Sudan: situational analysis of maternal health in Bara District, North Kordofan.

A high maternal mortality ratio was estimated in Bara District in Sudan during the late 1980's with approximately 407 women dying per 100,000 live births. In order to design effective intervention strategies, Care International and the Ministry of Health in Sudan conducted a study to identify the attitudes of women, staff, and TBAs towards motherhood, prenatal care, and practices affecting the health of women in the district. The previously conducted training programme for TBAs was also assessed in its impact. The study yielded the following results: in addition to the commonly known risk factors for maternal health e.g. haemorrhage, puerperal infection, obstructed labour, and anemia, the women in the villages and health staff identified female genital mutilation (pharaonic circumcision) as a major threat to safe motherhood. Health seeking behaviour was linked to problems of access and perceived quality of care: women did generally not wish to spend more than 30 minutes for reaching a facility. But if the quality of a particular institution was considered good, and supplies and equipment were available, women would cover great distances to reach such a facility. Participation in prenatal care suffered from the equation of preventive with curative care. Women would therefore tend to turn to a clinic or service provider, if symptoms of illness occurred during a pregnancy. The village-based services suffered from the lack of equipment and poor staff training, which further undermined the motivation to seek prenatal care. When health staff recommended referral of a pregnant women for delivery, the advice was usually followed.(ABSTRACT TRUNCATED AT 250 WORDS)