The Reduction of Infant and Maternal in Afghanistan - Assignment Example

The Reduction of Infant and Maternal Mortality in Afghanistan – Doctoral Research Proposal Background and significance In Afghanistan, the combined effects of more than 25 years of political and wartime unrest, persistent human rights violations, and Taliban restrictions on women’s rights have had devastating health consequences for women (Amowitz, Reis, & Iacopino, 2002). Prior to the overthrow and ejection of the Taliban, information on health services in Afghanistan was unreliable. Before taking over Afghanistan in 1994, multiple Mujahideen (religious fighters) waged war on the streets of Kabul, the capital city (Gessner, 1994). Their aim was to establish a conservative Islamic governance and social system that had little regards for modern methods in education and health. The Taliban regime forced women back into subservient roles. The Taliban denied women education, jobs, and access to healthcare in the name of religion. After the dismantling of the Taliban in 2001, health services were almost non existent or extremely dysfunctional (Bartlett et al, 2005). Afghanistan ranks at the bottom of the United Nations Development Programs Human Development Index and the main indicators of this index are maternal mortality, infant mortality, undernourishment, life expectancy, illiteracy, access to clean water, healthcare and schooling (Nojumi et al, 2009). This shows the extent to which the neglect of Afghanistan and the influence of the Taliban led to the destruction of the healthcare and social infrastructure. Like most places in the world, the depth of these destructive trends are felt more by women and children (Skaine, 2008) The Afghanistan maternal mortality rate has been as high as 1,600 per 100,000 live births, second only to Sierra Leone (Walsh, 2007). As the environment becomes more austere in Afghanistan the maternal mortality rates multiply. In Badakshan, a remote mountainous province on the northeastern border of Afghanistan, as many as 6,500 mothers die per 100,000 live births, this rate was the highest rate ever recorded in history (Walsh, 2007). The health of women and children are among the worst in the world, partly because of a fragmented health care delivery system (Guidotti, et al, 2009). The Ministry of Public Health (MOPH) has had the daunting task of attempting to address the rapid need for expansion of basic health care to all Afghan people (Kapur & Smith, 2010). The bulk of health care in Afghanistan, post Taliban has been provided by non-governmental organizations (NGOs) (Gessner, 2004). MOPH has paid particular attention to the healthcare needs in geographically remote locations for women and children. According to the National Center for Health Statistics, Infant mortality rates are an important indicator of the health of a nation because they are associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices (MacDorman, Mathews, 2011). This project will examine the correlation between of clean water systems and infant mortality among low birth weight infants and very low birth weight infants. Access to clean water affects developing countries ability to decrease morbidity and mortality (Kapur & Smith, 2010). As water consumption increases globally, challenges arise for those countries that continue to struggle with access to clean water (Population Bulletin, 2008). This therefore shows that the lack of clean water in Afghanistan is likely to have a strong impact on the maternal delivery conditions of women in the country. Hence the research will attempt to identify the exact link between clean water and maternal delivery issues in Afghanistan and potential solutions could be deduced from it. Statement of Purpose Problem Statement: High rates of low birth weight infants and very low birth weight infants continue to be reported in Districts 7 & 8 of Kabul, Afghanistan. The research seeks to determine if the Safe Water Intervention program had a positive impact on the reduction of infant mortality rates of low birth weight infants and very low birth weight infants. Research Question: Did the implementation of safe water systems in the homes of low birth weight and very low birth weight infants in Districts 7 & 8, Kabul, Afghanistan, within one week of birth impact mortality rates of infants in District 7 & 8 who were included in the intervention program? The objective are listed below. Objective #1: To identify the trend of infant/maternal mortality and birth weight in the Kabul region prior to the implementation of the Safe Water System Objective #2: The examination of the general effects of the Safe Water System on pregnant women and infants. Objective #3: The critical assessment of the effect of the Safe Water System on the birth weight and maternal/infant mortality one week before and after the implementation of the Safe Water System. Objective #4: Identification of the best ways of promoting clean water systems to the different parts of Afghanistan. Review of Literature Environmental factors are often the cause of maternal and neo-natal mortality (Loudon, 2002). Current research suggests specific determinants of