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Mianda S, Todowede O, Schneider H. Service delivery interventions to improve maternal and newborn health in low- and middle-income countries: scoping review of quality improvement, implementation research and health system strengthening approaches. BMC Health Serv Res 2023; 23:1223. [PMID: 37940974 PMCID: PMC10634015 DOI: 10.1186/s12913-023-10202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION This review explores the characteristics of service delivery-related interventions to improve maternal and newborn health (MNH) in low-and middle-income countries (LMICs) over the last two decades, comparing three common framings of these interventions, namely, quality improvement (QI), implementation science/research (IS/IR), and health system strengthening (HSS). METHODS The review followed the staged scoping review methodology proposed by Levac et al. (2010). We developed and piloted a systematic search strategy, limited to English language peer-reviewed articles published on LMICs between 2000 and March 2022. Analysis was conducted in two-quantitative and qualitative-phases. In the quantitative phase, we counted the year of publication, country(-ies) of origin, and the presence of the terms 'quality improvement', 'health system strengthening' or 'implementation science'/ 'implementation research' in titles, abstracts and key words. From this analysis, a subset of papers referred to as 'archetypes' (terms appearing in two or more of titles, abstract and key words) was analysed qualitatively, to draw out key concepts/theories and underlying mechanisms of change associated with each approach. RESULTS The searches from different databases resulted in a total of 3,323 hits. After removal of duplicates and screening, a total of 231 relevant articles remained for data extraction. These were distributed across the globe; more than half (n = 134) were published since 2017. Fifty-five (55) articles representing archetypes of the approach (30 QI, 16 IS/IR, 9 HSS) were analysed qualitatively. As anticipated, we identified distinct patterns in each approach. QI archetypes tended towards defined process interventions (most typically, plan-do-study-act cycles); IS/IR archetypes reported a wide variety of interventions, but had in common evaluation methodologies and explanatory theories; and HSS archetypes adopted systemic perspectives. Despite their distinctiveness, there was also overlap and fluidity between approaches, with papers often referencing more than one approach. Recognising the complexity of improving MNH services, there was an increased orientation towards participatory, context-specific designs in all three approaches. CONCLUSIONS Programmes to improve MNH outcomes will benefit from a better appreciation of the distinctiveness and relatedness of different approaches to service delivery strengthening, how these have evolved and how they can be combined.
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Affiliation(s)
- Solange Mianda
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa.
| | - Olamide Todowede
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Helen Schneider
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa
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Maluka SO, Mpambije CJ, Kamuzora PC, Fitzgerald S. The effects of community-based interventions on the uptake of selected maternal and child health services: experiences of the IMCHA project in Iringa Tanzania, 2015-2020. BMC Pregnancy Childbirth 2023; 23:328. [PMID: 37158851 PMCID: PMC10165785 DOI: 10.1186/s12884-023-05638-x] [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: 06/18/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Maternal and child health (MCH) improvement has been prioritised in resource-constrained countries. This is due to the desire to meet the global sustainable development goals of achieving a maternal mortality rate of 70 per 100000 live births by 2030. The uptake of key maternal and child health services is crucial for reducing maternal and child health mortalities. Community-Based Interventions (CBIs) have been regarded as among the important strategies to improve maternal and child health service uptake. However, a paucity of studies examines the impacts of CBIs and related strategies on maternal and child health. This paper unveils the contribution of CBIs toward improving MCH in Tanzania. METHODS Convergent mixed method design was employed in this study. Questionnaires were used to examine the trajectory and trend of the selected MCH indicators using the baseline and end-line data for the implemented CBI interventions. Data was also collected through in-depth interviews and focus group discussions, mainly with implementers of the interventions from the community and the implementation research team. The collected quantitative data was analysed using IBM SPSS, while qualitative data was analysed thematically. RESULTS Antenatal care visits increased by 24% in Kilolo and 18% in Mufindi districts, and postnatal care increased by 14% in Kilolo and 31% in Mufindi districts. Male involvement increased by 5% in Kilolo and 13% in Mufindi districts. The uptake of modern family planning methods increased by 31% and 24% in Kilolo and Mufindi districts, respectively. Furthermore, the study demonstrated improved awareness and knowledge on matters pertaining to MCH services, attitude change amongst healthcare providers, and increased empowerment of women group members. CONCLUSION Community-Based Interventions through participatory women groups are vital for increasing the uptake of MCH services. However, the success of CBIs depends on the wide array of contextual settings, including the commitment of implementers of the interventions. Thus, CBIs should be strategically designed to enlist the support of the communities and implementers of the interventions.
