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Grewal G, Fuller SS, Rababeh A, Maina M, English M, Paton C, Papoutsi C. Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs. BMJ Glob Health 2024; 9:e012894. [PMID: 38199778 PMCID: PMC10806884 DOI: 10.1136/bmjgh-2023-012894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/12/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Neonatal mortality remains significant in low-income and middle-income countries (LMICs) with in-hospital mortality rates similar to those following discharge from healthcare facilities. Care continuity interventions have been suggested as a way of reducing postdischarge mortality by better linking care between facilities and communities. This scoping review aims to map and describe interventions used in LMICs to improve care continuity for newborns after discharge and examine assumptions underpinning the design and delivery of continuity. METHODS We searched seven databases (MEDLINE, CINAHL, Scopus, Web of Science, EMBASE, Cochrane library and (Ovid) Global health). Publications with primary data on interventions focused on continuity of care for newborns in LMICs were included. Extracted data included year of publication, study location, study design and type of intervention. Drawing on relevant theoretical frameworks and classifications, we assessed the extent to which interventions adopted participatory methods and how they attempted to establish continuity. RESULTS A total of 65 papers were included in this review; 28 core articles with rich descriptions were prioritised for more in-depth analysis. Most articles adopted quantitative designs. Interventions focused on improving continuity and flow of information via education sessions led by community health workers during home visits. Extending previous frameworks, our findings highlight the importance of interpersonal continuity in LMICs where communication and relationships between family members, healthcare workers and members of the wider community play a vital role in creating support systems for postdischarge care. Only a small proportion of studies focused on high-risk babies. Some studies used participatory methods, although often without meaningful engagement in problem definition and intervention implementation. CONCLUSION Efforts to reduce neonatal mortality and morbidity should draw across multiple continuity logics (informational, relational, interpersonal and managerial) to strengthen care after hospital discharge in LMIC settings and further focus on high-risk neonates, as they often have the worst outcomes.
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Affiliation(s)
- Gulraj Grewal
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sebastian S Fuller
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Asma Rababeh
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Michuki Maina
- Health Services Unit, KEMRI - Wellcome Trust Research Institute, Nairobi, Kenya
| | - Mike English
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Health Services Unit, KEMRI - Wellcome Trust Research Institute, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Pn SR, Balachander B. Care of Healthy as well as Sick Newborns in India: A Narrative Review. Indian J Pediatr 2023; 90:29-36. [PMID: 37642888 DOI: 10.1007/s12098-023-04752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 08/31/2023]
Abstract
Majority of neonatal deaths occur in developing countries. There is an increase in the proportion of neonatal deaths as part of the under-5 mortality over the past decade. Hence we need to accelerate further to achieve the goal of single digit neonatal mortality rate (NMR) by 2030. The two major arms of NMR reduction include facility-based neonatal care (FBNC) and home-based neonatal care (HBNC). FBNC addresses care at birth, care of the normal newborn, and care of small and sick newborns. HBNC provides continuum of care for newborn and post-natal mothers facilitated by Accredited Social Health Activist (ASHA) workers. One of the main challenges is to maintain good quality of neonatal care. Zero separation, linkage of community & facility and roles of professional bodies are considered way forward to achieve India Newborn Action Plan (INAP) goals. This review summarizes existing programs for newborn health and diseases and provides an over-arching view of the way-forward.
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Affiliation(s)
- Suman Rao Pn
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, 560038, India.
