Maternal, Newborn and Child Health Continuum of Care: Experiences of Cambodian Mothers in Kampot and Preah Vihear
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Background: Cambodia suffers from high maternal and under-five mortality. Meeting Millennium Development Goals four and five, to reduce child mortality and to improve maternal health, relies heavily on a successful continuum of care (COC) targeting mothers and children. The World Health Organisation identifies five stages of the continuum: adolescence and before pregnancy; during pregnancy; childbirth; after childbirth; and during infancy and childhood. The Danish Red Cross (DRC) and Cambodian Red Cross’ (CRC) Community Based Health Development (CBHD) programme is being expanded to reach Kampot and Preah Vihear provinces. One key output of the programme is to improve maternal, newborn and child health (MNCH) through strengthening the COC at the community level.
Objective: This thesis aims to identify gaps in the MNCH COC in Kampot and Preah Vihear provinces in Cambodia, as perceived by mothers, to make recommendations for the CBHD programme to be implemented by DRC and CRC.
Methodology: This qualitative study employed focus group discussions (FGDs) with mothers as the lead method in order to gain an initial understanding of the situation in each village. They were followed by semi-structured interviews, which helped to further explain the major issues revealed during the FGDs and obtain more detailed information on key topics. The data was analysed using the Framework Analysis approach.
Results: Few gaps were revealed in the COC in Kampot, however, many gaps were revealed at each stage of the continuum in Preah Vihear. In both provinces mothers had not received education on basic reproductive health, however, knowledge gaps relating to other stages of the COC were generally only identified in Preah Vihear. In Preah Vihear, many mothers did not meet the national guidelines for antenatal and postnatal check-ups; they lacked knowledge on signs of pregnancy complications; and the majority delivered at home without a skilled birth attendant. Furthermore, they encountered great barriers to accessing health services and some mothers expressed unsatisfactory experiences with the care they received.
Conclusion: As a result of the clear distinction in the findings between Kampot and Preah Vihear provinces, it is recommended that the CBHD programme be tailored to meet their different needs. The programme should focus on the adolescence and before pregnancy stage of the COC and collaborate with the local health centres in both provinces. In Preah Vihear more specifically, greater attention needs to be paid to: overcoming logistical access issues; strengthening the relationship between the health centre and community; and issues related to learning and remembering, which stem from low formal education.