Effectiveness of the Maternal and Child Health handbook in Burundi for increasing notification of birth at health facilities and postnatal care uptake

Figures & data

Table 1. Stratified sample size along with the number of births in each facility for the estimated sample size of 368 with 5% excess.

	Name of health facility	Annual birth number in 2011	Stratified sample size in each facility for the estimated sample size of 368 plus 5% excess	Type of health facility
1	Gitega Hospital	2385	106	Hospital
2	Kibimba Hospital	1808	53	Hospital
3	Songa Clinic	422	21	Clinic
4	Vision santé Health Center	0	0	Health Center
5	Bukinga Health Center	219	15	Health Center
6	Gasunu Health Center	351	18	Health Center
7	Gisuru/Giheta Health Center	625	36	Health Center
8	Murayi Health Center	754	40	Health Center
9	Kibimba Health Center	0	0	Health Center
10	ABUBEF Gitega Health Center	0	0	Health Center
11	Cabinet Medical Nduwumwami Health Center	0	0	Health Center
12	Gitega Health Center	0	0	Health Center
13	Mubuga Health Center	506	29	Health Center
14	Mushasha Health Center	111	6	Health Center
15	La Sagesse Health Center	0	0	Health Center
16	S.O.S Health Center	0	0	Health Center
17	Nyamugari Health Center	0	0	Health Center
18	C.M.M Health Center	0	0	Health Center
19	Notre dame d’afrique Health Center	0	0	Health Center
20	Ceru Health Center	65	5	Health Center
21	M.M.K Health Center	224	15	Health Center
22	Rutegama Health Center	223	11	Health Center
23	Rutoki Health Center	493	29	Health Center
	Total	8136	384

Table 2. Burundian Maternal and Child Health handbook’s components and features.

Domain	Components	Main features and guiding principles to develop the components
Records of care	Names, identification numbers, and contacts of mother, child, and father/family.	To devise simpler and educative recording field for health providers.
	Vaccination of mother.	The formulation followed old home-based records and existing facility-based records, and all record fields were widened.
	ANC, delivery, PNC, and child growth monitoring.	The record items were updated according to current national health care norms and national health statistic report components.
	Child vaccinations until 5 years old.
	‘Clinical visits for mother and child.
	Family planning.
Notification of birth	Birth date, birth weight, name of mother, birthplace/facility, and name of birth attendants/profession.	The items were made to be consistent with the requirements for civil registration procedures.
	Affixed seal of the health facility.	Health providers are requested to complete the section only in the case of delivery at the health facility.
Educational messages	PNC, birth registration, family planning, I.M.CI (Integrated Management of Childhood Illness), child nutrition, and child growth.	Minimum messages were selected according to the priorities of national health policy.
		Some accompanying illustrations should be included along with messages in the local language, in consideration of the rural literacy rate (76.9%)[2].
		The illustrations were taken from community health workers’ materials, so that community health workers would be able to explain the contents to mothers with enough confidence.

Figure 1. Page for notification of birth in the MCH handbook.

Table 3. Characteristics of respondents in the pre- and post-studies of the MCH handbook in the Gitega District.

	Pre (n = 370)		Post (n = 344)
	n	(%)	n	(%)	p-value*
Age of mothers
15–34 years of age	335	(90.5)	317	(92.2)	0.15
> 34 years of age	31	(8.4)	27	(7.8)
Unknown	4	(1.1)	0	(0.0)
Parity
1–2	199	(53.8)	188	(54.7)	0.42
3–4	115	(31.1)	107	(31.1)
> 4	53	(14.3)	49	(14.2)
Unknown	3	(0.8)	0	(0.0)
Educational level
No school education	165	(44.6)	119	(34.6)	0.07
Primary	157	(42.4)	171	(49.7)
Secondary	38	(10.3)	38	(11.0)
High school	8	(2.2)	15	(4.4)
Graduated	2	(0.5)	1	(0.3)
Age of infant
Within 2 weeks after birth	79	(21.4)	62	(18.0)	0.15
3–4 weeks after birth	170	(45.9)	146	(42.4)
5–6 weeks after birth	121	(32.7)	136	(39.5)
Delivery place by type of health facility
Health center	196	(53.0)	177	(51.5)	0.69
Hospital and clinic	174	(47.0)	167	(48.5)

Notes: Pre- and post-studies included different individuals as respondents. *Chi-square test.

