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Introduction: It is estimated that any progress made towards improving maternal and child health in Mauritania has likely stalled. A lack of reliable and up-to-date data regarding maternal and child health indicators makes it difficult to identify current gaps and adapt international programmes to meet local needs Methods: Using secondary data collected as part of a baseline assessment for a maternal and child health programme being implemented in two health departments, we compared maternal and child health indicators across two different samples of pregnant women and children under-five in M’bagne and Guérou. Descriptive analyses were conducted using a Pearson’s Chi-Squared test, assuming a binomial distribution and a confidence level of alpha=0.05. Results: Our results indicated that there were marked regional differences in maternal and child health indicators between these two rural sites, with M’bagne generally performing better across a range of indicators including: immunisation rates, child registration, vitamin A supplementation, deworming, delivery in the presence of a skilled birth attendant, and post-natal care coverage. In Guérou we observed lower rates of fever, diarrhoea, and fast and difficult breathing among children under-five. Conclusion: Though socio-cultural differences may play a part in explaining some of these observed differences, these alone do not account for the observed differences in maternal and child health indicators. Context-specific activities to overcome barriers to care must be designed to address such rural regional differences if we are to see an improvement across maternal and child health indicators and accelerate progress towards MDGs 4 & 5 in Mauritania. © Frédérique Vallières et al.
The secondary data analysed for this paper were collected as part of a baseline assessment for a maternal and child health programme being implemented in both departments as part of World Vision Ireland’s Access to Infant and Maternal Health Programme (AIM-Health). The baseline exercise employed a cross-sectional household survey and used a two-stage probability sampling method to obtain a sample of the population in each parameter. Village lists were obtained for the rural departments of Guérou and M’bagne, and the probability of a village being selected was set as proportional to the number of households within that village. In Guérou, 48 of the 53 villages were visited and questionnaires were conducted across a sample of 397 households. In M’bagne, a total of 39 out of 46 villages were visited and questionnaires were conducted across a sample of 393 households. Sample size was calculated assuming a confidence level of alpha = 0.05. In the second stage of sampling, village leaders led field teams to the village centre where a pen was spun to determine the field team’s walking direction. A random number generation table was subsequently used to decide which household was to be visited first. Field teams were then instructed to proceed to the next house, until the intended number of household surveys from that village had been met. The survey tool was developed in consultation with local Ministry of Health representatives and with the assistance of maternal and child health experts within the World Vision Partnership. 30 Agents de santé communautaire (community health workers, or CHWs) were selected from both Guérou and M’bagne by their communities to participate in the five-day household survey training, hosted by experienced staff from neighbouring health centres. Though the questionnaire was printed in French, training was conducted in a mixture of French, Wolof, and Hassaniya. CHWs were permitted to conduct the interview in whichever language they felt best suited the household. Data collection took place from October-November 2011 and was carried out by World Vision Ireland and World Vision Mauritania. To be considered for analysis the data had to have been collected from an eligible household. The household was defined in terms of any people who were co-resident and shared common cooking arrangements, and were able to recognise one person as the head of household [26]. To be considered eligible, a household had to contain at least one child under the age of 60 months and/or a pregnant woman. Interviews were primarily conducted with the child’s primary caregiver, defined as the person who was, “primarily responsible for the health, safety and comfort of that child.” Informed written consent was obtained from all participants. If the participant was illiterate, signatures were obtained in the form of a fingerprint using an inkpad. Permission for the Centre for Global Health, Trinity College Dublin to use the de-identified baseline data for secondary analysis was obtained from both World Vision Ireland and World Vision Mauritania, and ethical approval was obtained from the Health Policy and Management/Centre for Global Health Research Ethics committee, Trinity College Dublin. Prior to data analysis, sample characteristics were compared to ensure homogeneity of pregnant women and children under-five in both Guérou and M’bagne. Age and education levels were compared for pregnant women and gender, and ages were compared for children under-five. Data was subjected to descriptive analysis in SPSS Statistics 17 (Release Version 17.0.0), and Pearson’s Chi-Squared test, assuming a binomial distribution, was used to test for significant differences. All data was analysed using a confidence level of alpha = 0.05. For child health indicators, respondents were asked to report whether or not there was an incidence of diarrhoea, cough and rapid and/or difficult breathing, and/or fever for each child under-five in that household over the two weeks preceding the survey. Whether or not the children were reportedly treated at a health centre within 24-hours of the occurrence of this illness was also recorded. Caretakers were also asked whether each child under-five had slept under a mosquito net during the night preceding the survey. Enumerators verified immunisations for children between the ages of 12-23 months by checking the child health card. Aligned to the guidelines developed by the World Health Organisation (WHO) and adopted by the Ministère de Santé et des Affaires Sociales in Mauritania, children were considered fully immunised when they had received the tuberculosis (BCG) vaccine, three doses of both the Pentavalent (Penta) and polio (OPV) vaccines, and a measles vaccination. Health cards for children over the age of 6 months were also verified for the receipt of Vitamin A supplementation in the last 6 months. Health cards were also verified for children over the age of 12 months for the presence of deworming in the last 6 months. Birth registrations were recorded by checking for the presence of a birth certificate. Mid-Upper Arm Circumference (MUAC) measurements were also taken to assess malnutrition among children under-five in both areas. Children who measured as yellow or red were considered to be malnourished. For each child under-five, the following information was collected: child delivered in a health centre or not; birth attended by SBA or not; birth attended by traditional birth attendant (TBA) or not. At the time of data collection, ANC visits were recorded for pregnant women by checking the maternal health card and recording the number of completed visits out of the minimum recommended 4 clinics. As part of ANC, pregnant women were asked to correctly identify where they could access prevention of parent to child transmission of HIV (PPTCT) services, whether or not they had slept under a mosquito net during the night preceding the survey, and whether they were currently taking iron and folic acid supplements. For each child under-five, whether or not their mother had received at least one of the recommended two PNC visits within 24 hours of their birth was also recorded.
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