Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

Disease, Death and <i>Dhandha: Gharwali’s</i>Perspectives on the Impact of AIDS on <i>Devadasi</i>System and the Sex Work in South India

Traditional Devadasi system based sex work (dhandha) is practiced inIndia. The communities that practice this system are affected severely by AIDS epidemic. Through this paper we present the views of gharwalis (brothel madams) regarding the impact of AIDS on the traditional system (Devadasi system) of initiating girls as sex workers (Devadasis) and on the practice of sex work (dhandha) associated with that system. Qualitative in-depth interviews were conducted with twelve gharwalis as a follow-up of a cohort study, which investigated the patterns and determinants of sex worker migration from northern Karnataka to southern Maharashtra, in India. According to gharwalis, the disease (AIDS) consequences;death, fear and stigma affected dhandha operations, changed the attitude of the Devadasi community against the practice of dhandha and the Devadasi system, besides, influenced the community to take actions to stop the practice of dhandha and the Devadasi system. The findings suggest that the interplay between the disease consequences and the community’s response to those consequences contribute to transition dhandha and the Devadasi system. We discuss our findings, describe the transition and the consequent risk enhancing conditions. Finally, highlight the need to address these conditions to reduce Devadasis risk and vulnerability to HIV infection.

Clustering of Pregnancy Wastages among Young HIV-Positive Women in a High HIV Prevalence District in India

Context: This paper examined the clustering of pregnancy wastage among HIV-infected pregnant women, particularly focusing on the outcomes of abortions and stillbirths, from a large sample of HIV-positive women to bridge the existing information gap. Methods: Data from a cross-sectional survey conducted among currently married HIV positive women aged 15-29 years in Bagalkot district, Karnataka, India were used. Further to assess the clustering of pregnancy wastage, the binomial distribution was used. Results: The study shows that 2% of the women account for 32% of the total pregnancy wastages and 7% of all the interviewed HIV positive women account for 62% of the total pregnancy wastages. The study further shows that a higher percent observed (29.6%) than expected (15.5%) who had experienced 2 pregnancy wastages suggesting 14.1% more women experienced 2 pregnancy wastages than expected. Again, a positive deviant of 19.2 among women with at least 3 pregnancy wastage also suggests a higher observed than expected pregnancy wastages, and suggests clustering of pregnancy wastages among HIV-positive women. After adjusting for the socio-economic characteristics, the variance of the observed and expected has reduced only marginally. Conclusions: Clustering of pregnancy wastages among HIV positive women suggests for an increased attention on reproductive health of this marginalized group. The findings will be useful for the interventions working with WLHA in India, particularly the knowledge of clustering would help policy makers and program implementers to focus on high risk women who are likely to experience multiple pregnancy losses.

Does HIV Status Affect Utilization of Maternal Care Services among Women in India: An Analysis of NFHS 2005-2006

The objective of the study is to understand the relationship between HIV status, fertility and utilisa-tion of maternal care services in India using the NFHS 2005-2006 data. The mean number of children ever born (a measure of fertility) is substantially higher among HIV-negative women than among the HIV-positive women (2.8 and 2.1 respectively). Ten-year age specific fertility rates (ASFR) were calculated, there is no noticeable difference in pattern of ASFR between HIV-positive and HIV-negative category of women observed though the ASFRs were substantially lower among the HIV-positive women. The total fertility rate (TFR) among HIV-positive women (0.84) is substantially lower at one third of the TFR among HIV-negative women (2.78). The proportion of HIV-positive pregnant women utilising ANC services is 92 percent compared to 78 percent among HIV-negative women, who have alive birth during the 5-year preceding the survey. Similarly, the proportion of HIV-positive women (67%) delivering their babies in an institution is also much higher than among HIV-negative women (40%). This study concludes that the effort of the government to integrate ART services with maternity care services is likely to have benefited the HIV positive mothers.