SAFE MOTHERHOOD INITIATIVE- SIK

TITLE: REDUCE INCIDENCE OF UNSAFE DELIVERY

The Safe Motherhood Initiative is a global effort that aims to reduce deaths and illnesses among women and infants, especially in developing countries. Partners in the Initiative support and implement safe motherhood interventions, in the context of broader reproductive health programmes.

Definition of safe delivery is any delivery that is conducted by a trained person.

Unsafe delivery is defined as all delivery that are not conducted by formally trained personnel. Classification:

1. Birth before arrival of any trained person such as nurse or doctor (mother delivers the baby alone).
2. delivery by TBA
3. delivery by untrained people or non-medical staff such as husband or mother-in-law.

The total number of unsafe deliveries in Sik in 1994,1995 and 1996 are 8.0%,5% and 11.8% respectively, which is consider very high.

Health indicator

1. % of unsafe deliveries

Number of unsafe deliveries among home deliveries x 100

Total of home deliveries

2. % of perineal tears (2^nd and 3^rd degree)

3. % of puerperal sepsis

Number ofpueperal sepsis among unsafe deliveries x 100

Total of unsafe deliveries

4. % of neonatal tetanus

Service indicator

1. % of Antenatal mother given advice on safe delivery

Number of antenatal mother given advice on safe delivery x 100

Total antenatal mother

2. % of antenatal mother at term who defaulted and were traced within 24 hours

Number of antenatal mother at term who defaulted and were traced within 24 hours x 100

Total antenatal mother at term

3. % of clinic staff given training on service of safe delivery

Number of clinic staff given training on service of safe delivery x 100

Total number of clinic staffs

4. % of staff who attended motivation courses

Number of staff who attended motivation courses x 100

Total number of staff

5. % of TBA who attended dialog session on safe delivery at least once a year.

Number of TBA who attended dialog session on safe delivery at least once a year

Total number of TBA

6. % of unsafe delivery among high risk mothers.

Number of unsafe deliveries among high risk mother x 100

Total number of deliveries among high risk mother

Difficulty indicator

1. % of unsafe deliveries due to non-availability of district nurses.

Number of unsafe deliveries due to non-availability of district nurses x 100

Total number of unsafe deliveries

Solution description

Issue of concern problem area	Interventions
1. Non-compliance of the mother	1. Health education about safe delivery - for mothers during every antenatal visit. - to mother at inaccessible area during home visit - give printed text about safe delivery for Iman to read during Friday prayers -Focal group discussion who had experience of unsafe deliveries and complications. - activate Panel Penasihat and community leaders to advice/ assist in social problem of the mothers -distribution of pamphlets to all mothers. orientation and visit to maternity ward in hospital. Defaulted tracing system between health clinics and hospital. Dialogue session for traditional birth attendants.
2. Inadequate knowledge of staff about complication of unsafe delivery.	1. organize talks by visiting specialist 2. increase frequency and quality of supervision/visit by supervisory 3. training programmes.
3. lack of motivation in hospital/ health clinics staff.	1. organize motivation talks 2. Islamic value by public service learn motivation counseling skill from counselor.
4. Unavailability of district nurses	1. Advertise date of leaves 2.cooperation from TBA
5. Ineffective supervision	1. increase frequency of supervison. 2. Appoint Staff with problems 3. give more attention to staff’s concern.

Implementations:

1. Hospital labor rooms visit by groups of antenatal mother who had no experience of delivering in hospital.
2. special marking and black string tie on the antenatal check up booklet for those who had experience of unsafe delivery.
3. nurses who have no experience of conducting a labor is sent to hospital for courses on conducting a labor.
4. those antenatal mother who have risk of unsafe delivery are invited to a focal group discussion on the importance of safe delivery in health clinic.
5. special arrangement is made for unwed mothers, they can have their antenatal check up at the day other than the antenatal day and if required, can be sent to other clinic to avoid public attention on them.
6. talks is given in villages which are located far from health clinic about the problems of unsafe delivery.
7. make sure all the antenatal mothers who are high risk for unsafe delivery have the chance to visit the hospital labor room.
8. increase number of Alternative birth centers especially in inaccessible villages for away from the hospital. Eg. Health clinics in Both Jeniang and Bulau have their ABCs operated at year 2001.

Beneficial experiences in Daerah Sik

Birth	1996	1997	1998	1999	2000
Total birth in District	1302	1232	1243	1275	1266
Total Home Delivery (safe)	427	289	196	165	115
Total unsafe delivery	45	48	33	19	16
% unsafe delivery of home deliveries	10.5	16.6	16.8	11.5	12.2
% general unsafe delivery	3.46	3.9	2.65	1.49	1.3

Result of antenatal visit to hospital Sik (year 2000)

Clinic	Total antenatal mother visit to hospital	Total visiting sessions to hospital	Total antenatal mother visit to hospital with partners	Total number of hospital delivery	Total number of delivery conducted by community nurses	Total number of unsafe delivery
Maternal and Child Health Clinic Sik	80	12	24	74	6	-
Health Clinic Jeniang	58	12	5	56	2	-
Health clinic Gulau	48	12	9	38	10	-
Total	186	36	38	168	18	-

By Teoh Jia Qing 0500038

REFERENCES

1. Yearly report of Safe motherhood initiative, district team problem solving, 1997.
2. Projek Kumpulan Meningkat Mutu Kerja KKM