Research Setting

 

The study will be conducted in one district or sub-district in four African countries; Burkina Faso, Kenya, Malawi and Mozambique. All public-sector health facilities providing postpartum, newborn and child care in the selected sites will be invited to participate in the study. Key relevant details of each study setting are provided below.

The research area in Burkina Faso is situated in the rural central-northern part of the country. The region is subdivided into four health districts: Kaya, Barsalogho, Boulsa and Kongoussi. In the district of Kaya there are 484 000 inhabitants and 40 primary health facilities. A health and demographic surveillance system has been in place in part of Kaya district since 2007 and is called KaDESS (the Kaya Demographic and Epidemiological Surveillance System). This covers 7 primary health care facilities and 18 villages of the district and a population of approximately 60 300. Demographic and health data are collected every six months. The health indicators of the region are poor: contraceptive coverage is 23.1%; coverage of postpartum care is 19.4% and skilled birth attendance 60.3%. The MOMI project research area covers the area of KaDESS.

In Kenya, the research will be conducted in the Kwale district within the Coastal province, which has a total population of 171,259 inhabitants. Maternal mortality ratio in the district is estimated to be 448/100,000 and only 17% of the deliveries are attended by a skilled birth attendant.

Research in Malawi will be conducted Ntchisi district, which has a population of 238,328 inhabitants (2008 census). Ntchisi district has 11 primary health care centres. In Malawi the maternal mortality ratio is 807/100,000; 56 % of the deliveries are attended by a skilled birth attendant and postpartum care coverage is 31%.

In Mozambique, the district of Chiuta, in Tete Province has been selected for this project. The Chiuta district is rural, has a population of 86 884, with 4 health facilities, and poor overall health indicators. There is no population-based surveillance system in place. Tete Province has a HIV prevalence of 13%, a high rate of maternal (984/100,000 live births) and neonatal mortality 40.9/1,000, only 33% of birth occur with a skilled birth attendant, low postpartum care coverage (49%), and low contraceptive use (17%).