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, 560038, India
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Islam MA, Khan MS, Khan AA, Narapureddy BR, Lingala KVR, Nasir N, Muzammil K, Ahmad I, Dawria A, Faheem A, Mohieldin A. Newborn Care Practices and Associated Factors Influencing Their Health in a Northern Rural India. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020408. [PMID: 36832537 PMCID: PMC9955279 DOI: 10.3390/children10020408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION In developing countries, neonatal mortality is the most neglected health issue by the health system, leading to its emergence as a public health problem. A study was undertaken to assess the influence of factors and newborn care practices influencing newborn health in the rural area of Bareilly district. METHODOLOGY The descriptive cross-sectional study was organized in the rural areas of Bareilly. Study participants were selected based on the mothers who gave birth to a baby during the last six months. The mothers who delivered in that area within six months were included and, using the semi-structured questionnaire, data were collected. Data were analyzed using Microsoft Excel and SPSS 2021 version for windows. RESULTS Out of 300 deliveries, nearly one-quarter of the deliveries, 66 (22%), were happening in homes, and most of the deliveries, 234 (78%), happened in hospitals. It was observed that unsafe cord care practices were observed more among nuclear families, 8 (53.4%), than joint families, 7 (46.6%), and it was found to be statistically insignificant. The Unsafe feed was given 48 (72.7%) more commonly among home deliveries than institutional deliveries 56 (23.9%). Mothers' initiation of delayed breastfeeding was nearly the same in both home and hospital deliveries. Delayed bathing was observed in nearly three-fourths of mothers, 125 (70.1%), aged 24-29 years, followed by 29 (16.8%) in the age period of 30-35 years. CONCLUSION The practice of essential newborn care still needs to improve in Bareilly; there is a need to create awareness among the mothers and family members on newborn and early neonatal care aspects, such as promoting exclusive and early initiation of breastfeeding and delayed bathing practices.
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Affiliation(s)
- Md Arfin Islam
- Department of Community Medicine, IIMS & R, Lucknow 226026, India
| | - Md Suhail Khan
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
| | - Anas Ahmad Khan
- Department of Community Medicine, United Institute of Medical Sciences, Prayagraj 231313, India
| | - Bayapa Reddy Narapureddy
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
- Correspondence:
| | | | - Nazim Nasir
- Department of Basic Medical Sciences, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
| | - Khursheed Muzammil
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
| | - Irfan Ahmad
- Department of Clinical Laboratory Sciences, CAMS Abha, King Khalid University, Abha 62529, Saudi Arabia
| | - Adam Dawria
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
| | - Ahmed Faheem
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
| | - Ali Mohieldin
- Department of Public Health, CAMS, Khamis Mushait Campus, King Khalid University, Abha 62529, Saudi Arabia
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Gupta M, Bansal A, Chakrapani V, Jaiswal N, Kiran T. The effectiveness of prenatal and postnatal home visits by paramedical professionals and women's group meetings in improving maternal and child health outcomes in low and middle-income countries: a systematic review and meta-analysis. Public Health 2023; 215:106-117. [PMID: 36682079 DOI: 10.1016/j.puhe.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the effectiveness of prenatal and postnatal home visits (HVs) and women group meetings (WGMs) by paramedical professionals to improve maternal and child health outcomes in low- and middle-income countries (LMICs). STUDY DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review of trials published till December 2020, as per registered protocol in The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42018091968). Outcomes were neonatal mortality rate (NMR), maternal mortality ratio (MMR), the incidence of low birth weight, and still birth rate (SBR). The Cochrane Pregnancy and Childbirth Group's Trials Register, Cochrane Central Register of Controlled Trials, PubMed, and Excerpta Medica Database (EMBASE) were searched. Pooled results were estimated using random-effects meta-analysis in RevMan version 5.2. RESULTS Twenty-five trials met the inclusion criteria. HVs were the key intervention in 12, WGMs in 11, and both interventions in 2 trials. The pooled estimates have shown that NMR was significantly reduced by HVs (OR 0.77, confidence interval [CI]: 0.67-0.90, P = 0.0007, I2 = 77%) and WGMs (OR 0.76, CI: 0.65-0.90, P = 0.001, I2 = 71%). SBR was significantly reduced by HVs (OR 0.77, CI: 0.70-0.85; P < 0.001, I2 = 0%). Subgroup analysis of studies in which more than 10% of pregnant women participated in the WGMs showed significant reduction in NMR (OR 0.67, CI 0.58-0.77, P = 0.00001, I2 = 31%) and MMR (OR 0.55, CI 0.36-0.84, P = 0.005, I2 = 27%). Two studies reported improvement in birth weight by HVs. CONCLUSIONS HVs and WGMs (with >10% pregnant women) by paramedical professionals are effective strategies in reducing the NMR and MMR in LMICs. HVs were also effective in reducing SBR.
