Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia

Abstract

BackgroundA community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia’s poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas.MethodologyThree serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0–5 months of age using a ‘before-and-after’ evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention.ResultsMothers’ mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38–1.99) and SBA (aOR 1.72; 95% CI 1.38–1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62–2.79) and a SMAG (aOR 4.87; 95% CI 3.14–7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20–2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88–5.75) were significant predictors for SBA at delivery and PNC.ConclusionsStrengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa.

Utilization of Maternity Waiting Homes to Increase Uptake of Immediate Postpartum Family Planning in Primary Health Care Facilities in Ethiopia

“…This nding is supported by other evidence which shows a positive relation between IPPFP use and FP counseling before or during delivery [28]. Studies have shown MWHs remain an important window of opportunity to provide access to FP messages and to offer women with various options of contraceptive methods [29,30]. Therefore, the study nding informs the need for service integration within the different service units in the public health facilities to take advantage of the MWHs to increase IPPFP uptake.…”

“…Note applicable. MWH refers to a waiting area/house prepared in a health center compound for pregnant women identi ed to be at risk who receives services, including health services, and later to delivers with a skilled provider in a facility [30]. Women who stayed in MWH =1, 0=otherwise…”

Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis

“…Each of the seven districts are also target sites for the Saving Mothers, Giving Life (SMGL) initiative, a public– private partnership aimed at accelerating reductions in maternal mortality by improving health systems and addressing the delays in seeking, reaching, and receiving care in Nigeria, Uganda, and Zambia. 25 In addition to general health system-strengthening approaches, key activities of SMGL include: 1) community mobilization activities to increase demand through community leaders and volunteers trained in delivering messages and supporting pregnant women, known as Safe Motherhood Action Groups (SMAGs); 26 2) infrastructure development and improvements to transport and communication systems to increase access to and availability of services; and 3) strengthening health facility capacity to manage obstetric complications and improve quality of care. 25 The first proof-of-concept phase of SMGL was launched in 2012 and targeted Chembe, Kalomo, Lundazi, Mansa, and Nyimba districts.…”

Association between socioeconomic status and fertility among adolescents aged 15 to 19: An analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)

“…All analyses were conducted using Stata version 13 [19]. Data were cleaned and adjusted for multistage cluster sampling using the 'svyset' survey command [20,21] During the analysis, the weights were taken into account at each stage of the analysis, ensuring nationally representative estimates. Proportions were used to describe the data.…”