The Maternal and Neonatal Health (MNH) module in the Health Services Report will capture MNH health service delivery on a monthly basis. All service data will be disaggregated by channel: Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision. For franchise facilities and service delivery partners, only services that meet PSI’s criteria for service delivery through partners can be reported. For detailed definitions of these channels, please see the common data elements definition page.

 

Why collect these data?

The MNH module collects service data related to antenatal care, facility delivery, neonatal and infant care. This data is useful for a variety of programmatic and reporting applications:

 

Internally , these data will provide important trend data on service delivery at the global level. Programmatic trends help to identify both challenges and successes; areas that need greater attention and support as well as opportunities for platform-to-platform assistance. These data are also key inputs for proposals, further ensuring MNH program strengthening through new funding.

 

Externally , these data will allow PSI to leverage its network to contribute to global discussions about MNH service delivery and policy agenda, particularly in the private sector. These programmatic data, aggregated across all PSI MNH programs, can provide critical information about service delivery models that successfully contribute to international and national health goals.

 

Impact Estimation ( e.g. DALYs averted, deaths averted): In each table, we have noted where data will be used to estimate impact.



The table below outlines the module’s sections, tables and their corresponding data elements:


Section 1: Antenatal Care

Data elements

Table 1: Antenatal care services by channel
 
Pregnant women receiving iron and folic acid supplementation (not as part of a multivitamin)

Pregnant women receiving multivitamin supplementation (which include iron/folic acid)

Pregnant women receiving the second dose of IPTp

Pregnant women screened for gestational diabetes (rapid blood glucose, fasting blood glucose, oral glucose tolerance test, hemoglobin A1C)

Pregnant women receiving monitoring for gestational diabetes but no medication (return visits for lifestyle counselling on diet, exercise, or tobacco/alcohol use or return visits to assess complications (hypertension, TB, retinopathy, neuropathy, renal damage))

Pregnant women receiving diabetes medication (oral medications OR insulin)

Pregnant women screened and treated for pre-eclampsia (with magnesium sulfate (MgSO 4))

Pregnant women given a long lasting insecticide-treated net (LLIN)

Section 2: Delivery

Data elements

Table 1: Delivery services by channel
Facility delivery with a skilled birth attendant
Facility delivery with basic emergency obstetric care (BEmOC)

Section 3: Neonatal and Infant Health

Data elements

Table 1: Neonatal health services by channel
Neonates receiving essential care (hygiene, warmth, & breastfeeding)
Neonates receiving resuscitation
Table 2: Infant health services by channel
Infants given vitamin A supplementation
Infants given zinc supplementation


Each table and data element are described in further detail below.



Section 1: Antenatal Care

Data elements

Table 1: Antenatal care services by channel
 
Pregnant women receiving iron and folic acid supplementation (not as part of a multivitamin)

Pregnant women receiving multivitamin supplementation (which include iron/folic acid)

Pregnant women receiving the second dose of IPTp

Pregnant women screened for gestational diabetes (rapid blood glucose, fasting blood glucose, oral glucose tolerance test, hemoglobin A1C)

Pregnant women receiving monitoring for gestational diabetes but no medication (return visits for lifestyle counselling on diet, exercise, or tobacco/alcohol use or return visits to assess complications (hypertension, TB, retinopathy, neuropathy, renal damage))

Pregnant women receiving diabetes medication (oral medications OR insulin)

Pregnant women screened and treated for pre-eclampsia (with magnesium sulfate (MgSO 4))

Pregnant women given a long lasting insecticide-treated net (LLIN)


Data element:
Pregnant women receiving iron and folic acid supplements (not as part of a multivitamin) by service delivery channel
Purpose: 
This data element records the number of pregnant women who received iron and folic acid supplements (not part of a multivitamin) during their antenatal visit
Precise Definitions:

This refers to iron and folic acid supplements that were given separately and not as components of a multivitamin supplement. If the iron and folic acid is part of a multivitamin supplement then this should only be reported under the 'multivitamin supplement' data element.

Daily iron and folic acid supplementation is recommended for pregnant women in all settings as part of the antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency (WHO). Supplementation should begin as early as possible and last throughout the pregnancy.
Unit of Measure:
Number of pregnant women
Disaggregated by:
Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)
For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help in tracking iron and folic acid supplementation for pregnant women to help programs plan and provide adequate services accordingly.



