Community Awareness for Action: Maternal and Newborn Danger Sign Knowledge in Rural Haitian Communities

The need for the global maternal and child health community to focus on maternal and newborn mortality is well-documented. Reducing maternal mortality is one of the Millennium Development Goals and newborn deaths account for 40% of the <5 Child Mortality Rate. One of the first delays to care is recognizing the problem—community danger sign recognition is critical.

The Haitian Health Foundation (HHF) has provided community based maternal and child health care to a rural Haitian population since 1987, currently serving 200,000 people. Child mortality reductions were accomplished through vaccinations, EBF, health education and well child care. Maternal/Newborn health (MNH) outcomes remain poor. HHF received a USAID Child Survival Grant to focus on MNH (2004). Prior to the start of this program a community survey of danger sign knowledge was conducted with a sub-sample of the periodic HHF census (2001-2002; n=810). In addition, two focus groups were conducted with mothers and community health workers in 2006.

Respondents were primarily female (84%); mean age 34.3; mean 3.7 children; 95% home deliveries with TBAs. Danger sign responses were unprompted; 102 danger signs were elicited including 20 traditional beliefs. Clinically accepted danger signs were grouped by types of complications and four perinatal periods. The major complications of pregnancy, child birth and postpartum were eclampsia, bleeding, and infection; for newborns, infection, malformation and other problems. Respondents averaged 7.44 total responses. Knowledge was highest for the newborn, postpartum and pregnancy periods (average 1.79, 1.69, 1.67 respectively). Women had higher knowledge than men, and women with children had highest knowledge.

Communities are the first responders to problems in the perinatal period. This study demonstrates the need to document community knowledge about clinically accepted danger signs as well as traditional beliefs. The information was used to develop a multi-faceted community education intervention on danger signs utilizing prenatal care, community leaders, mothers' and fathers' groups, theater groups and radio spots.