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BackgroundThis paper describes early results of an integrated maternal, newborn, and child health (MNCH) program in Northern Nigeria where child mortality rates are two to three times higher than in the southern states. The intervention model integrated critical health systems changes needed to reinvigorate MNCH health services, together with community-based activities aimed at mobilizing and enabling women to make changes in their MNCH practices. Control Local Government Areas received less-intense statewide policy changes.MethodsThe impact of the intervention was assessed using a quasi-experimental design, comparing MNCH behaviors and outcomes in the intervention and control areas, before and after implementation of the systems and community activities. Stratified random household surveys were conducted at baseline in 2009 (n = 2,129) and in 2011 at follow-up (n = 2310), with women with births in the five years prior to household surveys. Chi-square and t-tests were used to document presence of significant improvements in several MNCH outcomes.ResultsBetween baseline and follow-up, anti-tetanus vaccination rates increased from 69.0% to 85.0%, and early breastfeeding also increased, from 42.9% to 57.5%. More newborns were checked by trained health workers (39.2% to 75.5%), and women were performing more of the critical newborn care activities at follow-up. Fewer women relied on the traditional birth attendant for health advice (48.4% to 11.0%, with corresponding increases in advice from trained health workers. At follow-up, most of these improvements were greater in the intervention than control communities. In the intervention communities, there was less use of anti-malarials for all symptoms, coupled with more use of other medications and traditional, herbal remedies. Infant and child mortality declined in both intervention and control communities, with the greatest declines in intervention communities. In the intervention communities, infant mortality rate declined from 90 at baseline to 59 at follow-up, while child mortality declined from 160 to 84.ConclusionsThese results provide evidence that in the context of ongoing improvements to the primary health care system, the participatory and community-based interventions focusing on improved newborn and infant care were effective at changing infant care practices and outcomes in the intervention communities.

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Northern Nigeria has a history of low use of health services, resistance to immunization programs, and high maternal and child mortality rates. Cultural, physical, and financial barriers prevent many families from accessing health care. The Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal, Newborn, and Child Health Initiative (PRRINN-MNCH) was a project funded by the UK Department of International Development and the Norwegian government that used an integrated approach to strengthen health services and increase community demand for and access to quality health care. The project's community engagement approach aimed to empower communities, work with volunteers, and develop solutions to overcome barriers to health. Simultaneously, PRRINN-MNCH was building primary health care systems, including immunization, and strengthening governance to increase the availability and quality of services. Baseline and endline population-based random household surveys conducted in 2009 and 2013 showed improved community knowledge, increased use of antenatal care and immunization services, and a decrease in maternal, infant, and under-5 mortality. In the project areas, the maternal mortality ratio fell from 1,270 to 1,057; under-5 mortality decreased from 160 to 90.1 per 1,000 live births, and infant mortality decreased from 90 to 46.9 per 1,000 live births. The overall coverage of fully immunized children rose from 2.2% to 19.3%. Many of the PRRINN-MNCH lessons learned about community engagement are relevant to the Polio Eradication Initiative when Nigeria reaches polio-free status and community mobilizers are mainstreamed into routine health services.