At least 3 danger signs in this period increased sharply (4.7%-25.2%, p<0.001). The signs most mentioned by women at the end of the period were “heavy bleeding” and severe abdominal pain (51.6% and 41.2%). Other signs had a low rate of women mentioning at the end of the period (ranging from 5.5%-37.6%) [37]. The rate of women giving birth with medical staff was quite high at the end of the period in 7 provinces (88.6%), an increase of 5.1% compared to the beginning of the period (p<0.001). Most women with children under 24 months old in the 4 provinces of Phu Tho, Hoa Binh, Tien Giang and Ben Tre were assisted by medical staff when giving birth (99.5%-100%). Kon Tum is the province with a strong improvement in the rate of women giving birth with medical staff compared to the beginning of the period (increased by 21.2%, p<0.001), followed by Ninh Thuan (increased by 7.1%, p<0.05). In Ha Giang, although the rate of women giving birth with medical staff increased compared to the beginning of the period, the difference was not statistically significant (increased by 5.2%, p>0.05).
4.5.3. Effectiveness of communication intervention on postpartum care knowledge
Our research results show that in the control group, the results of women with knowledge of postpartum care about postpartum check-ups were not different before and after the study, but in the intervention group, the difference in knowledge about postpartum check-ups was very different between before and after the intervention (p<0.001). The effectiveness index between the two intervention and control groups before and after the intervention increased by 1595%, in which in the intervention group (increased from 50.0% -100% p<0.001), the rate of women with knowledge about postpartum check-ups after the intervention in the control group was 53.5% and 100% in the intervention group, however, there was a statistically significant difference between the two groups before and after the intervention.
The results of the LMAT intervention in 7 provinces also showed a very good improvement in knowledge and practice of postpartum care. The rate of women who did not know any signs decreased by 7% (29.7%-22.7%, p<0.001). In men, this rate decreased by 10% (from 47% to 36.7%, p<0.001). Women's awareness improved better than men's, the rate of women who knew 3 or more danger signs for postpartum women increased sharply (4.7%-25.7% p<0.001) while this rate in men only increased slightly (7.8%-9.9%, p<0.05) [37]. Postpartum re-examination is important to ensure timely detection of abnormalities in mothers and newborns. The survey results showed that the rate of postpartum women being re-examined 1 week and 6 weeks after giving birth was low (50.8% and 62.6%).
4.6. DISCUSSION ON RESCUE APPLICATIONS
Research Design: Our study is a descriptive study with only quantitative results. If this study could be combined with qualitative research, it would be more reasonable and effective. Combining qualitative research methods will explain the quantitative research results more specifically.
LMAT status: this study only describes the participation of mothers with children ≤ 2 years old in knowledge and practices of maternal care during pregnancy, childbirth, and postpartum and identifies some factors related to maternal participation but does not fully describe the current status of care and services of health workers on LMAT and accessibility to health services in the study area.
Factors related to: occupation, education level of mothers are some of the factors causing difficulties for pre-natal, intra-natal and post-natal care in the locality. Most mothers work in agriculture, their education level is mostly from junior high school down, so receiving information, understanding the responsibilities and importance of pre-natal, intra-natal and post-natal care is a matter of concern.
Intervention study: This study only has a part to evaluate the effectiveness of health education communication intervention to improve knowledge about safe motherhood for women of childbearing age 15-49 years old. The subjects are subject to intervention of the research program. The goal of the intervention is to improve and improve the limitations in awareness about safe motherhood before and after the intervention.
Errors and limitations: Limit errors caused by the research subjects themselves by creating an intimate, open atmosphere when interacting with the research subjects, clearly discussing the purpose of the research and information confidentiality so that the subjects feel comfortable and open during the interview process. Conduct a pilot survey to check the suitability of the questionnaire before conducting the official research, conduct a pilot test of the in-depth interview guide questionnaire by interviewing, and thoroughly train the investigators on how to interview and collect information.
Due to limited time and resources, the study was only conducted in 2 districts and is not representative of the entire Bo Li Kham Xay province.
There may be memory errors due to the long pregnancy period and the mother giving birth ≤ 2 years ago, mothers have difficulty remembering, especially ethnic minority mothers. Information collection errors are errors in the information collection process caused by the way the investigator asks questions or by the mothers' limited ability to grasp the questions, or by errors in recording information. The data collection area is large, some communes are located in difficult traffic locations, so the survey takes a lot of time and money.
The research subjects are mainly of working and school age, often working away from home. Furthermore, the data collection time is right in the harvest season, so meeting the research subjects is very difficult.