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Affiliation(s)
- M Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Bansal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - N Jaiswal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - T Kiran
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bogale DS, Abuhay TM, Dejene BE. Predicting perinatal mortality based on maternal health status and health insurance service using homogeneous ensemble machine learning methods. BMC Med Inform Decis Mak 2022; 22:341. [PMID: 36577978 PMCID: PMC9795949 DOI: 10.1186/s12911-022-02084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Perinatal mortality in Ethiopia is the highest in Africa, with 68 per 1000 pregnancies intrapartum deaths. It is mainly associated with home delivery, which contributes to more than 75% of perinatal deaths. Financial constraints significantly impact timely access to maternal health care. Financial incentives, such as health insurance, may address the demand- and supply-side factors. This study, hence, aims to predict perinatal mortality based on maternal health status and health insurance service using homogeneous ensemble machine learning methods. METHODS The data was collected from the Ethiopian demographic health survey from 2011 to 2019 G.C. The data were pre-processed to get quality data that are suitable for the homogenous ensemble machine-learning algorithms to develop a model that predicts perinatal mortality. We have applied filter (chi-square and mutual information) and wrapper (sequential forward and sequential backward) feature selection methods. After selecting all the relevant features, we developed a predictive model using cat boost, random forest, and gradient boosting algorithms and evaluated the model using both objective (accuracy, precision, recall, F1_score, ROC) and subjective (domain expert) based evaluation techniques. RESULTS Perinatal mortality prediction models were developed using random forest, gradient boosting, and cat boost algorithms with the overall accuracy of 89.95%, 90.24%, and 82%, respectively. Risk factors of perinatal mortality were identified using feature importance analysis and relevant rules were extracted using the best performing model. CONCLUSIONS A prediction model that was developed using gradient boosting algorithms was selected for further use in the risk factor analysis, generating relevant rules, development of artifacts, and model deployment because it has registered better performance with 90.24% accuracy. The most determinant risk factors of perinatal mortality were identified using feature importance and some of them are community-based health insurance, mother's educational level, region and place of residence, age, wealth status, birth interval, preterm, smoking cigarette, anemia level, hemoglobin level, and marital status.
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Affiliation(s)
- Dawit S. Bogale
- College of Informatics, University of Gondar, Gondar, Ethiopia
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Rai RK, Barik A, Chowdhury A. Use of antenatal and delivery care services and their association with maternal and infant mortality in rural India. Sci Rep 2022; 12:16490. [PMID: 36192467 PMCID: PMC9529891 DOI: 10.1038/s41598-022-20951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India.
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Affiliation(s)
- Rajesh Kumar Rai
- Department of Economics, University of Göttingen, 37073, Göttingen, Germany. .,Centre for Modern Indian Studies, University of Göttingen, 37073, Göttingen, Germany. .,Society for Health and Demographic Surveillance, Suri, West Bengal, 731101, India. .,Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, 02115, USA.
| | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, 731101, India.,Suri District Hospital, Suri, West Bengal, 731101, India
| | - Abhijit Chowdhury
- Society for Health and Demographic Surveillance, Suri, West Bengal, 731101, India.,School of Digestive and Liver Disease, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, 700020, India.,John C Martin Centre for Liver Research and Innovations, Indian Institute of Liver and Digestive Sciences, Liver Foundation West Bengal, Kolkata, West Bengal, 700150, India
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Bang A, Baitule S, Deshmukh M, Bang A, Duby J. Home-based management of neonatal sepsis: 23 years of sustained implementation and effectiveness in rural Gadchiroli, India, 1996-2019. BMJ Glob Health 2022; 7:bmjgh-2022-008469. [PMID: 36162868 PMCID: PMC9516090 DOI: 10.1136/bmjgh-2022-008469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Although hospitalisation remains the preferred management for neonatal sepsis, it is often not possible in resource-limited settings. The Home-Based Newborn Care (HBNC) study in Gadchiroli, India (1995–1998) was the first trial to demonstrate that neonatal sepsis can be managed in the community. HBNC continues to operate in Gadchiroli. In 2015, WHO recommended community-based management of neonatal sepsis when hospitalisation is not feasible but called for implementation research. We studied the implementation and effectiveness of home-based management of neonatal sepsis over 23 years in Gadchiroli. Methods In this cohort study (1996–2019), community health workers (CHWs) visited neonates at home in 39 villages in Gadchiroli, India. CHWs screened, diagnosed sepsis and offered home-based antibiotic treatment if hospitalisation was refused. We evaluated the implementation outcomes of coverage, diagnostic fidelity and adoption. We assessed the association between treatment type and odds of neonatal death using mixed effects logistic regression. Time trends were analysed using the Mann-Kendall test. Results CHWs screened 93.8% (17 700/18 874) of neonates (coverage) and correctly diagnosed 89% (1051/1177) of sepsis episodes (diagnostic fidelity). Home-based management was preferred by 88.4% (929/1051) of parents (adoption), with 5.6 percent of total neonates receiving antibioties at home. Compared with neonates treated at home, the adjusted odds of death was 5.27 (95% CI 1.91 to 14.58) times higher when parents refused all treatment, 2.17 (95% CI 1.07 to 4.41) times higher when CHWs missed the diagnosis and 5.45 (95% CI 2.74 to 10.87) times higher when parents accepted hospital referral. Implementation outcomes remained consistent over 23 years (coverage p=0.57; fidelity p=0.57; adoption p=0.26; mortality p=0.71). The rate of facility births increased (p<0.01) and the sepsis incidence decreased (p<0.05) over 23 years. Conclusion Implementation of home-based management of neonatal sepsis was sustainable and effective over 23 years. During this period, the need for home-based management in Gadchiroli is declining. Home-based management is advised where sepsis remains a major cause of neonatal mortality and hospital access is limited.
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Affiliation(s)
- Abhay Bang
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Sanjay Baitule
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Mahesh Deshmukh
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Anand Bang
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Jessica Duby
- McGill University Health Centre, Montreal, Québec, Canada
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Minuye Birhane B, Alebachew Bayih W, Chanie M, Awoke G, Simegn A, Asnakew S, Mamuye M, Yeshambel A, Muche T, Demis A, Munye T, Endalamaw A, Eshetie Y, Kefale D, Chanie ES, Mengesha Yalew Z, Mesfin Belay D. Home based postpartum care and determinants in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0272489. [PMID: 36007086 PMCID: PMC9409559 DOI: 10.1371/journal.pone.0272489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia. Methods A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care. Conclusion Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother’s knowledge about neonatal danger sign.
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Affiliation(s)
| | | | - Muluken Chanie
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Getaneh Awoke
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Amare Simegn
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis
- College of Health Sciences, Woldia University, Ethiopia
| | - Tigabu Munye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- School of Health Sciences, College Medicine and Health Sciences, Bahirdar University, Bahirdar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yeshambew Eshetie
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Zemen Mengesha Yalew
- Department Comprehensive Nursing, College of Health Sciences, Wollo University, Ethiopia
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Newton-Lewis TA, Bahety G. Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India. J Glob Health 2021; 11:04060. [PMID: 34737860 PMCID: PMC8542379 DOI: 10.7189/jogh.11.04060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Home visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child. Methods The study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level. Results The intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation. Conclusions Given the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.
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Affiliation(s)
| | - Girija Bahety
- Economics Department and The Fletcher School, Tufts University, USA
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