Role of safe motherhood action groups in the referral of mothers to health facilities: A case of Chadiza District, Eastern Province of Zambia

Abstract

The concept of using Safe Motherhood Action Groups (SMAGs) is emerging to be useful in referral of mothers to health facilities for antenatal care, delivery, postnatal care or in case of maternal and neonatal complication without delay (ZISSP, 2012). Chadiza district formed Safe Motherhood Action Groups in 2009. Despite Chadiza having formed SMAGs, maternal morbidity and mortality has persistently remained high. Statistics showed 456 out of 5,941 expected pregnancies developed complications. (Chadiza HMIS, 2012). The general objective of this study was to determine the role of SMAGs in the referral of mothers to health facilities and establish factors influencing their referral in Chadiza District. A descriptive cross-sectional study using simple random sampling was conducted. The study sample comprised SMAGs from Tafelansoni, Zemba, Chanjowe, Sinalo, and Chadiza Rural Health Centre catchment area (Zingalume and Kapachi) for the purpose of determining whether there was a relationship between variables such as knowledge, distance, resources and follow up of SMAGs in the referral of mothers to health facilities. SMAGs who met the selection criteria were recruited to participate in the study using simple random sampling method for quantitative data and purposive for qualitative data in order to ensure homogeneity of the groups. A total sample of 133 respondents and 20 for focus group discussions participated in the study. A structured interview using a questionnaire was used to collect quantitative data. Two focus group discussions were done and a focus group discussion guide was used to collect qualitative data among selected men and women of child bearing age. Data was analyzed using IBM SPSS version 20.0. Pearson’s Chi-square test was used to test associations between variables. A 95% confidence interval and P value of 0.05 were set. Qualitative data from focus group discussions was analyzed using content analysis. The findings revealed that 69% (n=92) of the SMAGs were trained for one day. The study further discovered that 87.8% (n=101) had low knowledge on danger signs in pregnancy and child birth. The study shows that 88.7% (n=118) of SMAGs are referring mothers to health facilities. On whether training included the referral process, 98% (n=91) of SMAGs answered in affirmative. The study showed that 88.7% of SMAGs are referring mothers to health facilities. The study further revealed that 61% (n=81) of SMAGs were not given written guidelines on referral process after training. However, the study showed that 54.1% (n=72) of SMAGs were followed up by health facility staff after training. The study revealed that 67% (n=89) of SMAGs were provided with referral forms to use when referring mothers to health facilities. The study also revealed that 70.7% (n=94) of SMAGs gave referral forms to mothers referred to health facilities. The study showed that 74.4% (n=99) of SMAGs were escorting mothers referred to health facilities. The study further revealed that 69.9% (n=93) of SMAGs received feedback from health facility staff on the outcome of mothers referred to health facilities. The study revealed that 59% (n=79) of SMAGs did not receive any resources to use from the District Health Office. It was discovered from the study that 51% (n=68) of SMAGs reported being 6 kilometres to 10 kilometres away. The study also revealed that 39% (n=52) of SMAGs said it takes more one to two hours to walk to the nearest health facilities and 61.7% (n=82) of SMAGs viii indicated that mothers use bicycles as mode of transport when referred to health facilities. The study revealed 88.7% (n=118) of SMAGs said mothers did not afford to pay for transport costs when referred to health facilities. The study showed that 54.9% (n=73) of SMAGs had put in place measures to help mothers who do not afford to pay for transport when referred to health facilities. The study revealed that 95.5% (n=127) of SMAGs said traditional beliefs were no longer contributing to critical delays in referral of mothers to health facilities. Findings from focus group discussions revealed that pregnant women were referred to the health facilities by SMAGs when labour had already started as expressed by one participant “Azimai apakati ambiri kuno kwanthu abalila munjira akalibe kufika kuchipatala chifukwa amatumizidwa mochedwa pamene mimba yauka.” (meaning that most pregnant women in our area deliver on the way before reaching the health facilities because they are referred late to health facilities when labour starts). The study further revealed that mothers were still being delivered by Traditional Birth Attendants as expressed by one participant “ife kuno kwanthu azimai ambiri akali kupapitsidwa ndi anyamwino mumidzi ngakhale wafika pa chipatala” (meaning that the mothers were still being delivered by Traditional Birth Attendants even when they have reached the health facilities). The focus group discussion also revealed that the main challenge contributing to delays in referral of mothers to health facilities by SMAGs was none availability of reliable transport as expressed by one of the male participants “Ine niwona kuti chomwe chichedwetsa azimai kufika musanga kuchipatala ngati atumidwa ndi SIMAGI simutunda chabe ai koma kusowekera kwa ma transport yoti inga wafikise msanga”. (Meaning that what I see myself delaying women to reach to health facilities early is not the distance but rather none availability and sometimes the type of transport used when referred by SMAGs). In conclusion, the current study revealed a significant association between the provision of resources and SMAGs referral of mothers to health facilities (p value 0.02). The current study further revealed a significant association between follow up by health facility staff after training and SMAGs referral of mothers to health facilities (p value 0.01). The current study however showed no significant association between distance to health facilities and referral of mothers to health facilities. Chadiza District Health Office through the Ministry of Health should source for funds to reorganize and retrain SMAGs as the initial training had limited time to learn as the duration of one day was too short. Keywords: Role, Safe Motherhood Action Group, Referral, Mothers, and Health facilities.