Reducing maternal mortality among Afghan refugees in Pakistan

Abstract

Objective: The International Rescue Committee (IRC) strove to reduce maternal mortality among Afghan refugees in Hangu district of Pakistan by improving access to emergency obstetric care (EmOC), community knowledge of danger signs of pregnancy, and the use of health information. Methods: IRC established EmOC centers, trained community members on safe motherhood, linked primary health care with education on danger signs of pregnancy and the importance of skilled attendance, and improved the health information system. Results: The maternal mortality ratio among Afghan refugees in the area improved from 291 per 100 000 live births in 2000 to 102 per 100 000 live births in 2004. The proportion of refugee births attended by skilled staff increased from 5% in 1996 to 67% in 2007. Complete prenatal care coverage increased from 49% in 2000 to 90% in 2006, and postnatal coverage more than trebled from 27% in 2000 to 85% in 2006. Conclusion: Improved services, community involvement and education, good coordination, and effective systems succeeded in reducing maternal mortality in a traditionally conservative environment.

Awareness of danger signs and symptoms of pregnancy complication among women in Jordan

“…Awareness of the danger signs and symptoms of pregnancy complication should help women make timely decisions about medical care [4,10,14,20]. A considerable proportion of women enrolled in the present study (84.9%) recognized fewer than 4 danger signs of serious pregnancy complications, and 38.8% could not name any of these signs and symptoms.…”

“…This failure may lead to delayed decision in seeking care, which is reported to be a contributing factor in 30%-77% of all maternal deaths [8,9]. Studies indicate that education about pregnancy danger signs and symptoms targeting healthcare providers at different levels, as well as women of reproductive age, increased awareness and recognition of complications, motivated women to seek timely support, and improved referral to health services [10][11][12][13][14].…”

Reproductive health for refugees by refugees in Guinea III: maternal health

“…Increasing maternal knowledge among refugee women, especially recognition of danger signs beyond abdominal pain and headaches, could improve care seeking and thus birth outcomes [6,21,22]. A study of Afghan refugees showed that providing information on danger signs in pregnancy increased timely seeking of skilled birth support [23]. A possible reason for better knowledge transmission in the Afghan study was the higher number of educational workers serving a smaller population, with 330 volunteer community health workers and 325 female health workers for 96,300 male and female refugees (1:300) versus 75 facilitators for 125,000 female refugees (1:1,700) in Guinea [12,23].…”

“…A study of Afghan refugees showed that providing information on danger signs in pregnancy increased timely seeking of skilled birth support [23]. A possible reason for better knowledge transmission in the Afghan study was the higher number of educational workers serving a smaller population, with 330 volunteer community health workers and 325 female health workers for 96,300 male and female refugees (1:300) versus 75 facilitators for 125,000 female refugees (1:1,700) in Guinea [12,23]. This suggests that observable increases in maternal knowledge and attitudes require considerable staff investment.…”

Editor's Comment

“…The international Rescue Committee has provided maternity care in camps for Afghan refugees in Pakistan for 20 years and gained the trust and participation of their clients as measured by the uptake of services [2]. When the article from Yemen was submitted, it described only the results of a needs assessment-a sad story indeed, with few obstetric services being provided [3].…”