Various studies conducted on Mamta session in Gujarat and other states,, found a similar scenario of health education.
Behavior change communication (BCC) is the key to sensitize population, and if done consistently, it will lead to major reform in health condition of population and need to be strengthened.
Growth monitoring is an important component of tracking child nutrition and it helps in identifying any deviation of anthropometric measurement from normal at right time and timely intervention can be given to child. Poor weight record maintenance on Mamta card was observed; only 12% children weight was recorded by health worker; it is actually a missed opportunity to detect early abnormality and further follow-up. A study conducted in an urban slum of adjacent city found a similar list in growth monitoring, but documentation was found to be more (61%) than the study finding.
Limitation of the study
The main limitation of the study was that the findings of study was entirely based on quantitative survey to assess the maternal and child health services provided at UHND but the reasons behind the low coverage of services could be explored by using qualitative methods of survey and would be very important to find out supply side and demand side barriers hindering the utilization of services that was not explored in this study.
| Conclusion|| |
In spite of functioning of the program for a long, the services provided to beneficiaries are average with promotive components of health the most neglected component. The observations indirectly indicate that quality health services were inadequate although coverage was relatively high sensitizing the need for improving the services provided by health-care workers and to build up their capacity by way of in-service training in the matters of MCH components.
There is a need to sensitize the health worker to effectively implement BCC activities during outreach session through periodic training.
The present study also prompted us to explore the reason behind low coverage of services, barriers, and facilitators of executing services to suggest remedial measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]