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

Friday, 16th of March 2018 Print

 

PLoS One. 2018 Jan 16;13(1):e0190145. doi: 10.1371/journal.pone.0190145. eCollection 2018.

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

Jacobs C1,2,3Michelo C2,3Chola M3Oliphant N4Halwiindi H5Maswenyeho S4Baboo KS5Moshabela M1,6.

Author information

1

School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.

2

Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia.

3

Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.

4

UNICEF, Lusaka, Zambia.

5

Department of Global Health, School of Public Health, University of Zambia, Lusaka, Zambia.

6

Africa Health Research Institute, Kwa-Zulu Natal, Durban, South Africa.

 

Abstract below; full text is at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190145

 

BACKGROUND:

A community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of the 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.

METHODOLOGY:

Three 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.

RESULTS:

Mothers 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.

CONCLUSIONS:

Strengthening 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.

 

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