Assessment of mother and child protection card utility in a rural block of Odisha

Susmita Dora; Debjyoti Mohapatra; Manish Taywade; Binod Kumar Patro; Vikas Bhatia

doi:10.4103/jphpc.jphpc_39_21

ORIGINAL ARTICLE

Year : 2023 | Volume : 4 | Issue : 1 | Page : 25-29

Assessment of mother and child protection card utility in a rural block of Odisha

Susmita Dora¹, Debjyoti Mohapatra², Manish Taywade¹, Binod Kumar Patro¹, Vikas Bhatia³
¹ Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
² Department of Community Medicine, SCB Medical College, Cuttack, Odisha, India
³ Executive Director, AIIMS, Bibinagar, Telangana, India

Date of Submission	18-Nov-2021
Date of Decision	10-Jan-2022
Date of Acceptance	05-Feb-2022
Date of Web Publication	15-Feb-2023

Correspondence Address:
Dr. Susmita Dora
Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jphpc.jphpc_39_21

Abstract

Background: Mother and Child Protection card was introduced for accelerating reduction in maternal, neonatal, and infant mortality and child under-nutrition & meant to be used by both beneficiaries and health care providers. It is a folding pictorial tool designed to assist mothers' understanding and monitor individual progress of maternal and child health and also enable the large networks of ASHAs, AWWs, and ANMs to converge their efforts and utilize the critical contact opportunities more effectively. Objective: To assess the completeness of information in MCP card filled by the AWW, ANM, and Beneficiary. Material and Methods: Twelve villages in mendhasal block of Khurdha district were selected for this study by multistage stratified random sampling method. MCP cards of Pregnant women from the second trimester onwards and Mothers of children 0-2 years of age were assessed for completeness using a Checklist. Results: A total of 34 and 46 items were checked for completeness in the MCP cards of Antenatal and post-natal women. The median entries found to be complete in Antenatal and Post-natal women were 34 and 26. Recording information on demographic details and antenatal care details was high but there was poor maintenance of other records like post-natal care, immunization, and growth chart. It was also found that beneficiaries are not marking the circles in the tablets consumption part. Conclusion: The study reported a gap in the maintenance of records in the Mother & Child Protection Card. Training for both the health care providers and mothers is needed for adequate use of the MCP card.

Keywords: Antenatal care, child protection card, knowledge of mothers, maternal, mother and child protection card, neonatal care

How to cite this article:
Dora S, Mohapatra D, Taywade M, Patro BK, Bhatia V. Assessment of mother and child protection card utility in a rural block of Odisha. J Public Health Prim Care 2023;4:25-9

How to cite this URL:
Dora S, Mohapatra D, Taywade M, Patro BK, Bhatia V. Assessment of mother and child protection card utility in a rural block of Odisha. J Public Health Prim Care [serial online] 2023 [cited 2023 Mar 25];4:25-9. Available from: http://www.jphpc.org/text.asp?2023/4/1/25/369665

Introduction

The mother and child protection (MCP) card (MCPC) was introduced by National rural health mission (NRHM) and Integrated child development scheme (ICDS) on April 1, 2010.^[1] It is one of the major initiatives for accelerating reduction in maternal, neonatal, and infant mortality and child undernutrition. The MCPC is a maternal and child care entitlement card, a counseling and family empowerment tool that would ensure tracking of mother–child cohort for health purposes.[²] It is meant to promote key family care behaviors, highlight danger signs, and link families to the referral system.

The concept for development of such a card was to have a home-based record that can be used by both the community health worker and the mothers.^[1] This common card would enable the large networks of accredited social health activists (ASHAs), Anganwadi workers (AWWs), and auxiliary nurse midwives (ANMs) to converge their efforts and utilize the critical contact opportunities more effectively.^[2] Being an entitlement card, it would ensure greater inclusion of unreached groups to demand and universalize access to key Maternal and child health (MCH) services.