Organizing group intervention classes takes a lot of time and requires many trips to do the work. Project participants have many jobs and many classes have been done at night at the commune health station.
Intervention tools included leaflets, models and manuals, and documents related to pre-, intra- and post-natal care were all available.
4.7. NEW POINTS TO RESCUE
The novelty of our study is that it is the first comprehensive study describing Lao mothers' knowledge and practices on safe motherhood and demonstrating the effectiveness of communication work on changing behavior on safe motherhood among Lao mothers living in mountainous areas.
This is the first study to apply the new national standards on reproductive health care of the Lao People's Democratic Republic in 2009 in assessing the current situation of safe motherhood and the effectiveness of communication interventions.
The study applied several multivariate regression analysis techniques to analyze factors affecting knowledge and practices on safe motherhood and calculated intervention effectiveness indicators.
The research results will contribute to policy making and planning to improve maternal and child health.
CONCLUDE
1. Mothers' knowledge and practices on safe motherhood
Knowledge of prenatal care of mothers in Bo Li Kham Xay province, Laos is better than practice. Regarding knowledge: 63.4% of mothers have knowledge of prenatal check-ups ≥3 times; 79.7% have knowledge of tetanus vaccination ≥2 times during pregnancy and 58.4% have knowledge of tetanus vaccination ≥2 times. Regarding practice: 60% of mothers have prenatal check-ups ≥3 times; 52.0% of mothers have tetanus vaccination ≥2 times and only 42.1% of mothers take iron tablets ≥3 months.
Mothers' knowledge of care during and after birth is still low: the rate of mothers knowing about danger signs that occur during and after birth is low, about half of mothers do not know any danger signs that may occur during and after birth (during birth is 48.5% and after birth is 56.3%); only 59.0% of mothers have knowledge about breastfeeding for the first time within one hour after birth.
Mothers' practices regarding prenatal and postnatal care were not good: 54.7% of mothers gave birth at a health facility; 56.3% of mothers were assisted by health workers in their last birth; 56.1% of mothers breastfed their babies for the first time within the first hour after birth and only 25.3% of mothers went for a follow-up visit within 42 days after birth.
2. Factors related to mothers' knowledge and practices of LMAT
Ethnic minority mothers, those living in mountainous areas, with low education, speaking ethnic languages, having more than two children, and having more than two pregnancies received less prenatal care than other mothers.
Ethnic minority mothers, those living in mountainous areas, with low education, speaking ethnic languages, having more than 2 children and having more than 2 pregnancies have higher rates of home births than other mothers.
Ethnic minority mothers, those living in mountainous areas, with low education, speaking ethnic languages, having more than 2 children and having more than 2 pregnancies have a lower rate of births attended by specialized medical staff than other mothers.
Mothers aged ≥25, ethnic minorities, living in mountainous areas, low education, speaking ethnic languages, having more than 2 children and having more than 2 pregnancies had a lower rate of returning for at least 1 check-up within 42 days after birth than other mothers.
3. The effectiveness of health education communication intervention on LMAT
Interventions to improve knowledge about LMAT for women aged 15-49 years have achieved good results. Knowledge about LMAT of women in the intervention group is higher than the control group and the rate of mothers knowing about danger signs is also better in the intervention group than in the control group.
Knowledge of pre-, intra- and post-natal care of women in the intervention group before and after the intervention was better than that of the control group before and after the intervention, such as going to prenatal check-ups ≥3 times was 82.0% and 100% compared to 80.5% and 88.5%; tetanus vaccination ≥2 times was 58.5% and 99.5% compared to 53.5% and 54.5%; taking iron tablets for ≥3 months was 43.5% and 97.5% compared to 45.0% and 47.5%. Giving birth at a medical facility was 50.0% and 100% compared to 55.0% and 59.0%; being assisted by medical staff was 80.0% and 100% compared to 90.0% and 91.0%; Early breastfeeding within 30 minutes to 1 hour after birth was 48.0% and 95.0% compared to 45.0% and 46.0%. Postpartum follow-up visits were 50.0% and 100% compared to 50.5% and 53.5%.
ANTI
Strengthening communication and education on health care about LMAT and some factors related to mothers during pregnancy, childbirth and postpartum care. Using a variety of communication forms: talking, consulting, group discussions, organizing activities integrating communication on the benefits and necessity of LMAT for mothers. Disseminating knowledge and practices of maternal and newborn health care in general and essential interventions from pregnancy to postpartum for mothers as well as family members, emphasizing the benefits of good practice of this work for each mother, each family and the whole country.
