Measuring the impact of non‐monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial

Wang, P.; Connor, Alison; Guo, Exiang; Nambao, Mary; Chanda‐Kapata, Pascalina; Lambo, N.; Phiri, Caroline

doi:10.1111/tmi.12678

Cited by 18 publications

(24 citation statements)

References 20 publications

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“…However, in that context the kits were provided at ANC visits, and thus kit uptake was tied to ANC attendance; the paper did not report effect on other health services. In a RCT in Zambia, provision of a mama kit containing diapers, a sheet and a blanket to women who deliver at health facilities increased facility-based delivery levels [19]. However, the fact that receipt of the kit was conditional on utilization renders this context very different from the trial analyzed here.…”

Section: Discussionmentioning

confidence: 96%

“…In general, there is limited evidence around the associations between safe birth kits and maternal health service use. However, one RCT conducted in Zambia reported that distribution of “mama kits” containing only a cloth, diapers and blanket to women delivering in a facility (and only these women) increased the rate of facility delivery [19].…”

Section: Introductionmentioning

confidence: 99%

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Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

et al. 2018

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BackgroundThe burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes. This paper reports a secondary analysis of data from a cluster randomized trial in rural northern Nigeria in which birth kits were distributed by community health workers to pregnant women in their homes, analyzing non-experimental variation in receipt and use of birth kits. More specifically, associations between pregnant women’s baseline characteristics and receipt and use of birth kits, and associations between birth kit use, care utilization and maternal and newborn outcomes were assessed.Methods and findingsBaseline, post-birth and endline data related to 3,317 births observed over a period of three years in 72 intervention communities in Jigawa state, Nigeria, were analyzed using hierarchical, logistic regression models. In total, 140 women received birth kits, and 72 women used the kits. There were no associations between baseline demographic characteristics, health history, and knowledge and attitudes and receipt of a kit, suggesting that community health workers did not systematically target the distribution of birth kits. However, women who used the kit reported reduced odds of past pregnancy complications (OR = 0.44, 95% CI: 0.19-1.00) as well as significantly higher odds of feeling generally healthy at baseline (OR = 2.00, 95% CI: 1.06-3.76), of exposure to radio media (OR = 1.97, 95% CI: 1.21-3.22), and of perceiving themselves as having a low-risk pregnancy (OR = 3.05, 95% CI:1.39-6.68). While there were no significant associations between birth kit use and facility based delivery, skilled birth attendance or post-natal care, women who used a kit exhibited significantly lower odds of completing four or more ANC visits (adjusted OR = 0.39, 95% CI: 0.18-0.85) and significantly higher odds of reporting prolonged labor (adjusted OR = 4.75, 95% CI: 1.36-16.59), and post-partum bleeding (adjusted OR = 3.25, 95% CI: 1.11-9.52).ConclusionsThis evidence suggests that use of birth kits is low in a rural population characterized by minimal baseline utilization of maternal and neonatal health services, and the use of birth kits was not associated with reductions in maternal or neonatal morbidity. While further research is required to understand how the effectiveness of birth kits may be shaped by the mechanism through which women access and utilize the kits, our findings suggest that the provision of kits to women outside of the formal health system may be associated with increased risk of adverse outcomes.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

et al. 2018

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“…Nine studies were conducted in East Africa (Kenya (n = 3) [20][21][22], Uganda (n = 2) [23,24] Tanzania (n = 2) [9,25], Eritrea (n = 1) [26], and Ethiopia (n = 1) [27]). Two were conducted in Southern Africa (Zambia (n = 1), [28], and Lesotho (n = 1) [29]), and one in West Africa (Mali) [30].…”