Infant Mortality Rates. The strongest impact on infant mortality rates is maternal literacy, followed by access to clean water (Barnett, 1993). The importance of clean water in the prevention of maternal and neo-natal mortality is linked to several factors include the prevention of diseases like diarrhea, provision of clean sanitary conditions prior to childbirth and the prevention of infections after childbirth (WHO Report, 2005: Coliver, 2007) Clean water is essential for the maintenance of a healthy atmosphere both for the mother and unborn child. This is because water is the agent for cleanliness and sanitation. Also, mothers consume water and thus, infections and other agents of complications at childbirth could be transmitted through unclean water (Loudon, 2002). It is therefore important for people health facilities and households with pregnant and expectant mothers to have access to clean water. The Islamic Republic of Afghanistan faces numerous challenges and has been widely considered one of the worst places in the world to have a baby (Amowitz, Reis, Iacopino, 2002; Barlett et al, 2005; http://www.amddprogram.org/index.php). This is mainly because there is the lack of major items that hamper the preparedness of a mother for a safe delivery. These factors have impacts on both the mother and the unborn child. Prenatal care in the first trimester is necessary for identification of preventable causes of maternal complications (Barlett et al, 2005). Prenatal care in the second trimester or later is strongly based on delivery preparedness (Barlett et al, 2005). The preparedness items include money for transportation, availability of skilled birth attendants, and maternal nutrition (Barlett et al, 2005). These requirements for safe delivery are barely met in the cities of Afghanistan (Kapur & Smith, 2010). The concerns become even more calamitous in remote regions of the country. The Safe Water/Motherhood project is a part of the Afghanistan Health Initiative (Expectmore.gov). This objectives of the program include amongst other things: 1. Promotion of public health amongst women and children 2. Reduce maternal mortality at the Rabia Balkhi Hospital (a major hospital in Kabul) 3. Decrease mortality rates amongst babies 4. Improve delivery services for mothers 5. Provide adequate logistical support for pregnant women and nursing mother (Afghanistan Health Initiative, 2009) The Safe Water project was aimed at providing water to the homes of people in the Kabul 7 & 8 District. The Safe Water project sought to reduce the chances of maternal and neo-natal mortality related to the lack of safe water. The end of this project is support in the decrease of the number of infant mortality cases in low birth weight infants and very low birth weight infants. The findings of the research is aimed at providing the best way maternal mortality can be reduced in the different parts of Afghanistan through maternal health education on clean water use. It seeks to provide guidance in development of best practices for maternal/ child health programs and services in the Islamic Republic of Afghanistan. 1. a. b. c. 2. 3. a. b. c. d. 4. a. b. c. 5. 6. 1. 2. 3. 4. 5. 6. 7. 8. Research Methodology The independent variable is the maternal/neo-natal mortality and its related complications like low weight. The dependent variable in this research revolves around the importance of clean/safe water in the maternity process. The primary hypothesis for the research is that clean/safe water is a major factor that reduces maternal/neo-natal mortality and its complications in the Kabul Region 7 and 8. The secondary hypothesis is that the actual or potential success of the clean/safe water intervention of Kabul can be duplicated in other parts of Afghanistan to reduce maternal/neo-natal mortality and its related complications. The research will be conducted in four phases, corresponding to the four objectives outlined above. Due to the nature of the topic at hand, the research will be deductive and explorative in nature. Hence it will examine the trends and relevant observations made from the Safe Water Intervention project. Phase 1: This will entail the examination of data about maternal/neo-natal mortality in the Kabul Region of Afghanistan. It will look at the data on birth weight and the mortality rates in Afghanistan, prior to the Afghanistan Health Initiative. This will involve the analysis of data available ranging from past records of healthcare facilities like RBH. This data will help to establish the rate of deaths and the weights of babies before the Safe Water Initiative commenced. Also, relevant data on water sources will be collected at this stage. This will involve data on the sources of water in Afghanistan during the time of the Taliban. This data on water availability for pregnant and newly delivered mothers and their households in the Kabul Regions 7 and 8 after the fall of the Taliban but before the Safe Water initiative was in force will be collected. The data on the maternal/neo-natal mortality and birth weight will be entered into an SPSS system and plotted to identify the trend of these two variables when most pregnant women