Although it is a common card to be used by both beneficiaries and health-care provider, according to the UNICEF, it was found that the use of the MCPC is restricted to service recording only.^[3],[4] Only a few studies have assessed the completeness and utility of the MCPC in India. Hence, we conducted this study to assess the utility of the comprehensive card prepared and provided to every registered pregnant mother in India with a vision to improve maternal and child health.

Objectives

To assess the completeness of information in MCPC filled by the AWW, ANM, and beneficiary
To assess the knowledge of the beneficiaries regarding the information in the MCPC.

Materials and Methods

A community-based cross-sectional study was conducted from July 2019 to September 2019 in Mendhasal Block of Khordha District, Odisha. Community health center (CHC), Mendhasal, is the field practice area of AIIMS, Bhubaneswar. A multistage simple random sampling technique was used to select the villages [Figure 1]. Pregnant women and mothers of children 0–2 years of age were included in the study from the selected villages by universal sampling. Participants without an MCPC, pregnant women in the first trimester, or seriously ill women were excluded from the study.

Figure 1: Sampling technique

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Sample size estimation

Considering 50% completeness of information in MCPC and 10% of relative precision and assuming a confidence level of 95%, the sample size was calculated to be 400 using the formula.

= 4 × 50 × 50/5 × 5

= 400.

Study tools

A structured checklist was used to check if required details are filled in the MCPC or not and a structured questionnaire was used to assess the knowledge of the MCPC holders about the essential information provided in the card.

Study variables

Different variables used for checking the completeness of entries in MCPC were sociodemographic details, emergency contact details, institutional details, pregnancy details, delivery details, and child details. Different variables used for the assessment of participant's knowledge were danger signs during antenatal and postnatal period, danger signs of a newborn, antenatal care, breastfeeding, warm care of newborn, umbilical stump care, preparation for home delivery, preparation for institutional delivery, and child development.

The data were collected using Epicollect5 mobile application. Data analysis was done using Microsoft Excel 2010 and IBM SPSS version 20 (IBM Inc., Armonk, New York).

Ethical approval was obtained from the Institutional Ethical Committee of AIIMS, Bhubaneswar. Written permission was also obtained from the medical officer-in-charge of CHC, Mendhasal, and written informed consent was taken from each participant.

Methodology

MCPCs of antenatal women and lactating mothers were assessed during the Village health and nutrition day (VHND) sessions in their respective villages. Completeness of entries in the MCPC was checked by using the checklist designed, after which each one of them was interviewed separately using the structured questionnaire for knowledge regarding the information provided in the card.

Mothers of children <2 years of age were interviewed at their home. Home visits were made along with the ASHA of the village.

Results

A total of 400 MCPCs were checked for completeness of entries, and 336 participants were interviewed for knowledge of information given in MCPC.

Baseline characteristics of the study participants whose MCPC was assessed for completeness of data are described in [Table 1]. Majority of the participants (92.5%) were in the 19–35 years of age group and had middle school (39.8%) and high school (35.8%) education. Antenatal women having MCPCs were 62.75%. Among mothers with children till 2 years of age, 61.07% had children <1 year.

Table 1: Baseline characteristics of study participants whose mother and child protection card was assessed for completeness (n=400)

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Baseline characteristics of the study participants whose knowledge was assessed regarding the vital information provided through MCPC are described in [Table 2]. Among 336 participants, 93.2% belonged to 19–35 years of age group. Majority (40.2%) were educated till middle school. Antenatal women were 61%, and postnatal women were 38%. Out of the 129 postnatal participants, 71% had children within 1 year of age and 28% had children in 1–2 years of age group.

Table 2: Baseline characteristics of study participants whose knowledge was assessed (n=336)

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The MCPCs of antenatal and postnatal women were assessed separately for completeness of entries [Table 3] and [Table 4]. Out of 34 items in the antenatal section of MCPC, median entries were 23, and out of 46 items in postnatal section, median entries were 36.

