INTRODUCTION: Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality. METHODS: The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed. RESULTS: Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%. CONCLUSION: These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients. / <p>Article No. 2140</p><p>Funding Agencies|Pravara Medical Trust, India||Swedish International Development Cooperation Agency, Sweden||Linkoping University||County Council in Ostergotland, Sweden||</p>

Mozambique is in the process of setting up maternity waiting homes (MWHs) in an attempt to improve access of women living in remote areas. It is expected that MWHs will increase institutional deliveries and consequently, decrease maternal mortality caused by the delay in reaching obstetric care. However, no evidence for this assumption has been found in the literature. The objective of this research was, using Geographical Information Systems (GIS), to assess the impact of MWHs in increasing institutional deliveries coverage. GIS technology is a valuable methodology to analyse access, especially in contexts where official records are weak. An ecological study, using a sample of 28 health facilities, was conducted in six districts in northern Mozambique. The findings suggest that MWHs could contribute to increasing institutional deliveries coverage in a range of 4% to 2 %. However, they do not appear to increase access of women living in remote areas. / M.A. (Public Health)

Mozambique is in the process of setting up maternity waiting homes (MWHs) in an attempt to improve access of women living in remote areas. It is expected that MWHs will increase institutional deliveries and consequently, decrease maternal mortality caused by the delay in reaching obstetric care. However, no evidence for this assumption has been found in the literature. The objective of this research was, using Geographical Information Systems (GIS), to assess the impact of MWHs in increasing institutional deliveries coverage. GIS technology is a valuable methodology to analyse access, especially in contexts where official records are weak. An ecological study, using a sample of 28 health facilities, was conducted in six districts in northern Mozambique. The findings suggest that MWHs could contribute to increasing institutional deliveries coverage in a range of 4% to 2 %. However, they do not appear to increase access of women living in remote areas. / M.A. (Public Health)