Reproductive health for refugees by refugees in Guinea III: maternal health

Data comes from a 1999 cross-sectional survey of 444 female refugees in 23 camps. Associations of reported maternal health outcomes with exposure to health education (exposed versus unexposed), formal education (none versus some), age (adolescent versus adult), or parity (nulliparous, parous, grand multiparous), were analysed using logistic regression.No significant differences were found in maternal knowledge or attitudes. Virtually all respondents said pregnant women should attend antenatal care and knew the importance of tetanus vaccination. Most recognised abdominal pain (75%) and headaches (24%) as maternal danger signs and recommended facility attendance for danger signs. Most had last delivered at a facility (67%), mainly for safety reasons (99%). Higher odds of facility delivery were found for those exposed to RHG health education (adjusted odds ratio 2.03, 95%CI 1.23-3.01), formally educated (adjusted OR 1.93, 95%CI 1.05-3.92), or grand multipara (adjusted OR 2.13, 95%CI 1.21-3.75). Main reasons for delivering at home were distance to a facility (94%) and privacy (55%).Refugee-led maternal health education appeared to increase facility delivery for these refugee women. Improved knowledge of danger signs and the importance of skilled birth attendance, while vital, may be less important in chronic emergency settings than improving facility access where quality of care is acceptable.Three-quarters of maternal deaths occur during delivery or the immediate post-partum period [1]. An estimated 358,000 women worldwide died from pregnancy-related causes in 2008, commonly from preventable or treatable conditions such as haemorrhage, eclampsia, obstructed labour, sepsis, and unsafe abortion [2-4]. The maternal mortality ratio (MMR) globally has decreased 1-3% annually since 1990, but this will not achieve Millennium Development Goal (MDG) 5 - to improve maternal health - for which an annual decline of 5.5% is needed. In Sub-Saharan Africa, where the annual decline re