Manual for the use of pictorial card and pregnant women register for emergency obstetric care
Maternal morality ratio in Bangladegh at 4.5 per 1,000 live births is one of the highest in the world. Although Bangladesh has an extensive health and family planning service-delivery network starting from the community to higher levels, their utilisation is limited. Referral and linkages for emergency obstetric care (EOC) services is poor and most women with obstetric complications do not get the care they need in time. They either die at home or on the way to hospital. Many women are not aware of the complications that may occur during pregnancy and childbirth. Recognition of pregnancy and childbirth complications and timely referral for appropriate care are important for the reduction of materna morality and morbidity. Raising community awareness about obstetric complications is, therefore, essential for preventing maternal deaths. The Operations Research Project (ORP) of the ICDDR,B introduced a pictorial card in the Project field areas. This pictorial card is being used as a tool for raising community awareness regarding the complications of the pregnancy and childbirth. It shows pictures of the symptoms of complications like bleeding during pregnancy, swelling of feet and face, severe headache, fever, premature rupture of membranes, prologed labour, exessive bleeding and abnormal presentation of the foetus. A pregnant women register has also been developed by the Project for record-keeping and better follow-up of pregnant women. This manual has been prepared to facilitate the use of the pictorial card and the pregnant women register by the field workers and paramedics for referral and linkage for EOC services. The manual can also be used by community mobilizers/depots holders and community volunteers. All pregnant women will be given a pictorial card either by the field worker of the community mobilizer or the paramedic. They will explained the symptoms of the complications of pregnancy and childbirth to the mothers as shown in the card. It is also expected that the card will be explained to the pregnant women in presence of the husband and/or ralatives. This manul will also enable the field workers and paramedics on record-keeping and linking pregnant women to different health service providers/facilities. A detailed guideline on how to explain the pictorial card to pregnant women and maintain records on demographic information, and the current pregnancy have been presented in this manual. This manual will help providers in the pictorial card and the pregnant women register to raise community awareness about the danger signs of obstetric complications so that women will seek appropriate care leading to improved maternal health.