had little or no access to clean and safe water. Phase 2 This will involve the assessment of the effects of Safe Water system on mothers and their newly born babies. This stage will entail the collection of information about the effectiveness of the Safe Water Intervention program. The end will be to identify how the safe water intervention impacted on the lives of people involved in the project. This will be a combination of interviews and surveys. The interview will be conducted with the medical officers who were tasked with the Safe Water Intervention project of the Afghanistan Health Initiative. These interviews will be conducted after an appreciable level of examination of information about the initiative. The interviews will be designed to collect information about the project and how it impacted on the women and their newly born babies. Also, issues in the project will be identified and conclusions will be drawn about the strategy, complications and effectiveness. These trends identified in Phase 1 and the strategic view of the interviewees above will be used as a yardstick for the creation of questionnaires and surveys that will be conducted on families that benefited from the Clean/Safe Water Intervention. The aim of this will be to identify relevant information that has an impact on the masses. This will help the researcher to identify ways in which the Clean/Safe Water Intervention can be duplicated on a large scale to other parts of Afghanistan. Phase 3 This phase will analyze reports on the various cases of the Safe Water Intervention project conducted via RBH. It will involve an analytical review of the reports and events that occurred during the project. This will involve the examination of salient issues relating to the observations documented in the projects of the initiative. After this initial examination, the rate of maternal/neo-natal mortality and baby weight and well being for the beneficiaries will be identified. Abnormal cases will be sampled and checked in-depth to the reports to identify anomalies. The observations will be collated and trends will be established. These trends will be based on variables identified in Phase 1 in order to support comparison. Phase 4 This will involve the comparison of the SPSS correlations between the trends of maternal/neo-natal mortality under the Taliban, under Coalition Rule (but before the Safe Water Intervention) and after the Safe Water Intervention. These trends will lead to the generalization of findings and a conclusion will be drawn on the three regimes. The finding will form a basis for an opinion on the efficiency and effectiveness of the Safe Water Intervention project on preventing maternal and neo-natal mortality and complications. Afterwards, the findings from Phase 2, will be used as basis for the recommendation of the best ways of promoting the Clean/Safe Water Intervention to other parts of the country to help reduce infant and maternal mortality. Background to the Research Methods. Descriptive analyses concerning the relationship between the dependent and independent variables will be utilized including frequencies, chi-square, t-tests and ANOVA/MANOVA. Regression analyses will also be utilized for model selection of variables as outcome predictors. Prior to analysis the data will require review to assess the validity and reliability regarding variables selected. Data will be reviewed for assessment of missing or data entry errors. Limitations of Research The research has several inherent limitations. First of all, data for health history on maternity in the Taliban era and the early years of their ejection are not readily available. This will present some challenges in the comparison of figures to get a clear view of trends and events. Secondly, the Kabul region is quite safe when compared to some parts of Afghanistan. This therefore implies that recommendations made on the extension of Clean/Safe Water Interventions to parts of the country will be dependent on the security situation in those areas. This therefore means there might be the need to generalize certain things that might not be applicable to all parts of the country. Timeline The research will be conducted in 8 different periods. Each period will be XXX (divide the period of the research into 8). ACTIVITY/PERIOD 1 2 3 4 5 6 7 8 1. Preliminary Research 2 Definition & Operationalization of Variables 3. Field work 4. Collation of Results 5. Contingent Research 6. Conclusion 7 Submission for Approval References Afghanistan health sector balanced scorecard national and provincial results. Round three. Kabul: Ministry of Public Health; 2006. Retrieved from http://www.jhsph.edu/publichealthnews/press_releases/2007/Burnham_afghanistan.html. Afghanistan Health Initiative (2009) Afghanistan Health Initiative: US Department of Health & Human Sciences, Office of Global Health Available online at: http://www.globalhealth.gov/initiatives/afghanistanhealthinitiative.html Accessed: 30/07/2011 Afghanistan Information Management System. Retrieved from http:// www.aims.org.af/. Afghanistan National Health Resources Assessment final report. 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