Analyses confirm effect of women's groups on maternal and newborn deaths

Prost, Audrey; Colbourn, Tim; Tripathy, Prasanta; Osrin, David; Costello, Anthony

doi:10.1016/s0140-6736(13)61082-x

Cited by 8 publications

(7 citation statements)

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“…First, the design uses the PRECEDE-PROCEDE framework for health promotion through system-wide changes in health planning and implementation which facilitate changes in MNCH health knowledge, practices, and outcomes, incorporating participatory methods and operations research to assess progress in achieving changes at each stage [ 28 ]. Second, the intervention design is implemented spatially through a cluster approach, which focuses on reducing the three delays to emergency obstetrical care [ 29 - 31 ]. The program focuses on improving MNCH care by clusters of Local Government Areas (LGAs) per state, which each comprise a catchment area for emergency obstetrical care (EOC) services, with one Comprehensive EOC facility per 500,000 people.…”

Section: Methodsmentioning

confidence: 99%

Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011

et al. 2013

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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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Section: Methodsmentioning

confidence: 99%

Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011

et al. 2013

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“…Though often expensive, high-quality research is a vital investment towards future health and social services that are effective and cost-effective. Many initiatives aim to improve research design, execution, and reporting so that questions are robustly answered [ 12 , 29 , 30 ]. More important is to ask the “right” research questions in the first place.…”

Section: Potential Next Stepsmentioning

confidence: 99%

Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI)

Angood¹,

McGrath²,

Mehta

et al. 2015

PLoS Med

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“…In that study, women were facilitated to identify and formulate actions to address perinatal problems, resulting in a reduction in neonatal mortality rate of 30 % and increased coverage of antenatal care, institutional deliveries, skilled birth attendance and hygienic care. Replications of the Nepalese study in South Asia and Africa have also been successful [ 18 , 19 ].However, the reduction in neonatal mortality is limited with this approach when trying to cover larger populations [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…The intervention resulted in increased attendance to antenatal care clinics and reduced neonatal mortality (adjusted odds ratio 0.51; 95 % confidence interval, 0.30–0.89) after a latent period [ 22 ]. In contrast with the trials targeting women’s groups [ 18 , 19 ], we decided to compose groups consisting of local healthcare staff and local key stakeholders, i.e., trained professionals and influential commune members. These (intervention) groups were called maternal and newborn health groups (MNHGs).…”

Section: Introductionmentioning

confidence: 99%

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

Eriksson

Huy

Đức

et al. 2016

Trials

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BackgroundAnnually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health – Knowledge Into Practice trial evaluated facilitation of community groups (2008–2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30–0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention.MethodsProcess data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models.ResultsTo ensure eight active facilitators over 3 years, 11 Women’s Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19–0.73) than control communes (n = 46).ConclusionsThis evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups’ work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.Trial registrationISRCTNISRCTN44599712.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1141-z) contains supplementary material, which is available to authorized users.

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Analyses confirm effect of women's groups on maternal and newborn deaths

Cited by 8 publications

References 5 publications

Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011

Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011

Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI)

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

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