MCW coverage survey report – November 2009 Round

Each year Pakistan witnesses preventable deaths of nearly 400,000 children under-five and 20,000 mothers due to causes related to pregnancy and child birth. Among the under-five deaths, two-thirds are in the newborn period (first 28 days of life) and the remaining are largely due to pneumonia (13%) and diarrhoea (11%). Pneumonia is a seasonal calamity, where a number of cases start rising in November and peak around December & January each year. About 52,000 children in Pakistan die due to pneumonia, every year. Most of these precious lives can be saved by simple knowledge about prevention, treatment and promotion of some key measures at home and appropriate health care seeking practices.

To address the above issues by raising awareness and strengthening the health system to become more responsive, National Programmes for Family Planning and Primary Health Care and EPI, Ministry of Health launched Mother & Child Week (MCW), initially as a pilot project. A pre MCW campaign and post MCW campaign was organized  in April 2008 had shown improvement in de-worming coverage from 24% to 87%, home purification of water by boiling from 71% to 91% and TT1 coverage from 33% to 67% and TT2 from 19% to 20% . This achievement resulted in a decision to scale up the MCW to 29 districts in April 2009 and then to scale-up MCW to nationwide.

The 5^th round of MCW took place from 2^nd to 7^th November 2009. The partners included Provincial Health Departments, Ministry of Environment, Ministry of Population Welfare, three national Programmes of Ministry of Health, the National Maternal, Newborn and Child Health Programme, National EPI, National Programme on Family Planning and Primary Health Care. International partners including UNICEF, UNFPA, WHO, Rural Support Programme Network, Plan International and PAIMAN also supported this campaign.  This MCW round covered 93 districts of the country which included both LHW covered and uncovered areas. In previously targeted 29 districts both LHW covered and uncovered areas were targeted, whereas in all remaining districts only LHW covered areas were focused.

The November 2009 MCW reached around 100 million population among which were 15 million children under-five and 3.4 million pregnant women. Around 90,000 Lady Health Workers and 3500 Lady Health Supervisors were trained and involved in the activity together with vaccinators and health care providers from more than 5692 health facilities.

The series of activities during the week included public awareness activities at village and union council level, supplemented by immunization and de-worming for children, tetanus toxoid vaccination for pregnant mothers, refresher trainings for health workers, and strengthened public health systems to ensure that Oral Rehydration Salts (ORS) and other essential supplies of pneumonia management (antibiotics and nebulisers) are available and correctly used. Each pregnant woman also received counselling on recognition of danger signs among mothers and newborns, the significance of at least four ANC visits, delivery by a skilled birth attendant, post natal care, early initiation of breast feeding, exclusive breast feeding, immunization of the child and optimal birth spacing. As has been the practice since initial pilot the April round’s communication focus was diarrhoea prevention & care and the November rounds focus was on pneumonia prevention and management. Ministry of Population Welfare also partnered at district level to spread the messages of maternal and child health through their outlets and ensuring adequate supplies of contraceptives.

To determine the contribution of the November’09 round of MCW, a post campaign survey was conducted in January 2010 in a total of 60 districts. These 60 districts included the 29 districts to track changes in indictors in these districts over the rounds and a random sample of 31 districts to establish representative baseline for all provinces and regions.

Following are some of the main findings:

1. Interviews with the target mothers revealed that, overall access to immunization as indicated by BCG coverage (among children of 0-2 years) was estimated to be 84%. 57% of the pregnant mothers received any TT vaccination; 69% children between 2-5 years had received de-worming; 62% mothers reported attending a health education session.
2. Evidence from ICT district shows high acceptability of de-worming tablets and a 30% reduction in children complaining of abdominal pain.  The MCW targeted 15 million children under-five with 69% coverage and 10.35 million children would have received de worming tablets. This is the single biggest achievement of MCW and could have positive impact on child health, growth and development. 
3. In LHW covered areas BCG coverage was 84%, same as the overall coverage but de-worming coverage was 83%. This was 14% higher than LHW un-covered areas.
4. In the 29 districts where MCW was conducted both during April and November rounds of 2009, de-worming coverage increased from 76% to 83%, participation of mothers in health education increased from 38% to 59%, knowledge about birth spacing over two years increased from 45% to 47%, reported use of ever hand-washing with soap increased from 89% to 91% and children receiving three doses of DPT-HepB-Hib increased from 25% to 44%.
5. It is noteworthy that Mohmand Agency, had the highest coverage of TT vaccination to pregnant mothers in spite of the fact that this area is inaccessible due to conflict and has cultural restriction on women compared to accessible areas. The high coverage of women from Mohmand agency could be due to the contribution of intensive efforts to vaccinate internally displaced people of the region.
6. Out of the total 47% of women received advocacy leaflets during the April round, whereas 39% pregnant mothers received the same during November round showing the decline by 8%. Overall knowledge of number of ANC visits required is low. This deserves attention of managers and call for more focus in subsequent MCW linked communication.
7. The proportion of newborns, whose weight was reported to be recorded at the time of birth, comes to about 80% of all deliveries (6221 cases) which took place at health facility. This represents a missed opportunity for taking weight of the newborn, which is critical for identifying and caring for low birth weight babies.
8. Modern method of family planning seems to be very popular in Pakistan compared to traditional methods. Out of all who used contraception about 37% of the total), 90% users used modern methods of family planning. Among provinces 97% mothers from ICT reported use of modern family planning methods. This was followed by KP and Balochistan (91% each), Punjab (89%), Sindh, FATA, Gilgit/ Baltistan (88% each) and AJK (86%) reporting use of modern method. Use of traditional family planning methods (withdrawal & safe period) was relatively higher in Hyderabad (32%), followed by Ziarat (29%), Pakpattan (27%), Kalat and Mirpur (25% each).
9. Regarding the knowledge of mothers about use of drugs during pneumonia, better awareness was observed at district of Sanghar, where 78% mothers responded correctly. This was followed by Mohmand Agency (74%), Umerkot (69%) and DG Khan/Noshki (68%). However higher percent of mothers from the districts of Bolan, Buner, Kambar, Kashmore and Battagram were ignorant about what medicine could be used for pneumonia.
10. Mothers knowledge about use of ORS to prevent dehydration during Diarrhea   decreased by 3% in the November’09 round from the 58% of the April ’09 round survey. This could be because the April round focus on health education was on diarrhea while that of the Nov. round was on Pneumonia.