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About The Research

Background

Pregnancy is a precious event offering a human value to the biosphere. It is special to every woman and societal unit. Women suffer in comparison with men over a wide spectrum of human activity. The health situation of women in Nepal is poor. Maternal mortality in Nepal is among the highest in Asia (over 190/100,000 live births) and one of the worst ten in the world (WHO 2015). Although this national estimate has fallen over the last decade, the rural maternal mortality rate is at least double the national average (Vanwinge and Adamchak 1994, Dhakal 2007, Bhandari, Gordon et al. 2011). This disparity between urban and rural maternal health poses a significant challenge to meet the Millennium Development Goal- 5, (134 per100, 000 live births) in Nepal.

Lack of awareness about the importance of antenatal care and skilled delivery is one of the principal causes of maternal death. The deficiency of health care systems and an unsupportive sociocultural environment combine to create poor outcomes in maternal care for pregnant women in Nepal. Singing is a prominent feature of everyday rural life in Nepal. We aim to engage female community health workers and school students in developing health messages using traditional songs to transmit knowledge through the community and change attitudes surrounding pregnancy to improve maternal outcomes. This research will develop an awareness program owned by the community. We expect that this program will lead to improved community knowledge concerning the key health messages needed to improve maternal mortality in rural Nepal and increase the number of women accessing health care prenatally and at the time of delivery.  Our project seeks to change maternal mortality from the grass roots level using health messages transmitted to the whole community through songs created within the community. The project will evaluate the conclusion and results in our intervention communities compared with those in control communities to determine its effectiveness. Results will be published and used to influence National Policy.

Hypothesis

The community attitude to maternal care during pregnancy and childbirth can be changed through the use of traditional singing programs.

 Purpose

The goal of this research is to investigate whether the involvement of people within a community in the process of creating awareness through singing health messages can improve the level of maternal health care as well as knowledge of the need for maternal health care among community members.

Objective

To establish the knowledge of men and women before and after an intervention about the role of family and community during pregnancy and childbirth.

 

Methodology

Baseline survey: We plan to carry out the baseline survey in both clusters (intervention and control) using a uniform questionnaire. This study will provide information on the level of awareness and health seeking behaviour about pregnancy of the population. All the households (1,861) of the study area (intervention and control) will be surveyed. We will plan to have equal numbers of adult male and female respondents from the total households to be interviewed.

Intervention Cluster an Inter-school Song Writing Competition on Maternal Health Issues:  A meeting of teachers, student representatives, female community health workers and community people will be organised to explain the theme / critical messages (as mentioned below) and the importance of the program and finalise the dates for the songwriting competition. Information about the program will sent to all the schools in the cluster. School teachers, students and female community health workers will participate jointly in the songwriting competition. A panel of independent judges will be formed to evaluate the songs written by the groups. Rehearsals and actual singing of the songs developed will be organised in the respective communities. The final competition will be held in either Thanti or Chitre at the convenience of the respective schools and villagers

The winning songs will teach to traditional singers (Gandharbas): The winning song will provide to Gandharba travelling minstrels. This is an old community of minstrels who perform singing and dancing to entertain the Gods. Gandharba singing is a well-accepted and popular in the rural area of Nepal. Orientation on the healthcare song for the traditional singers will be organised. After orientation and rehearsal, they will travel to the villages /households (921) of the intervention cluster and sing the health song. The local community health workers will coordinate and inform villagers about the singing programs. The health songs recorded by the local students will be played before and after their singing. There will be a minimum of five singing sessions in a day. Through this process, villagers will experience a musical awareness of the campaign and the participation of all community people is ensured.

The introduction of a Holy Duty Wall Chart: To provide antenatal care visits, improved nutrition practices at home, as well as planning and preparation for delivery by a skilled attendant, a holy duty wall chart with recommended monthly actions will be introduced and given to each family of the intervention cluster. This wall chart will remind the family to inform the health worker or health facility of the expected date of delivery.
 Post-intervention survey: After the intervention, a survey (data collection) will be organised using the same tool and the number of households to establish the effectiveness of the intervention and any natural changes in the control population.
 

Anticipated results

  1. Improved awareness and care during pregnancy and childbirth
  2. Improved family responsiveness to care during pregnancy and childbirth
  3. Number of antenatal visits increased
  4. Reduction in number of delivery complications
  5. Improved pregnancy outcomes
  6. Sustained community awareness of the need for improved maternal health outcomes