Table 3: Completeness of entries in the mother and child protection card of ante-natal women (n=251)

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Table 4: Completeness of entries in the mother and child protection card of postnatal women (n=149)

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Knowledge of beneficiaries

While 96.13% of the participants had knowledge about preparation for institutional delivery, only 82.14% had knowledge about preparation for home delivery. Among all participants, 94.04% had knowledge regarding care during antenatal period, and 100% had knowledge regarding breastfeeding. Majority of the participants (91.07%) did not know about warm care of the neonate, and none of them had any knowledge about development of the child till 2 years of age. However, 88.98% of participants had knowledge about umbilical stump care.

Knowledge of beneficiaries about danger signs during antenatal and postnatal period is shown in [Figure 2] and [Figure 3]. Jaundice, head reeling, edema, and fever were then commonly known danger signs during antenatal period. Majority (89.88%) of beneficiaries were not aware of danger signs during postnatal period. Awareness regarding the danger signs of a newborn among the beneficiaries is shown in [Figure 4].

Figure 2: Knowledge of beneficiaries regarding danger signs during antenatal period

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Figure 3: Knowledge of beneficiaries regarding danger signs during postnatal period

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Figure 4: Knowledge of beneficiaries regarding danger signs of a newborn

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Discussion

In this study, among 251 MCPCs of antenatal women, median Inter Quartile Range (IQR) entry was 23 (4), and among 149 MCPCs of postnatal women, median (IQR) entry was 36 (15). A similar study done by Bag and Datta reported that the median entry of details in MCPC was 63 with a range of 56–70.^[5]

Bairya et al. reported that 65.1% of beneficiaries had read the MCPC and 60.5% of beneficiaries were instructed to read the card by health-care provider.^[6] Furthermore, Mani et al. showed that only 13.3% of mothers had read the MCPC, and the mean knowledge score of the participants was only 19.6 ± 5.5.^[7]

However, the study done by Jena et al.^[8] revealed that 86% of mothers had read the MCPC. Furthermore, 81.4% of mothers had appropriate knowledge about breastfeeding, and very few (23.2%) knew about Kangaroo Mother Care (KMC). Another study done by Elavarasan et al.^[9] showed that 49.48% of mothers had knowledge about initiation of breastfeeding and exclusive breastfeeding.

Similarly, Rama et al. reported that only 48% of the beneficiaries had knowledge about initiation of breastfeeding within 1 h of childbirth,^[10] but 64% knew the duration of exclusive breastfeeding. In contrast, a study done by Timilsina and Dhakal^[11] showed the highest (82.7%) knowledge of beneficiaries about danger signs during antenatal, postnatal, and neonatal period. In the study done by Gopalakrishnan,^[12] 46% of the study participants knew about danger signs of pregnancy, and 45% had adequate knowledge about antenatal care.

A study done by Agarwal et al.^[12] found that 71.4% of mothers had received diet advice and 31.4% were informed danger signs during pregnancy by health-care provider. Melwani et al.^[13] assessed knowledge of the health-care workers. Majority (87.6%) had knowledge regarding immunization, whereas only 10.5% knew about five cleans.

Conclusion

MCPCs have been developed to support families to understand and follow positive practices for achieving good health for pregnant women and young mothers. It serves not only the purpose of a health record but also a very educative material. Health education during VHND sessions can create awareness about antenatal, postnatal, and neonatal care among health beneficiaries, which will empower them to make right decisions regarding their health.

Recommendation

Beneficiaries and family members should be sensitized periodically about the information in the MCPC. They should also be encouraged to read this card at Anganwadi center. Special efforts such as pictorial materials and situational descriptions should be used to educate then illiterate beneficiaries.

Periodic monitoring of the VHND sessions and supervision of the health-care providers by the superior officials will lead to proper utilization of then MCPC.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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