Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi

Callaghan-Koru, Jennifer A.; Guenther, Tanya; Sitrin, Deborah; Ligowe, Reuben; Chimbalanga, Emmanuel; Zimba, Evelyn; Kachale, Fannie; Shah, Rashed; Baqui, Abdullah H

doi:10.1186/1471-2458-13-1052

Cited by 42 publications

(60 citation statements)

References 44 publications

(41 reference statements)

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“…Previous studies also demonstrated that the coverage of PNHVs was low with only 4 countries having over 50%% (27). Our finding is higher than a study conducted on newborn care practices at home and in health facilities in Ethiopia and Malawi (28,29). However, it is very low compared to other studies done in Uganda, Nepal, Bangladesh, and…”

Section: Factors Associated With Pnhv Receiptcontrasting

confidence: 91%

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design

Tesfau

Kahasay

Gebrehiwot

et al. 2020

Preprint

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Background : In low-income countries like Ethiopia, where families have poor access to or do not utilize services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia.Methods : We conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression.Results : One hundred two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.58; CI 3.59-15.98), participated in pregnant women forum (AOR, 3.21; CI 1.70-6.05), notified their birth (AOR, 6.15; CI 3.50-10.80) and those member of community health insurance (AOR, 1.88; CI 1.14-3.12) were significantly associated factors with postnatal home visit by a health extension worker.Conclusion : The coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. Existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.

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Section: Factors Associated With Pnhv Receiptcontrasting

confidence: 91%

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design

Tesfau

Kahasay

Gebrehiwot

et al. 2020

Preprint

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“…In a program aimed at increasing facility births, the level of improvement is minimal if almost all women have intrapartum care within a facility. Results from studies in Malawi and other countries have not shown a significant effect of CHW programs on improving facilitybased births [10,[29][30][31]. However, this study shows that it was possible to increase the number of women giving birth in a health facility in Malawi by using maternal health focused CHWs.…”

Section: Discussionmentioning

confidence: 54%

“…9 Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands. 10 Athena Institute, VU University, Amsterdam, the Netherlands.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…The CHWs conducted initial home visits to identify pregnant women, followed by three ANC and three postnatal care home visits. Although the study showed an increase in the proportion of women utilising at least one ANC visit and intrapartum care, it lacked a comparison site, and did not explore the impact of CHWs on the timing and frequency of ANC and postnatal care attendance [10]. A randomised control trial conducted in 13 facilities in one district between 2005 and 2009 did not find evidence to support the role of CHW home visits on ANC attendance, completion of four or more visits, utilisation of intrapartum care, or postnatal care attendance [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

Kachimanga

Dunbar²,

Watson

et al. 2020

BMC Pregnancy Childbirth

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Background: By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods: A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the postintervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a "counterfactual site" was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results: Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions: In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

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“…5,6 Recognizing this situation, health programmers in low-and middle-income countries have, over the past decade, aimed to implement strategies that favour the poorest members of communities and promote community linkages within primary health care. [7][8][9][10] Certain interventions, such as training community members to make health promotion visits to families, have improved the practice of healthy behaviours in communities and increased care-seeking in health facilities. 11,12 In 2012, in regions across Nigeria, Ethiopia and India, the implementation of community-based programming was prioritized.…”

mentioning

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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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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Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi

Cited by 42 publications

References 44 publications

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

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

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