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Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Improving Refugee Women's Health During Pregnancy and Delivery
| Moderator: Deborah Maine, Heilbrunn Center for Population
and Family Health, Columbia University |
Presentations:
| Linda Bartlett |
The burden of mortality due to reproductive health-related
causes among Afghan refugees in Pakistan |
| Jeannie Chamberlain |
Returning to Kosovo, CARE's lessons learned from
implementing a region-wide reproductive health training
project |
| Ahlam Abd Elmgeed |
CARE International in Sudan, "Basic health assistance
for war displaced" (BHAWD) impact assessment, July 2000 |
|
The burden of mortality due to reproductive health-related
causes among Afghan refugees in Pakistan
Abstract revision date: January 15, 2001 |
| Authors |
L. Bartlett, Division of Reproductive Health, Centers
for Disease Control and Prevention
Tila Khan, International Rescue Committee (IRC), Hangu,
Pakistan
Munawar Sultana, International Rescue Committee (IRC),
Hangu, Pakistan
D. Jamieson, Division of HIV/AIDS Prevention, Centers
for Disease Control and Prevention Reproductive Health
for Refugees Steering Committee |
| Presenter |
Linda Bartlett |
| Background |
Documentation of the public health importance of reproductive
health (RH) related mortality among refugees is needed
to guide resource allocation, plan health care services
and develop policy. However, RH surveillance is rarely
conducted in refugee camps and RH has only recently been
recognized as a major contributor to morbidity and mortality
in these settings. This study reports RH-related mortality
among Afghan refugees in Pakistan. |
Purpose of study
or program |
To determine the burden of RH-related mortality among
refugees measured as the proportional mortality due to
RH-related causes, assess patterns in cause of death,
and identify barriers to health care access. |
Data collection
methods |
RH-related deaths were defined as deaths in women due
to complications of pregnancy, puerperium or post-partum,
gynecological infections; and deaths of neonates (
28 days of age). All deaths during January 20, 1999 to
August 31, 2000 among males and females of all ages were
actively identified in a census of all families living
(population=134,406) in 12 villages served by IRC in Hangu,
Pakistan. IRC staff recorded the identity, age and gender
of the deceased. Deaths among women of reproductive
age were further investigated using verbal autopsy interviews
of family members to identify the cause of death, if it
was RH-related and if there were avoidable factors that
contributed to deaths. |
Study or
program findings |
Overall, 1195 deaths occurred during the study period.
17% more deaths were identified by the census than had
been reported through routine sources in 1999. Preliminary
analyses indicate that RH-related causes were the leading
cause of death at 22% (95% CI = 19.8-24.6%), including
28 maternal and 234 neonatal deaths. We found that 79%
of maternal deaths had barriers to health care access,
while only 58% of non-maternal deaths in women of reproductive
age had identifiable barriers. |
Conclusions
and program
implications |
As a result of this study, IRC plans to develop interventions
to address barriers to health care access such as increasing
the number and training of birth attendants; and
improving access to emergency transportation and emergency
obstetric services. Furthermore, we anticipate these data
will inform resource allocation among other refugee populations
globally and indicate areas for further research and policy
development. |
For further
information |
Linda Bartlett, Division of Reproductive Health, National
Center for Chronic Disease Prevention and Health Promotion,
4770 Buford Highway NE, MS-K-23, Atlanta, GA 30341
Telephone: (770) 488-5187
Fax: (770) 488-5628
Email: ltb7@cdc.gov |
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| : |
Returning to Kosovo, CARE's lessons learned from implementing
a region-wide reproductive health training project
Abstract revision date: January 15, 2001 |
| Authors |
Jeannie Chamberlain, formerly CARE Kosovo's Reproductive
Health Training Project (RHTP) Manager |
| Presenter |
Jeannie Chamberlain |
| Background |
In September 1999, when CARE Kosovo's Reproductive
Health Training Project (RHTP) started, the majority
of ethnic Kosovar Albanians had returned to Kosovo from
neighboring countries where they had fled ethnic violence
and conflict in Kosovo. Upon return, they found a collapsed
health care system and health professionals who lacked
information on current RH knowledge, skills and practices. |
Purpose of
study or program |
To improve the RH status of Kosovar women and infants
by increasing the RH knowledge of health care providers
throughout Kosovo. |
Data collection
methods |
CARE International, Relief International (RI) and
International Rescue Committee (IRC) joined together
to implement a standardized RHTP throughout Kosovo for
health care providers.
- As lead agency, CARE organized and implemented
a two-week Training of Trainers (TOT) course for
National and International Trainers from CARE, IRC
and RI. They were trained in participatory
methodologies, training techniques and course content.
- The RHR manual, A Five-Day Training Program
for Health Personnel, RH Programming in Refugee
Settings, was adapted as the standard training
curriculum by CARE, IRC and RI.
- The curriculum was translated into Albanian and
revised by CARE to meet the special cultural needs
of the Kosovar returnees.
