Publicatie

Safe motherhood: preparedness for birth in rural Kyrgyzstan and Tajikistan.

Wiegers, T.A., Boerma, W.G.W., Haan, O. de. Safe motherhood: preparedness for birth in rural Kyrgyzstan and Tajikistan. European Journal of Public Health: 2007, 17(suppl. 2), p. 166. Abstract. EUPHA Conference "The Future of Public Health in the Unified Europe", 11-13 October 2007, Helsinki, Finland.
Kyrgyzstan and Tajikistan, both former Soviet republics, are neighbouring states in Central Asia. In Central Asia most maternal deaths are due to five major medical causes: severe bleeding; infection; unsafe abortion complications; hypertensive disorders of pregnancy; and obstructed labour. Some of the explaining factors are: the extremely limited knowledge of the population on reproductive health issues and the absence of a well-functioning health system that provides accessible, high-quality care. In trying to improve this situation the Netherland School of Public & Occupational Health has launched a safe motherhood project in collaboration with family planning associations in Kyrgyzstan and Tajikistan. The project is funded by the Dutch Ministry of Foreign Affairs and runs from January 2006 to January 2011. The study presented here is a baseline study, to determine the knowledge, attitudes and practices of users of reproductive health services and of the providers of these services. Methods: To assess the level of birth preparedness and complication readiness, the so-called Standard Tool Kit, developed by the Safe Motherhood Initiative, has been adapted and translated to be used by local partners of the project in Kyrgyzstan and Tajikistan. Structured face-to-face interviews were held with pregnant women and with men by trained interviewers of the same sex as the respondents. Health care providers in regional centres and in family medical centres completed a Professional Knowledge Questionnaire. Trained observers completed a Provider Skills Checklist and a Facility Audit. Results: Overall, results in both countries point to very little knowledge among women and men on possible complications during pregnancy, labour and childbirth, and the postpartum period. Of all Tajik women (100) only two (2%) could mention all three key danger signs during pregnancy, two (2%) could mention all three key danger signs during the postpartum period and none mentioned all four danger signs during labour and childbirth. Of the Kyrgyz women (118) only one (0.8%) mentioned all key danger signs during the postpartum period and none mentioned all danger signs during pregnancy or during labour and childbirth. None of the men in either country (20 and 31, respectively) could spontaneously mention any of the key danger signs. The results also show that the professional knowledge in both countries is far from up-todate, according to Safe Motherhood standards. Of all the professionals (obstetricians /gynaecologists, family doctors, midwives, and nurses) not one achieved a score of 80% correct answers on all six themes in the questionnaire. The highest scores were of three Kyrgyz and two Tajik obstetricians/gynaecologists, who reached the standard of 80% or above of correct answers on two of the six themes. Conclusions: Tajikistan and Kyrgyzstan are risky places to be pregnant and to have a child. Women (and men) lack the basic knowledge on reproductive health issues to be able to recognize danger signs during pregnancy, labour and childbirth, and the postpartum period, while health care providers lack the professional level of knowledge on perinatal health issues, often have to work in an insufficiently equipped environment, and display a predominantly medical-technical attitude, without consideration for building trustful relations with their clients.(aut. ref.)