Data element:
Pregnant women receiving multivitamin supplements (which include iron/folic acid) by service delivery channel
Purpose: 
This data element records the number of pregnant women who received multivitamin supplements (which includes iron and folic acid) during their antenatal visit
Precise Definitions:

This data element measures the number of pregnant women who received multivitamin supplements (which includes iron/folic acid) during their antenatal visit. If iron and folic acid supplements are issued separately and not as part of a multivitamin supplement, they should be reported under the 'iron/folic acid supplement' data element.

Pregnant women are particularly vulnerable to vitamin and mineral deficiencies because of the increase in metabolic demands to meet fetal requirements for growth and development (WHO). Multivitamin supplements help to restore and/or provide these nutrients to the pregnant mother and the developing foetus. Multivitamin supplements may include iron, folic acid, calcium, iodine, vitamins A, C and D depending on the nutritional requirements of the pregnant woman and in settings where consumption of these nutrients is low.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help in tracking multivitamin supplementation for pregnant women to help programs plan and provide adequate services accordingly.


Data element:
Pregnant women receiving the second dose of IPTp by service delivery channel
Purpose: 
This data element records the number of pregnant women who received the second dose of IPTp during their antenatal visit.
Precise Definitions:

This is the number of pregnant women who received the second dose of intermittent preventive treatment of malaria in pregnancy (IPTp2) in the reporting month.

Pregnant women are among the most vulnerable groups that are at risk of malaria as pregnancy reduces a woman's immunity to malaria. IPTp is a full therapeutic course of antimalarial medicine given to pregnant women at routine prenatal visits, regardless of whether the recipient is infected with malaria. IPTp reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth weight, and neonatal mortality (WHO). WHO recommends IPTp with sulfadoxine-pyrimethamine (IPTp-SP) in all areas with moderate to high malaria transmission in Africa. IPTp should be given to all pregnant women at each scheduled antenatal care visit except during the first trimester and each SP dose should be given at least 1 month apart. The WHO recommends a schedule of four antenatal care visits.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help in tracking IPTp uptake and trends by pregnant women to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.



Data element:
Pregnant women screened for gestational diabetes by service delivery channel
Purpose: 
This data element records the number of pregnant women who were screened for gestational diabetes during their antenatal visit.
Precise Definitions:

Gestational diabetes is hyperglycaemia (high blood glucose) that is first recognized during pregnancy among women who had previously not been diagnosed with diabetes. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery (WHO). Standard practice in many countries involve universal screening at first antenatal visit and an oral glucose tolerance test at 24-28 weeks; however, screening coverage may be determined by local health authorities depending on  local burden, resources and priorities (WHO).

Screening for gestational diabetes involves measuring the levels of glucose in the blood under specified conditions (after fasting, 2 hours after a meal, and at random) using a glucose test. Another test involves measuring blood glucose concentrations after drinking a glucose solution (oral glucose tolerance test). The hemoglobin A1c test (glycated haemoglobin test) measures the average levels of blood glucose over a 2 or 3 months period and is normally used as a monitoring test for diabetic patients.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help in assessing incidence of gestational diabetes in pregnant women to help programs plan and provide adequate services accordingly.


Data element:
Pregnant women monitored (without medication) for gestational diabetes by service delivery channel
Purpose: 
This data element records the number of pregnant women who were monitored for gestational diabetes during their antenatal visit but did not receive any medication for diabetes
Precise Definitions:

Monitoring for gestational diabetes entails return visits by pregnant women for lifestyle counselling on diet, exercise, or tobacco/alcohol use or return visits to assess diabetes-related complications such as hypertension, TB, retinopathy, neuropathy and renal damage.

Gestational diabetes is hyperglycaemia (high blood glucose) that is first recognized during pregnancy among women who had previously not been diagnosed with diabetes. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery (WHO).

Treatment for gestational diabetes involves actions or interventions to lower blood glucose levels which may include diet, exercise and/or medication.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help track management of gestational diabetes in pregnant women to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.