- A One-Day RH Awareness course was used
to sensitize department heads and program planners
to the critical need for RH services.
|
Study or
program findings |
CARE's RHTP ran from September 1999 through June 2000.
- During a six-month training period over 800 health
professionals were trained. In total over
1600 health care providers were trained throughout
Kosovo by the combined effort of CARE, IRC and RI.
- CARE's course participants represented 38 health
facilities and 14 municipalities surrounding Pristina
and Mitrovica.
- Health care providers were trained in Maternal/Newborn Care,
Family Planning, STDs including HIV/AIDS, and Sexual
and Gender-Based Violence.
- RH knowledge improved by 30% as a result of the
training (comparing pre- and post- tested scores).
- In follow-up visits, health care providers reported
spending more time with clients and providing them
with more RH information and guidance than before
the training.
- Participatory methodologies, new to the Kosovar
context, proved to be powerful teaching and learning
tools for participants and trainers.
- During project implementation, trainees and trainers
identified additional RH clinical training needs
at the health facility level.
|
Conclusions
and program
implications |
- Prior to the RHTP, there were no comprehensive
RH education programs or services in Kosovo.
CARE's lead in the RHTP laid the groundwork for
a coordinated, inter-agency RH effort in Kosovo.
- Throughout the program, an active communication
network developed among donors, the National Institute
for Public Health, UNFPA, WHO and other NGOs involved
in RH training in Kosovo allowed for sharing information
and discussion of pertinent RH issues.
- Based on the success of the RHTP, WHO and UNFPA
are promoting the use of a joint agency approach
in RH training programs in Kosovo.
- Inter-agency collaboration and standardization
of the RH training program proved successful for
training a large number of health professionals
across Kosovo.
|
For further
information |
Jeannie Chamberlain, 6542 4th NW, Seattle, WA
98117 USA
Email: jeanniechamberlain1@hotmail.com
Susan Igras, CARE Atlanta
Email: igras@care.org |
|
CARE International in Sudan, Basic health assistance for
war displaced (BHAWD) impact assessment, July 2000
Abstract revision date: December 5-6, 2000 |
| Authors |
Ian Willis, Project Manager, CARE International, Sudan
Ahlam Abd Elmgeed, Monitoring and Evaluation Officer,
CARE International, Sudan |
| Presenter |
Ahlam Abd Elmgeed |
| Background |
BHAWD is a partnership project comprising health,
water, sanitation and flood mitigation components. The
project coordinates health services among implementing
NGOs. CARE works with 25 clinics in 8 partner organizations. |
Purpose of study
or program |
The 2000 Impact Assessment (IA) is a tool that the
project introduced to better orient project activities
towards achieving goals. The IA looked into behavioral
changes and discussed utilization and dissemination
of information. |
Data collection
methods |
Both quantitative tools (questionnaires) and qualitative
tools (Participatory Learning and Action) were used.
The quantitative assessment targeted women of child
bearing age with children. Material consulted in the
preparation of the assessment was the BHAWD phase 1
baseline survey in August 1998 and phase 2 logical framework,
monitoring plan and indicators. For the 2000 IA, 41
clusters were selected randomly using cluster sampling
methodology. The assessment was carried out by teams
of project staff and some partner NGOs. |
Study or program
findings |
Ante-natal care (ANC). In 1998, 70% of women
interviewed had at least 1 ANC visit. The 2000 IA figure
was 88.4%. The project is currently looking into the
detection of pregnancy complications and referrals.
Tetanus Toxoid (TT). In 1998, 45.7% of women
in their last pregnancy received 1 shot; the 2000 IA
found that 79% had.
Who helped with delivery?
The 1998 baseline found that 43.3% were helped by untrained
personnel and 56.8% by trained providers. In 2000, the
percentage of deliveries attended by midwives and trained
TBAs was 58%, and 37.2% of the deliveries were aided
by an untrained provider.
Vitamin A after
birth. The 1998 baseline survey found that only
26.5% of respondents were given Vit A after birth; this
rose to 51.4% in 2000. More progress is needed.
Post-natal care (PNC) in 24 hours. The 2000 IA
revealed that 75.2% of new mothers were visited during
the first 24 hours after delivery.
Exclusive
breastfeeding. The 2000 IA revealed that 85.9% did
not breastfeed their children exclusively.
Modern
methods of family planning. In the 2000 IA, 20.4%
used no method for spacing, 7.8% used the rhythm method,
25.1% mentioned abstinence, 37.9% mentioned breastfeeding
and 8.8% used the pill. Condoms were not mentioned at
all. |
Conclusions and
program implications |
- We do not know our target population well enough.
- We must place more emphasis on child spacing.
- We need more activity for Vitamin A and TT coverage.
- Can the project have an impact on exclusive breastfeeding
if the message has not been working for the last
6 years?
- The project needs to focus on information gathering,
pregnancies, deliveries and outcomes.
- All our partners in the project must learn to
use and analyze information in order to fine tune
their project activities.
|
For further
information |
Ian Willis, Project Manager, CARE International, Sudan
Email: willisi@care.org |
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