Table 4. Changes in proportion of mothers per outcome variables between the pre- and post-studies in the Gitega District.

	Pre (n = 370)	Post (n = 344)
Variable	Proportion (95% CI)	Proportion (95% CI)	p-value
Having MCH handbook	0.0%	95.1%	< 0.05^b
	(0.0%–0.0%)	(92.8%–97.3%)
Having received the notification of birth at health facilities	4.6%	61.0%	< 0.05^a
	(2.5%–6.7%)	(55.9%–66.2%)
Having data on delivery mode records at home	0.0%	29.7%	< 0.05^b
	(0.0%–0.0%)	(24.8%–34.5%)
Having accurate birth weight data at home by recall-based or record	50.8%	73.5%	< 0.05^a
	(45.7%–55.7%)	(68.9%–78.2%)
Receiving guidance on PNC from health personnel	35.9%	64.2%	< 0.05^a
	(31.1%–40.8%)	(59.2%–69.3%)

Notes: Pre- and post-studies included different individuals as respondents. CI = Confidence interval. ^aChi-square test. ^bFisher exact test.

Figure 2. Annual PNC coverage changes from 2013 [14] to 2014 [15] by targeted and non-targeted areas among four Districts (D.S) in the Gitega Province and whole country.

Table 5. Association of notification of birth, delivery mode records, birth weight data, and guidance on PNC with socio-demographic characteristics of respondents who received the MCH handbook.

			Notification of birth^a		Delivery mode records^b		Birth weight data^c		Guidance on PNC^d
Socio-demographic variable		n	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Age of mothers	15–34 yr	300	1.00	Ref	1.00	Ref	1.00	Ref	1.00	Ref
	> 34 yr	27	3.03*	1.01–9.06	0.27	0.07–1.09	0.77	0.19–3.09	1.03	0.38–2.80
Parity	1–2	180	1.00	Ref	1.00	Ref	1.00	Ref	1.00	Ref
	3–4	99	1.12	0.66–1.89	0.96	0.54–1.70	1.72	0.97–3.05	0.87	0.51–1.49
	> 4	48	0.74	0.32–1.71	1.22	0.50–2.98	4.52*	1.32–15.43	0.78	0.34–1.77
Age of infant	< 2 weeks	58	1.00	Ref	1.00	Ref	1.00	Ref	1.00	Ref
	3–4 weeks	130	0.87	0.45–1.68	0.65	0.33–1.31	1.34	0.68–2.63	0.69	0.36–1.35
	5–6 weeks	139	1.13	0.58–2.20	0.78	0.39–1.56	2.02	1.00–4.08	0.81	0.41–1.59
Education	No education	115	1.00	Ref	1.00	Ref	1.00	Ref	1.00	Ref
	Primary	163	0.83	0.50–1.39	1.24	0.70–2.20	0.61	0.34–1.10	1.38	0.83–2.30
	Secondary or more	49	1.20	0.56–2.56	1.56	0.72–3.38	0.46	0.21–1.01	2.15	1.00–4.63
Delivery place	Health Center	154	1.00	Ref	1.00	Ref	1.00	Ref	1.00	Ref
	Hospital and clinic	173	2.62*	1.63–4.22	3.25*	1.96–5.39	1.13	0.68–1.87	0.51*	0.32–0.81

Notes: OR: Odds ratio adjusted for other socio-demographic variables in a logistic regression. CI: Confidence interval. Mothers having received notification of birth at health facility, mothers having delivery mode records, mothers having accurate birth weight data by record, mothers receiving guidance on PNC. *p < 0.05.

MOH Burundi. Burundi demographic and health surveys 2010. Bujumbura: Institut de Statistiques et d’Études Économiques du Burundi, Ministry of Health and Fight against HIV/AIDS, Burundi and ICF International; 2012. French.

 Google Scholar