Mixed-methods reproductive health knowledge, attitudes and practices survey of IDPs, returnees and host communities in Jonglei State, South Sudan.

Objectives: To understand the current state of maternal, newborn and child health (MNCH) among internally displaced persons (IDPs), returnees and host communities in remote counties of Jonglei state.

Design: Cross-sectional, randomly sampled, mixed-methods, population-based household study.

Setting: Ayod, Nyirol, Fangak and Pigi counties of Jonglei, South Sudan.

Participants: 859 households, including 586 adult females and 273 adult males.

Primary And Secondary Outcome Measures: Knowledge, attitudes and practices of MNCH. Secondary: contraception, pregnancies, pregnancy outcomes, use or non-use of antenatal care (ANC)/postnatal care (PNC), use of skilled birth attendants, breastfeeding, knowledge of warning or danger signs of pregnancy, gender-based violence (GBV) and MNCH attitudes/cultural norms.

Results: A total of 859 households consented to the study (586 females and 273 males) with a response rate of 96% among females and 94% among males. The ability to list at least three warning/danger signs or essentials of care for different MNCH categories among respondents was low (range, 37·0%-47·1%). 1% of females and 3% of males use contraception. ANC and PNC are suboptimal and largely provided by unskilled providers. 26% of women exclusively breastfed for up to 6 months. For respondents with children<2 years of age, 68·9% (95% CI 64·7 to 72·7) had received three doses of Penta valent vaccine. Females and males reported similar lifetime GBV rates.

Conclusion: Conflict and flooding in the remote survey areas are significant barriers to MNCH. Evidence-based interventions that decrease mortality and morbidity are lacking and the dearth of skilled health providers and healthcare facilities limits improvements in MNCH. Establishing cost-effective and evidence-based interventions proven to reduce MNCH mortality either at fixed facilities and/or in combination with mobile clinics and community outreach are necessary to ensure that IDPs and returnees are reached.