Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

Abstract

Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17–1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.

Maternal and neonatal implementation for equitable systems. A study design paper

“…In addition to this design paper, there is one more methodological paper that describes the PAR approach in more detail [33]. Two of the papers [25,26] summarize the results of the intervention on some of the key outcomes of the study (knowledge about maternal and newborn danger signs, birth preparedness and utilization of maternal and newborn health services and newborn care practices). Two other papers describe the characteristics of saving groups and the saving practices of the community for maternal and newborn health, highlighting opportunities for promoting saving for maternal and newborn health [27,28].…”

‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

“…The influence of saving on utilization of maternal health services and the influence of other components of the intervention have been described in the other papers that are included in this supplement [24,25]. …”

Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

“…They built on previous interventions that led to significant gains in community newborn health practices and facility deliveries [10]. The extent to which these single interventions sustained health gains was partly limited by their isolated implementation within the dynamic, broader health systems in which they were embedded [9]. Knowing that they had to address capacity gaps across health-system levels, the team sought to consolidate the gains previously realized by embarking on the Maternal and Neonatal Implementation for Equitable Systems project (MANIFEST) detailed in this volume [11].…”

“…Rather than being daunted by these substantial and varied barriers, a team at the Makerere University School of Public Health, Kampala, embraced the importance of a systems lens that considers how numerous levels and partners dynamically interact to advance or stall maternal and newborn health [9]. They built on previous interventions that led to significant gains in community newborn health practices and facility deliveries [10].…”

“…To ensure that this increased demand was met with quality services, MANIFEST also facilitated enabling environments for healthcare workers to respond through supportive supervision, clinical mentoring and participatory action research steered by local district health teams [9,14,15].…”