Factors that Affect Maternal Care Seeking Behaviour and the Choice of Practitioner(s) during Complications: the Case of Mang’anja Tribe in Malawi

Despite the high prevalence rate of maternal mortality coupled with under-utilisation of health services, little attempt has been made in Malawi to explore and document people’s understanding and beliefs about causes and appropriate treatment of the major complications that are medically believed to be the causes of maternal deaths. Any difference between the insider’s and the biomedical perceptions of what is a serious maternal complication is dangerous because it may delay seeking of lifesaving care. This study was therefore, designed to elicit and explore the local explanatory associated with the major biomedical cause of maternal mortality (haemorrhage) among Mang’anja tribe in Malawi and how these influence care seeking behaviour. Descriptive qualitative research design was adopted and data was collected using Kleinman’s ‘explanatory model interview guide’ from 25 respondents. The findings generally suggest that being aware of maternal danger signs is not enough to provoke a trip to the appropriate healer. Since it is the cause not the effect of the maternal complications that determines care seeking, a shift in approach of health education provided to pregnant women is recommended. Keywords: Malawi, maternal health, explanatory model, care seeking, haemorrhag

Reaching the poor with health interventions: Programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa

Background Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa. Methods We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70 574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results. Results Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them. Conclusions Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants' convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos