1. Discussion and Conclusion
Addressing gaps in optimal and equitable access to primary health care: A focus on rural households from hard to reach areas Su Latt Tun Myint1, Khin Thet Wai1, Thae Mg Mg1, Khin Wuit Ye Hla2, Myat Phone Kyaw1 1Department of Medical Research, 2Save the Children, Myanmar
Introduction
In Myanmar, achieving the national maternal mortality rate (MMR) target of 130 per 100,000 live births by 2015 remains a challenge [1].
Access to skilled birth attendants has been more or less stagnant at around 70%.
Nearly 64% of mothers give birth at home [2].
Three quarter of all maternal deaths occur during delivery and the immediate post-partum period [3].
60% of the total population live in the malaria endemic areas, in Myanmar [4].
Kayah State is known to be a malaria epidemic prone area with higher incidence rate of 31 per 1000 population[5]. The main aim is to improve primary health care in those hard to reach areas.
Objective
To explore the awareness, knowledge and experiences related to Maternal, Newborn and Child Health (MNCH) and malaria.
Methodology
Study design: A cross-sectional study.
Study areas: 40 villages of 3 townships in Kayah State, Myanmar.
Study period: November March 2015.
Sampling: Multi-stage sampling. Randomly selected 40 villages. For each village, 17 households were selected randomly.
Data collection: Face-to-face interviews
For malaria-674 households . For MNCH, 521 out of 674 households being selected due to the history of giving birth to a child within past five years.
Discussion and Conclusion
There was a need to improve awareness raising activities related to danger signs in pregnancy.
Challenges to improve an access to quality ANC required attention.
Promoting ANC and delivery by skilled providers more than at present to avoid unnecessary consequences.
Misconceptions and misunderstanding regarding maternal health beliefs still existed. Practices to enhance the women’s health during AN, PN and delivery was to be attempted further.
There was a low level of knowledge related to prevention and control of malaria that required further improvement.
A gap between the awareness of quality care at government health facilities and actual treatment seeking for fever suspected of malaria.
Challenges for an access to quality care required detailed exploration and further decisions for pragmatic solutions.
Key Findings
For MNCH services,
Only 41% (214/521) of respondents recognized the danger signs of pregnancy
Nearly 48% of respondents had received ANC more than four times.
Midwives delivered 40.1% (209/521) of pregnant women.
Only 18.8% (98/521) of respondents were referred mainly to the state hospital (73/98; 74.5%) for complications during delivery.
Around 16% (81/521) of respondents reported acute diarrhea and 62% (322/521) reported acute respiratory infections in their children within past two weeks.
Nearly 80% of mothers sought health care for their children from the nearest health facilities.
Only 53% (276/521) of respondents could recall measles vaccination.
For prevention and control
of malaria
Nearly 86% (577/674) of respondents were aware of malaria illness
Only 27.7% (184/665) mentioned that sleeping under insecticide treated nets (ITN) could prevent malaria transmission.
Although more than 70% of households had ITN, the rate of sleeping under the bed-net previous night was not up to the satisfactory level
Only 28.4% (64/225) went to rural health centers for the advice or treatment of malaria.
Recommendations
Need to identify challenges for an access to quality care by mixed methods approach.
Further evidence to make decisions for programmatic solutions requires implementation research in problematic areas.
Strengthening database for primary care component through an innovative mobile technology and electronic data capture in hard-to-reach areas would be helpful for program planners.
References:
Ministry of Health. Health in Myanmar 2014.
Ministry of Health. Public Health Statistics Report 2012.
Ministry of National Planning and Economic Development. Millennium Development Goals report 2013.
Strategic Framework for Artemisinin Resistance Containment in Myanmar (MARC) 2011‐2015. WHO Country Office for Myanmar.
Ministry of Health. Myanmar Health Statistics 2010. 
Address for correspondence:
Dr. Su Latt Tun Myint,
Department of Medical Research Myanmar.