Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma

The MOM project

Luke C Mullany, Thomas J. Lee, Lin Yone, Catherine Irene En-Lin Lee, Katherine C. Teela, Palae Paw, Eh Kalu Shwe Oo, Cynthia Maung, Heather Kuiper, Nicole F. Masenior, Christopher Beyrer

Research output: Contribution to journalArticle

Abstract

Background:Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. Methods:Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. Results:Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR=2.69 [95% CI 2.69-3.54]), malaria screening (55.9% versus 21.9%, PRR=2.88 [95% CI 2.15-3.85]), and deworming (58.2% versus 4.1%, PRR =14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR=1.88 [95% CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1% to 48.7% (PRR= 9.55 [95% CI 7.21-12.64]).&Conclusions:Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.

Original languageEnglish (US)
JournalPLoS Medicine
Volume7
Issue number8
DOIs
StatePublished - Aug 2010

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Myanmar
Confidence Intervals
Postnatal Care
Prenatal Care
Parturition
Capacity Building
Pregnancy
Reproductive Health
Marital Status
Family Planning Services
Emergency Medical Services
Vulnerable Populations
Population Characteristics
Maternal Health
Contraception
Malaria
Obstetrics
Emergencies
Public Health
Urine

ASJC Scopus subject areas

  • Medicine(all)

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Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma : The MOM project. / Mullany, Luke C; Lee, Thomas J.; Yone, Lin; Lee, Catherine Irene En-Lin; Teela, Katherine C.; Paw, Palae; Oo, Eh Kalu Shwe; Maung, Cynthia; Kuiper, Heather; Masenior, Nicole F.; Beyrer, Christopher.

In: PLoS Medicine, Vol. 7, No. 8, 08.2010.

Research output: Contribution to journalArticle

Mullany, Luke C ; Lee, Thomas J. ; Yone, Lin ; Lee, Catherine Irene En-Lin ; Teela, Katherine C. ; Paw, Palae ; Oo, Eh Kalu Shwe ; Maung, Cynthia ; Kuiper, Heather ; Masenior, Nicole F. ; Beyrer, Christopher. / Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma : The MOM project. In: PLoS Medicine. 2010 ; Vol. 7, No. 8.
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title = "Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma: The MOM project",
abstract = "Background:Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. Methods:Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. Results:Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8{\%} versus 39.3{\%}, prevalence rate ratio [PRR] = 1.83 [95{\%} confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4{\%} versus 15.7{\%}, PRR=2.69 [95{\%} CI 2.69-3.54]), malaria screening (55.9{\%} versus 21.9{\%}, PRR=2.88 [95{\%} CI 2.15-3.85]), and deworming (58.2{\%} versus 4.1{\%}, PRR =14.18 [95{\%} CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9{\%} to 45.0{\%} (PRR=1.88 [95{\%} CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7{\%} to 40.5{\%}, a relative reduction of 35{\%} (95{\%} CI 28{\%}-40{\%}). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1{\%} to 48.7{\%} (PRR= 9.55 [95{\%} CI 7.21-12.64]).&Conclusions:Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.",
author = "Mullany, {Luke C} and Lee, {Thomas J.} and Lin Yone and Lee, {Catherine Irene En-Lin} and Teela, {Katherine C.} and Palae Paw and Oo, {Eh Kalu Shwe} and Cynthia Maung and Heather Kuiper and Masenior, {Nicole F.} and Christopher Beyrer",
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T1 - Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma

T2 - The MOM project

AU - Mullany, Luke C

AU - Lee, Thomas J.

AU - Yone, Lin

AU - Lee, Catherine Irene En-Lin

AU - Teela, Katherine C.

AU - Paw, Palae

AU - Oo, Eh Kalu Shwe

AU - Maung, Cynthia

AU - Kuiper, Heather

AU - Masenior, Nicole F.

AU - Beyrer, Christopher

PY - 2010/8

Y1 - 2010/8

N2 - Background:Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. Methods:Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. Results:Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR=2.69 [95% CI 2.69-3.54]), malaria screening (55.9% versus 21.9%, PRR=2.88 [95% CI 2.15-3.85]), and deworming (58.2% versus 4.1%, PRR =14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR=1.88 [95% CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1% to 48.7% (PRR= 9.55 [95% CI 7.21-12.64]).&Conclusions:Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.

AB - Background:Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. Methods:Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. Results:Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR=2.69 [95% CI 2.69-3.54]), malaria screening (55.9% versus 21.9%, PRR=2.88 [95% CI 2.15-3.85]), and deworming (58.2% versus 4.1%, PRR =14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR=1.88 [95% CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1% to 48.7% (PRR= 9.55 [95% CI 7.21-12.64]).&Conclusions:Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.

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