Gambia: evaluation of the mobile health care service in West Kiang district

Abstract

A project to improve the quality of maternal health services was carried out over a 3-year period in West Kiang district, Gambia. Coverage of maternal care was strengthened through upgrading of personnel, TBA training, improved treatment and referral schemes, and increased numbers of visits to rural outreach areas. A control district was used to compare the impact of the interventions. During the project period of 3 years a single maternal death was registered in the intervention district, and 5 in the control area. While improved staffing and service provision led to higher degrees of coverage of maternal care services, reductions in maternal morbidity could not be documented in the intervention area. Given concern over the quality of the data possibly influencing this result, further research is necessary to determine the relationship between improved mobile maternal care services and their impact on maternal morbidity and perinatal outcome.

PIP: During 1989-91 the Dunn Nutrition Unit of the British Medical Research Council (MRC) conducted a study in the West Kiang district of Gambia to determine the effectiveness of using traditional birth attendants (TBAs) to identify pregnant women, register pregnant women early in a prenatal care program, treat anemia, identify obstetric problems with prompt referral to a hospital when indicated, and provide emergency treatment and rapid transfer of obstetric emergencies for specialist care. The MRC Dunn Nutrition Unit supplements government prenatal care services in the remote district of West Kiang via its mobile health care service. The interventions in West Kiang included improved staffing at Karantaba Health Centre, TBA training, community health nurse (CHN) training in essential laboratory tasks, and expansion of staff in West Kiang district. The remote district of Upper Baddibu did not receive this supplementary health service during the study period. By 23 weeks gestational age, women in West Kiang were more likely to be registered with the prenatal care service than those in Upper Baddibu (63.3% vs. 24%). Throughout pregnancy, the mean hemoglobin level was higher in West Kiang women than in Upper Baddibu women (11 vs. 8.4 g/dl). The upgrading of personnel, diagnostic, and therapeutic skills and adherence to established schedules and procedures significantly improved maternal care in West Kiang. The pregnant women in West Kiang were more likely to seek and receive medical care for minor and major conditions than those in Upper Baddibu (794 women/841 treatment episodes vs. 722/149, respectively). Maternal mortality was higher in Upper Baddibu than in West Kiang (7/1000 vs. 1.3/1000 live births). Yet both fetal deaths and early perinatal deaths were much higher in West Kiang than Upper Baddibu (39.9/1000 vs. 24.5/1000 births and 54.9/1000 vs. 39.6/1000, respectively). Underreporting in the control area may have accounted for the differences in pregnancy outcomes. It would also make it difficult to document the effect of the mobile health service unit on maternal health and pregnancy outcome.