Data element:
Pregnant women given medication (oral medications OR insulin) for gestational diabetes by service delivery channel
Purpose: 
This data element records the number of pregnant women who received oral medication or insulin for gestational diabetes during their antenatal visit
Precise Definitions:

Gestational diabetes is hyperglycaemia (high blood glucose) that is first recognized during pregnancy among women who had previously not been diagnosed with diabetes. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery (WHO).

Treatment for gestational diabetes involves actions or interventions to lower blood glucose levels which may include diet, exercise and/or medication. Medication can be either medicine given to lower glucose levels and/or insulin therapy.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help track management of gestational diabetes in pregnant women to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.



Data element:
Pregnant women screened and treated for pre-eclampsia with magnesium sulfate by service delivery channel
Purpose: 
This data element records the number of pregnant women who were screened and treated for pre-eclampsia with magnesium sulfate during their antenatal visit.
Precise Definitions:

Pre-eclampsia is one of the hypertensive disorders of pregnancy that is characterized by the onset of a new episode of high blood pressure during pregnancy with the occurrence of substantial protein in the urine (proteinuria). It is one of the leading causes of maternal and perinatal mortality and morbidity worldwide and should therefore be detected and properly managed before the onset of eclampsia (WHO).

Screening for pre-eclampsia involves measuring blood pressure and protein concentrations in the urine. Magnesium sulfate (MnSO 4) is one of the drugs recommended for the prevention of eclampsia in women with pre-eclampsia (WHO).
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help monitor incidence and management of pre-eclampsia in pregnant women to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.


Data element:
Pregnant women given a long lasting insecticide-treated net (LLIN) by service delivery channel
Purpose: 
This data element records the number of pregnant women who received a long lasting insecticide-treated net (LLIN) during their antenatal visit
Precise Definitions:

Pregnant women are among the most vulnerable groups that are at risk of malaria as pregnancy reduces a woman's immunity to malaria. Malaria in pregnancy is a major, preventable cause of maternal morbidity (e.g. anemia) and poor birth outcomes (e.g. low birth weight or neonatal mortality).

Long Lasting Insecticide-treated Nets (LLINs) provide both a physical and a chemical barrier between humans and the Anopheles malaria vector and have been known to be an effective means of reducing the risk of malaria infection when used correctly and consistently.
Unit of Measure:
Number of pregnant women
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help track uptake of LLINs by pregnant women to help programs plan and provide adequate services accordingly.



Section 2: Delivery

Data elements

Table 1: Delivery services by channel
Facility delivery with a skilled birth attendant

Facility delivery with basic emergency obstetric care (BEmOC)



Data element:
Facility deliveries with a skilled birth attendant by service delivery channel
Purpose: 
This data element records the number of deliveries with a skilled birth attendant that occurred at the health facility.
Precise Definitions:

The highest incidence of maternal and perinatal mortality occurs around the time of birth with the majority of deaths occurring within the first 24 hours after birth (WHO). Deliveries at health facilities with a skilled birth attendant are important in averting maternal and neonatal morbidity and mortality.

Skilled attendance is the presence, at childbirth, of an accredited health professional who has been trained in the skills needed to manage uncomplicated deliveries and in the identification, management and referral of complications in women and newborns.
Unit of Measure:
Number of deliveries
Disaggregated by:
Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page.
Justification/Management Utility:
This information will help track facility deliveries with skilled birth attendants to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.


Data element:
Facility deliveries with basic emergency obstetric care (BEmOC) by service delivery channel
Purpose: 
This data element records the number of deliveries that occurred at a health facility with basic emergency obstetric care.
Precise Definitions:

The highest incidence of maternal and perinatal mortality occurs around the time of birth with the majority of deaths occurring within the first 24 hours after birth (WHO). Deliveries at health facilities with basic emergency obstetric care are critical in averting maternal and neonatal morbidity and mortality.
Basic emergency obstetric care is the capability of providing the following by a skilled attendant at a health facility:
  • Administering antibiotics, uterotonic drugs (oxytocin) and anticonvulsants (magnesium sulphate);
  • Manual removal of the placenta;
  • Removal of retained products following miscarriage or abortion;
  • Assisted vaginal delivery, preferably with vacuum extractor;
  • Basic neonatal resuscitation care (UNFPA, 2014)

A basic emergency obstetric care facility is one in which all the above functions are performed.
Unit of Measure:
Number of deliveries
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page
Justification/Management Utility:
This information will help track facility deliveries with basic emergency obstetric care to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.



