title: A mixed methods assessment of barriers to maternal, newborn and child health in gogrial west, south Sudan.
abstract: BACKGROUND
  Health conditions for mothers, newborns, and children in South Sudan are among the worst worldwide. South Sudan has the highest rate of maternal mortality in the world and despite alarming statistics, few women and children in South Sudan have access to needed healthcare, especially in rural areas. The purpose of this study was to understand the barriers to maternal, newborn and child health in Gogrial West, Warrap State, South Sudan, one of the most underdeveloped states.
  
  
  METHODS
  A randomized household quantitative study and supplemental qualitative interviews were employed in 8/9 payams in Gogrial West, Warrap, South Sudan. Interviews were conducted with randomly selected female household members (n = 860) who were pregnant or had children less than 5 years of age, and men (n = 144) with a wife having these characteristics. Non-randomized qualitative interviews (n = 72) were used to nuance and add important socio-cultural context to the quantitative data. Analysis involved the estimation of weighted population means and percentages, using 95% confidence intervals and considering p-values as significant when less than 0.05, when comparisons by age, age of marriage, wife status and wealth were to be established.
  
  
  RESULTS
  Most women (90.8%) and men (96.6%) did not want contraception. Only 1.2% of women aged 15-49 had met their need for family planning. On average, pregnant women presented for antenatal care (ANC) 2.3 times and by unskilled providers. Less than half of households had a mosquito net; fewer had insecticide treated nets. Recognition of maternal, newborn and child health danger signs overall was low. Only 4.6% of women had skilled birth attendants. One quarter of children had verifiable DPT3 immunization. Five percent of men and 6% of women reported forced intercourse. Overall men and women accept beatings as a norm.
  
  
  CONCLUSIONS
  Barriers to care for mothers, infants and children are far more than the lack of antenatal care. Maternal, newborn and child health suffers from lack of skilled providers, resources, distance to clinics. A lack of gender equity and accepted negative social norms impedes healthy behaviors among women and children. The paucity of a peer-reviewed evidence base in the world's newest country to address the overwhelming needs of the population suggests these data will help to align health priorities to guide programmatic strategy for key stakeholders.
authors.affiliation: Overseas Strategic Consulting, Ltd, 1500 Walnut Street, Suite 1300, Philadelphia, PA, 19102, USA. llawry@ihresearch.org.
authors.forename: Lynn
authors.initials: L
authors.lastname: Lawry
authors.affiliation: , Poeta Esteban Villegas, 12, 12°B 28014, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Canteli
authors.affiliation: , 609 Aquaview Drive, Ottawa, ON, K4A 4W1, Canada.
authors.forename: Tahina
authors.initials: T
authors.lastname: Rabenzanahary
authors.affiliation: Canadian Red Cross, National Office, 170 Metcalfe Street, Suite 300, Ottawa, ON, CA K2P2P2, Canada.
authors.forename: Wartini
authors.initials: W
authors.lastname: Pramana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D012959:Socioeconomic Factors; D000068037:South Sudan; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: MNCH; Sexual Gender Based Violence; South Sudan