265114 From home births to hospitals: Trends in maternal health in rural central Malawi across economic development intervention and control areas

Monday, October 29, 2012

Loren W. Galvao, MD, MPH , Center for Cultural Diversity and Global Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Katarina Grande, MPH , Department of Population Health Sciences, University of Wisconsin-Madison Population Health Institute, Madison, WI
Thokozani Mwenyekonde, BSc , CARE, CARE International in Malawi, Lilongwe, Malawi
Naoyo Mori, PhD , College of Health and Sciences Center for Urban Population Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Jennifer Kibicho, PhD , Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
Patricia E. Stevens, RN, PhD, FAAN , College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Lance S. Weinhardt, PhD , Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Background: We are evaluating an economic intervention combining Village Savings and Loan Associations (VSLA) and agricultural training to determine its impact on childbirth practices in Malawi, where maternal mortality is extremely high. Methods: In this five-year, mixed-methods quasi-experimental study, we are examining birth practices and barriers to delivery services in 900 households in rural central Malawi; 600 in the intervention area, 300 in the control area. Baseline and 18 month follow-up surveys were completed. Results: Eighteen months into the intervention, differences in birth practices between the intervention and control areas were not observed, although trends in both indicate movement toward institution-based births. Between baseline and follow-up, intervention households (101 births) and control households (50 births) delivered fewer babies at home (Intervention: 8.8% decrease, p=0.10; Control: 17.5% decrease; p=0.02); only change in control households was significant. Deliveries by traditional birth attendants (TBAs) decreased (Intervention: 10.7% decrease, p=0.03; Control: 9.3% decrease; p=0.26); only change in intervention households was significant. Attended births at health facilities increased significantly in both intervention and control areas (Intervention: 21.6% increase, p=0.001; Control: 26.7% increase; p=0.005). Barriers to service including lack of transportation and cost did not differ significantly between intervention and controls or between baseline and follow-up. Conclusions: Increased births in health facilities in control and intervention areas suggest the trend is independent of intervention participation. New policies banning TBAs and increased country-wide focus on maternal health offer potential explanations, but require further exploration. Our 36-month follow-up survey may reveal intervention effects requiring more time to manifest.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Identify epidemiological trends related to maternal health and birth practices in rural Malawi, in the intervention and control areas of this quasi-experimental study. 2. Describe the village savings and loans association (VSLA) intervention methodology as an structural approach that may contribute to improve maternal health in rural Malawi. 3. List at least two recent maternal health national policies in Malawi that may be affecting maternal health and birth practices in this rural area.

Keywords: Maternal Health, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Co-Principal Investigator in this 5-year R01 NIH funded project. I have been the principal or co-principal of multiple federally funded and foundation grants on the social, behavioral and epidemiological studies in the field of HIV prevention, maternal & child health and reproductive health. Among my scientific interests the most recent one is on the evaluation of structural interventions (economical, agricultural and educational) on maternal & child health, HIV and other health outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.