Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia

Allen, Elizabeth; Schellenberg, Joanna; Berhanu, Della; Marchant, Tanya

doi:10.1371/journal.pone.0199937

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…We performed cluster-based household surveys in 2012 and 2015, which involved interviewing women who reported a live birth in the preceding 12 months. 19,20 The same methods and sampling frames were applied in both years and covered the entire area of implementation (Appendix 1). We applied multistage random sampling to generate a representative sample of women living in the implementation areas.…”

Section: Survey Overviewmentioning

confidence: 99%

“…In 2012, coverage levels were all about 50% or above, with the exception of at least 4 antenatal visits (28% [170/604]; 95% CI 24%-33%) and postnatal care for the newborn (19% [114/604]; 95% CI 15%-23%); these 2 indicators still had the lowest coverage in 2015 ( Table 6). Evidence of inequity in relation to socioeconomic status was present in 2012 for antenatal care (p < 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) Note: CI = confidence interval, NA = not applicable, OR = odds ratio, SES = socioeconomic status. *The p value for OR for difference in coverage over time.…”

Section: Six Districts Of Uttar Pradesh Indiamentioning

confidence: 99%

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Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Marchant

Beaumont

Makowiecka

et al. 2019

CMAJ

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BACKGROUND: Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India. METHODS: We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity. RESULTS: In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria (n = 1100 women), Ethiopia (n = 404) and Uttar Pradesh, India (n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups (p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%. INTERPRETATION: Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas.

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Section: Survey Overviewmentioning

confidence: 99%

Section: Six Districts Of Uttar Pradesh Indiamentioning

confidence: 99%

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Marchant

Beaumont

Makowiecka

et al. 2019

CMAJ

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“…Health systems strengthening and the focus on an integrated approach coincides with increasing awareness that quality of care is a complex, multifactorial, but critical driver that can catalyze progress or mire potential success [8]. The Lancet Global Health Commission on High Quality Health Systems, which called for a better understanding of the dimension of quality for health systems in resource-limited settings [9], has contributed growing evidence that merely accessing or reaching the doorstep of a healthcare system does not equate to or ensure receipt of high-quality care [10,11].…”

Section: Introductionmentioning

confidence: 99%

Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study

Chou¹,

Walker²,

Kanyangarara³

2019

PLoS Med

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BackgroundIn low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions.Methods and findingsIn this study, we created deterministic models to project health outcomes if quality of care was addressed in a representative sample of 81 low- and middle-income countries (LMICs). First, available data from health facility surveys (e.g., Service Provision Assessment [SPA] and Service Availability and Readiness Assessment [SARA]) conducted 2007–2016 were linked to household surveys (e.g., Demographic and Health Surveys [DHS] and Multiple Indicator Cluster Surveys [MICS]) to estimate baseline coverage for a core subset of 19 maternal and newborn health interventions. Next, models were constructed with the Lives Saved Tool (LiST) using country-specific baseline levels in countries with a linked dataset (n = 17) and sample medians applied as a proxy in countries without linked data. Lastly, these 2016 starting baseline levels were raised to reach targets in 2020 as endline based upon country-specific utilization (e.g., proportion of women who attended 4+ antenatal visits, percentage of births delivered in a health facility) from the latest DHS or MICS population-based reports. Our findings indicate that if high-quality health systems could effectively deliver this subset of evidence-based interventions to mothers and their newborns who are already seeking care, there would be an estimated 28% decrease in maternal deaths, 28% decrease in neonatal deaths, and 22% fewer stillbirths compared to a scenario without any change or improvement in quality of care. Totals of 86,000 (range, 77,800–92,400) maternal and 0.67 million (range, 0.59 million–0.75 million) neonatal lives could be saved, and 0.52 million (range, 0.48 million–0.55 million) stillbirths could be prevented across the 81 countries in the calendar year 2020 when adequate quality care is provided at current levels of utilization. Limitations include the paucity of data to individually assess quality of care for each intervention in all LMICs and the necessary assumption that quality of care being provided among the subset of countries with linked datasets is comparable or representative of LMICs overall.ConclusionsOur findings suggest that efforts to close the quality gap would still produce substantial benefits at current levels of access or utilization. With estimated mortality rate declines of 21%–32% on average, gains from this first step would be significant if quality was improved for selected antenatal, intrapartum, and postnatal interventions to benefit pregnant women and newborns seeking care. Interventions provided at or around the time of childbirth are most critical and accounted for 64% of the i...

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“…Here we focus on implementation in the project areas. Evaluation of project outcomes as well as scale-up of innovations are reported elsewhere 23 31–39…”

Section: The Studymentioning

confidence: 99%

Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

Makowiecka

Marchant

Betemariam³

et al. 2019

BMJ Glob Health

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Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the ‘characterisation framework’, based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where.

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Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia

Cited by 8 publications

References 22 publications

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study

Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

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