Section: Characteristics Of Studies Included In the Reviewmentioning

confidence: 99%

Interventions to increase facility births and provision of postpartum care in sub-Saharan Africa: a scoping review

et al. 2021

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Background Most maternal deaths occur during the intrapartum and peripartum periods in sub-Saharan Africa, emphasizing the importance of timely access to quality health service for childbirth and postpartum care. Increasing facility births and provision of postpartum care has been the focus of numerous interventions globally, including in sub-Saharan Africa. The objective of this scoping review is to synthetize the characteristics and effectiveness of interventions to increase facility births or provision of postpartum care in sub-Saharan Africa. Methods We searched for systematic reviews, scoping reviews, qualitative studies and quantitative studies using experimental, quasi experimental, or observational designs, which reported on interventions for increasing facility birth or provision of postpartum care in sub-Saharan Africa. These studies were published in English or French. The search comprised six scientific literature databases (Pubmed, CAIRN, la Banque de Données en Santé Publique, the Cochrane Library). We also used Google Scholar and snowball or citation tracking. Results Strategies identified in the literature as increasing facility births in the sub-Saharan African context include community awareness raising, health expenses reduction (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Strategies that were found to increase provision of postpartum care include improvement of care quality, community-level identification and referrals of postpartum problems and transport voucher program. Conclusions To accelerate achievements in facility birth and provision of postpartum care in sub-Saharan Africa, we recommend strategies that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend that more intervention studies are implemented in West and Central Africa, and focused more on postpartum. Plain English summary In in sub-Saharan Africa, many women die when giving or few days after birth. This happens because they do not have access to good health services in a timely manner during labor and after giving birth. Worldwide, many interventions have been implemented to Increase the number of women giving birth in a health facility or receiving care from health professional after giving birth. The objective of this study is to synthetize the characteristics and effectiveness of interventions that have been implemented in sub-Saharan Africa, aiming to increase the number of women giving birth in a health facility or receiving care from health professional after birth. To proceed with this synthesis, we did a review of studies that have reported on such interventions in sub-Saharan Africa. These studies were published in English or French. The interventions identified to increase the number of women giving birth in a health facility include community awareness raising, reduction of health expenses (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Interventions implemented to increase the number women receiving care from a health professional after birth include improvement of care quality, transport voucher program and community-level identification and referrals to the health center of mothers’ health problems. In sub-Saharan Africa, to accelerate increase in the number of women giving birth in a health facility and receiving care from a health professional after, we recommend interventions that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend the conduct in West and Central Africa, of more studies targeting interventions to increase the number of women giving birth in a health facility and or receiving care from a health professional after birth.

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“…This incentive was found to be a cost-effective way of increasing facility delivery in rural Zambia. 55…”

Section: Journal Of Global Health Reportsmentioning

confidence: 99%

Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis

Mshelia

Analo

2020

Journal of Global Health Reports

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Introduction High-quality facility-based birth reduces maternal and perinatal morbidity and mortality. Previous multi-country systematic reviews have analysed qualitative research studies to understand the barriers and facilitators of delivery in a health facility. However, questions remain as to the extent to which generic multi-context reviews capture nuanced insights from a specific country context. Nigeria contributes significantly to the global burden of maternal mortality and hence the need to explore the country’s contextual factors affecting maternal mortality viz-a-viz a previous international review. Methods To synthesise published and unpublished qualitative research on factors that influence decision-making and use of facility-based delivery services in Nigeria using a qualitative evidence synthesis methodology. Multiple electronic databases, citation chaining and checking of reference lists were searched. Studies were screened by title, abstract and full text. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for appraising a qualitative study. Synthesis of extracted data followed the ‘best-fit’ framework method which combines deductive and then inductive approaches to analysis. Results 27 eligible studies were identified. Data were organised around four principal themes, further divided into subthemes: perceptions of pregnancy and childbirth, the influence of the sociocultural context and care experiences; resource availability and access and perceptions of quality of care. Conclusions Beyond the structural gaps that exist which affect quality care provided at health facilities, wider social determinants like sociocultural beliefs, care experience and resource availability impact upon the utilisation of facility-based delivery services. Future research should prioritise interventions and programmes to address prevalent gaps involving distance and access. In this way, progress can be made against longstanding deficits in the quality of maternal and infant care.

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Measuring the impact of non‐monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial

Cited by 18 publications

References 20 publications

Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

Interventions to increase facility births and provision of postpartum care in sub-Saharan Africa: a scoping review

Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis

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