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

Abstract

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.

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

“…Sixty-six eligible studies were identified from 2,662 studies, after applying pre-defined exclusion criteria to the title/abstract and the full text evaluation [ 18 , 20 , 22 , 31 , 49 - 108 ]. Additional file 2 : Table S1 presents a detailed description of the included studies.…”

“…There was multi-centric intervention studies conducted between 2006–2008 [ 60 , 62 ], which produced favourable results about the effectiveness of Magnesium Sulphate in the management of pre-eclampsia. On the other hand there are interventions [ 22 ], which were executed after the development of the integrated maternal, newborn and child health strategy (IMNCH; 2007). On the whole many of the policies have no temporal association with the intervention studies.…”

“…This systematic review presents a cross-sectional description and an indirect measurement of the coverage and effectiveness of the published MNCH interventions implemented in Nigeria since 1990. During the 24 years of observation, the Government of Nigeria, academic/health institutions, and development partners have jointly implemented and published a number of intervention projects to promote MNCH [ 18 , 20 , 22 , 30 , 31 , 49 - 108 ]. Results from this systematic review showed that majority (90%) of the interventions were commenced after 2000 and 65% were published between 2010 and 2014.…”

“…To address this problem, many interventions were instituted to ensure that Nigeria achieves the relevant Millennium Development Goals (MDGs) [ 11 , 16 - 25 ]. Nevertheless, various intervention reports have documented mixed findings of the successes and challenges as well as threats to the attainment of MDGs 4 and 5 (child and maternal mortality reduction, respectively) in Nigeria [ 10 , 21 , 22 , 26 - 32 ]. It has been observed that Nigeria is off track in meeting MDG 4 and according to the United Nations mortality estimates, Nigeria has only achieved an average of 1.2% annual reduction in under-five mortality since 1990.…”

Health-related quality of life for pre-diabetic states and type 2 diabetes mellitus: a cross-sectional study in Västerbotten Sweden

“…The pre-diabetic states are impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and a combination of both (IFG&IGT). Subjects in any of these three pre-diabetic states have moderate to severe insulin resistance, impaired insulin secretion and/or insulin sensitivity, and each state has distinct pathophysiologic etiologies and risks of developing into T2D [ 6 , 7 ].…”