Community-Based Maternal and Neonatal Health Services in Kolda and Sedhiou Districts of Senegal

INTRODUCTION: A recent assessment of the Millennium Development Goals has shown significant gaps in most developing countries, particularly with regard to the decline in maternal and infant mortality. Unaccess to health services is a major obstacle to reducing maternal and infant mortality. To support the Ministry of Health and Social Action in the implementation of its Strategic Plan for Reproductive Health (2012-2015), the NGO Micronutriment Initiative has developed a project based on Community-based Maternal and Neonatal Health services (CBMNH), which will be implemented at the level of the Kolda region. The general objective of this study is to carry out a situational analysis of maternal and neonatal health in the health districts of Kolda and Sedhiou to help the implementation and the evaluation of the project.

METHOD: It was a descriptive and analytical cross-sectional survey. The study included women who gave birth between February 2013 and January 2014. The sampling was random at two degrees. The sample size was 471 women for each of the two health districts. The data collected during an individual interview focused on prenatal consultation (PNC), delivery, postnatal consultation (PONC) and exclusive breastfeeding (EBF). The quantitative analysis of the data consisted of the estimation of the main indicators, the comparison of the indicators between the health district of Sedhiou and the health intervention district of Kolda. Multivariate analysis identified factors associated with PNC, delivery, and EBF.

RESULTS: In total, 965 women were interviewed. The results of the study show that the average duration of PNC1 ranged from 3.41 months in Sedhiou to 3.82 months in Kolda. The proportion of women with full PNC was 38.8% and 54.9% respectively in Kolda and Sedhiou. The proportion of women who took iron-folic acid for at least 90 days ranged from 78.8% (Sédhiou) to 71.7% (Kolda). The delivery was carried out by trained staff in 61.0% and 57.4% respectively in Kolda and Sedhiou. The EBF was initiated in the first hour in 47.0% (Kolda) and 52.6% (Sédhiou).
The results of the multivariate analysis showed that the early use of PNC services was related to low household income (0.65 [0.50-0.86]), proximity to the health facility (1.93 [1.34-2.78]) and multiparity (1.4 [1.05-1.87]). Completion of all PNC was associated with household income and early PNC1 (3.65 [2.58-5.18]). With regard to iron-folic acid intake, it was more common in women who achieved early PNC1 (2.19 [1.58-3.04]) and all PNC (3.58 [2.22- 5.77]). The delivery by trained personnel was related to the proximity of the structure (2.43 [1.75-3.37]), but also to the preparation of the delivery. Women who knew the period of the MBF (1.37 [1.04-1.81]) and the protective role of the EBF (1.71 [1.28-2.27]) started their children early at the EBF.

CONCLUSION: The results of the study show that the use of reproductive health services was linked to environmental, economic, cultural and structural factors. Improving the accessibility of these services requires joint action by the government, NGOs, community actors and the involvement of the population. This will be done through the construction, equipping and rehabilitation of health facilities, strengthening the knowledge of providers, community actors, women and support groups.