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  • Title: Evaluation of the home-based maternal record: a WHO collaborative study.
    Author: Shah PM, Selwyn BJ, Shah K, Kumar V.
    Journal: Bull World Health Organ; 1993; 71(5):535-48. PubMed ID: 8261557.
    Abstract:
    Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks. An evaluation was made of the home-based maternal record (HBMR) as an impetus to improved continuity of care and to improved education of women about their health status. The study involved Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen, and Zambia. THe HBMR is a system for recording risk factors and early signs of complications, referrals, and treatment of the mother and infant. Data entry comes from a variety of sources, including the mother and other health personnel. Previous experience with home-based recording systems was reviewed. The WHO record was developed in 1982 and a set of guidelines was developed to evaluate the objectives and explore the functions. The evaluation was conducted between 1984 and 1988 in the 13 countries previously indicated with pre- and post-intervention designs and with controls, where possible. HBMRs were given to mothers during the second through the eight month of pregnancy, and those identified at risk were referred for appropriate care. Study populations ranged from 14,000 to 250,000 and female literacy ranged from 15% to 91%. Sample populations ranged from 75 to 819. Evaluation and results were provided for each of 6 objectives: 1) to encourage continuity of care from pregnancy through interpregnancy periods; 2) to encourage early identification of at-risk women and newborns; 3) to promote referral suitable to women and encouraging self-care; 4) to promote initiation of appropriate care suitable to needs; 5) to provide a useful and practical record of care; and 6) to provide a focus for health education about risk and health care during pregnancy and the interpregnancy period, and for the neonatal period. The findings revealed that HBMR was an important asset in increasing the quality and quantity of prenatal, postnatal, and interpregnancy care of mothers. There was also improved neonatal health care. Mother's knowledge about helpful practices was improved. Other improvements were evident in early identification of risk factors both before and after pregnancy, referrals of at-risk persons, initiation of care, registration of mothers and infants at health centers, vaccination with tetanus toxoid, and provision of useful health information. Continuity of care was improved when compared with baseline and control data. The HBMR was found to be suitable for use with all women regardless of childbearing age.
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