Section3: Neonatal and Infant Health

Data elements

Table 1: Neonatal health services by channel
Neonates receiving essential care (hygiene, warmth & breastfeeding)

Neonates receiving resuscitation
Table 2: Infant health services by channel
Infants given vitamin A supplementation

Infants given zinc supplementation



Data element:
Neonates given essential care (hygiene, warmth & breastfeeding) by service delivery channel
Purpose: 
This data element records the number of neonates who received essential newborn care (hygiene, warmth and breastfeeding)
Precise Definitions:

A neonate is a child under 28 days of age.

Neonatal deaths account for about 45% of all under five child deaths every year. Three quarters of all newborn deaths occur in the first week of life and about two thirds of these deaths can be prevented if known, effective health measures are provided at birth and during the first week of life (WHO).

Essential Newborn Care (ENC) is a comprehensive strategy designed to improve the health of newborns through a range of effective interventions that can essentially be delivered through low level health workers. These include early (within 1 hour) initiation of breastfeeding, delayed bathing, kangaroo mother care, promotion of hygiene and cord care, assessment of danger signs and referral.
Unit of Measure:
Number of neonates
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page
Justification/Management Utility:
This information will help track neonatal essential care to help programs plan and provide adequate services accordingly.


Data element:
Neonates given resuscitation by service delivery channel
Purpose: 
This data element records the number of neonates who received resuscitation
Precise Definitions:

A neonate is a child under 28 days of age.

Neonatal deaths account for about 45% of all under five child deaths every year. Globally, about one quarter of all neonatal deaths are caused by birth asphyxia, defined as the failure to initiate and sustain breathing at birth. Effective resuscitation at birth can prevent a large proportion of these deaths (WHO).

Birth asphyxia is the inability of a newborn to establish breathing at birth. Resuscitation in newborns involves interventions or actions that are done to a newborn to assist it to breathe and may include thorough drying and rubbing the back,  positive pressure ventilation, and suctioning of the mouth, nose or trachea (WHO).
Unit of Measure:
Number of neonates
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page
Justification/Management Utility:
This information will help track neonatal resuscitation cases to help programs plan and provide adequate services accordingly.



Data element:
Infants given vitamin A supplements by service delivery channel
Purpose: 
This data element records the number of infants who received vitamin A supplements
Precise Definitions:

An infant is a child between the ages of 1 to 12 months.

Vitamin A is essential to support rapid growth and to help combat infections in children and inadequate intakes of vitamin A may lead to vitamin A deficiency which can cause visual impairment in the form of night blindness and may increase the risk of illness and death from childhood infections, including measles and those causing diarrhoea (WHO). WHO recommends a high-dose of vitamin A supplementation in infants and children 6–59 months of age in settings where vitamin A deficiency is a public health problem (1% or higher prevalence of night blindness in children) or where prevalence of deficiency is 20% or higher in infants and children under five years of age. This should be given once to infants. Vitamin A supplementation in infants 1–5 months of age is not recommended as a public health intervention for the reduction of morbidity and mortality (WHO).
Unit of Measure:
Number of infants
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page
Justification/Management Utility:
This information will help track vitamin A supplementation for infants to help programs plan and provide adequate services accordingly.



Data element:
Infants given zinc supplements by service delivery channel
Purpose: 
This data element records the number of infants who received zinc supplements
Precise Definitions:

An infant is a child between the age of 1 to 12 months.

Zinc is essential for normal growth and development in children, and zinc deficiency can lead to impaired functioning of the immune and digestive systems and lead to stunted growth. There is also evidence that zinc supplementation may reduce the frequency and severity of respiratory infections in children (WHO).
Unit of Measure:
Number of infants
Disaggregated by:

Service delivery channel (Franchise Facilities, Service Delivery Partners, and PSI Direct Service Provision)

For common data element definitions see common data elements definition page
Justification/Management Utility:
This information will help track zinc supplementation for infants to help programs plan and provide adequate services accordingly. It is also used to estimate impact e.g. DALYs averted.