Invest resources and funding to conduct systematic research on LMAT exposure methods in Laos to assess understanding, acceptance and propose solutions to improve the practice of these methods.
Develop and promulgate policies on knowledge and routine practices for maternal care during pregnancy, childbirth, and postpartum check-ups at health facilities, and develop a system of routine interventions based on scientific evidence of the benefits of the method.
Integrate reproductive health projects with economic development projects to reduce poverty in mountainous areas.
Communication work on reproductive health care for ethnic minorities in mountainous areas needs to be specific, respect local culture and customs, focus on the community and apply oral methods through women, neighbors, village elders, village chiefs and especially mobilize and encourage men to participate.
If possible, having Video tools or promotional images will increase the effectiveness of the propaganda.
Train additional local staff to increase the continuity of outreach activities.
LIST OF PUBLISHED RESEARCH PROJECTS
Number
Name of published study | |
1 | Khamphanh Prabouasone 1 , Ngo Van Toan 2 , Le Anh Tuan 3 , Bui Van Nhon 2 . Knowledge and practice of prenatal care of mothers with children under 2 years old and some influencing factors in Bo Li Kham Xay province, Laos in 2010. Journal of Medical Research, Vol. 80, N 0 4 - Dec, 2012. |
2 | Khamphanh Prabouasone 1 , Ngo Van Toan 2 , Le Anh Tuan 3 , Bui Van Nhon 2. Effectiveness of intervention to improve knowledge and practice of safe motherhood for mothers mothers aged 15-49 years in Bo Li Kham Xay province, Laos in 2011. Journal of Practical Medicine, Vol. 859, N 0 2 - March, 2013. |
3 | Khamphanh Prabouasone 1 , Ngo Van Toan 2 , Le Anh Tuan 3 , Bui Van Nhon 2. Knowledge and practice of care during and after birth of mothers with young children under 2 years old in Bo Li Kham Xay province, Laos in 2010. Journal of Medical Research, Vol. 82, No. 0 2 - April, 2013. |
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VIRTUAL TEACHING MATERIALS
Vietnamese:
1. Ministry of Health (1998), Health care and nutrition for pregnant mothers. Nutritional care for mothers and children at home , Medical Publishing House, Hanoi.
2. Ministry of Health (2001), Reproductive health care, Document for grassroots health workers , Medical Publishing House, Hanoi, pp. 4-5, 145-178.
3. Ministry of Health (2001), National Strategy on Reproductive Health Care for the 2001-2010 period , People's Army Publishing House, Hanoi, pp. 20-23.
4. Ministry of Health (2003), National standard guidelines on reproductive health care services , Medical Publishing House, Hanoi, pp. 31-44, 52-65.
5. Ministry of Health (2003), Statistical Yearbook 2002 , Medical Publishing House, Hanoi, pp. 33-34.
6. Ministry of Health (2003), Department of Maternal and Child Health and Family Planning, Regional workshop on developing national plan for safe motherhood , pp. 2-21.
7. Ministry of Health (2004), Statistical Yearbook 2003 , Medical Publishing House, Hanoi, pp. 35-36.
8. Ministry of Health (2005), Statistical Yearbook 2004 , Medical Publishing House, Hanoi, pp. 23-34.
9. Ministry of Health (2006), Statistical Yearbook 2005 , Medical Publishing House, Hanoi, pp. 45-47.
10. Ministry of Health (2007), Statistical Yearbook 2006 , Medical Publishing House, Hanoi, pp. 34-36.
11. Ministry of Health (2007), Training materials on national standards for reproductive health care services , Hanoi.
12. Ministry of Health (2009), Report on the results of the basic survey of the Program to reduce maternal and neonatal mortality in 14 project provinces. Hanoi .
13. Ministry of Health (2009), Priority Health Care Program (Safe Motherhood) .
14. Ministry of Health and Department of Maternal and Child Protection/Family Planning (1997), Some routines on maternal and child health care/Family Planning, Vietnam-Sweden health cooperation program in the field of maternal and child protection/Family Planning , pp. 9-38.
15. Bui Thi Thu Ha and Vu Manh Duong (2008), "The current situation of home birth in Luong Son, Hoa Binh " , Journal of Preventive Medicine . 3 (95), pp. 27-32.
16. Dam Khai Hoan, Luong Thu Ha and et al (2006), "The current situation of safe motherhood program in Tan Long commune, Dong Hy district, Thai Nguyen province " , Journal of Medical Information . 6 (11), pp. 25-26.