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Affiliation(s)
- Stephen Oswald Maluka
- Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169, Dar Es Salaam, Tanzania
- Dar Es Salaam University College of Education (DUCE), P. O Box 2329, Dar Es Salaam, Tanzania
| | - Chakupewa Joseph Mpambije
- Department of Development Studies, History and Political Sciences, Mkwawa University College of Education (MUCE), P.O. Box 2513, Iringa, Tanzania.
| | - Peter Clever Kamuzora
- Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169, Dar Es Salaam, Tanzania
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Canuto K, Preston R, Rannard S, Felton-Busch C, Geia L, Yeomans L, Turner N, Thompson Q, Carlisle K, Evans R, Passey M, Larkins S, Redman-MacLaren M, Farmer J, Muscat M, Taylor J. How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature. BMJ Open 2022; 12:e055756. [PMID: 35190438 PMCID: PMC8862452 DOI: 10.1136/bmjopen-2021-055756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This systematic review was undertaken to assist the implementation of the WOmen's action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women's group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs? METHODS We systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. RESULTS Thirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear. DISCUSSION A framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH. PROSPERO REGISTRATION NUMBER CRD42019126533.
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Affiliation(s)
- Karla Canuto
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Naghir Tribe of the Kulkagul Clan, Torres Strait, Queensland, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Sam Rannard
- Library and Information Services, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
| | - Catrina Felton-Busch
- Murtupuni Centre Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
- Yangkaal and Gangaidda, Mount Isa, Queensland, Australia
| | - Lynore Geia
- College of Healthcare Sciences, James Cook University, Bebegu Yumba, Townsville, Queensland, Australia
- Bwgcolman, Palm Island, Queensland, Australia
| | - Lee Yeomans
- Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - Nalita Turner
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Anmatyerre/Jaru, Northern Territory, Northern Territory, Australia
| | - Quitaysha Thompson
- Gurindji Aboriginal Corporation, Kalkaringi, Northern Territory, Australia
- Gurindji woman, Kalkaringi, Northern Territory, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
| | - Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, Nguma-bada, Cairns, Queensland, Australia
| | - Jane Farmer
- Swinburne Social Innovation Research Institute, Centre for Social Impact, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melody Muscat
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
- Bijara, Charleville, Queensland, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Bebegu Yumba,Townsville, Queensland, Australia
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Saadati F, Nadrian H, Hosseini Golkar M, Taghdisi MH, Gilani N, Ghassab-Abdollahi N, Fathifar Z. Indices and indicators developed to evaluate the "strengthening community action" mechanism of the Ottawa Charter for Health Promotion: a scoping review. Am J Health Promot 2022; 36:881-893. [PMID: 35081768 DOI: 10.1177/08901171211069130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine 1) the indexes/indicators used for evaluating the "strengthening community action" mechanism of the Ottawa Charter for health promotion, and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review. DATA SOURCE In May 2020, the search was conducted across three databases; Medline (via Pub Med), Embase, and Scopus. INCLUSION AND EXCLUSION CRITERIA All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the "strengthening community actions" were included. The review articles were excluded. DATA EXTRACTION The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data. Data Synthesis To summarize and report the data, a descriptive numerical analysis, and a narrative descriptive synthesizing approach were used. Results In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n=3), community capacity (n=1), community participation (n=7), social capital (n=6), social network (n=3), social support (n=1), and others (n=5). CONCLUSIONS Having a collection of "strengthening community action" indices/indicators in hand, health policy-makers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.
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Affiliation(s)
- Fateme Saadati
- Dept. of Health Education and Promotion48432Tabriz University of Medical Sciences
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.48432Tabriz University of Medical Sciences
| | - Mostafa Hosseini Golkar
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health48463Kerman University of Medical Sciences
| | | | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health,48432Tabriz University of Medical Sciences
| | | | - Zahra Fathifar
- School of Management and Medical Information48432Tabriz University of Medical Sciences
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Joseph C, Maluka SO. The influence of community factors in the implementation of community-based interventions to improve antenatal care: a qualitative study based on the IMCHA programme in Tanzania. Reprod Health 2021; 18:188. [PMID: 34551794 PMCID: PMC8456547 DOI: 10.1186/s12978-021-01225-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services. METHODS A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation. RESULTS Key factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders' engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions. CONCLUSION This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members' reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.
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Affiliation(s)
- Chakupewa Joseph
- Department of Development Studies, History and Political Science, Mkwawa University College of Education (MUCE), P.O. Box 2513, Iringa, Tanzania.
| | - Stephen O Maluka
- Institute of Development Studies, University of Dar es Salaam, P.O. Box 35169, Dar es Salaam, Tanzania
- Dar es Salaam University College of Education (DUCE), Dar es Salaam, Tanzania
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Baumgartner JN, Ali M, Gallis JA, Lillie M, Owusu R, Abubakr-Bibilazu S, Adam H, Aborigo R, McEwan E, Zhou Y, Kim ET, Mackness J, Williams JKA, Hembling J. Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial. Glob Ment Health (Camb) 2021; 8:e18. [PMID: 34104458 PMCID: PMC8157813 DOI: 10.1017/gmh.2021.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/09/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Caregiver mental health is linked to early childhood development, yet more robust evidence of community-based interventions to prevent maternal depression and optimize socio-emotional development of young children is needed. Objectives of this cluster-randomized controlled trial (cRCT), based in Northern Ghana, are to assess the impact of the lay counselor-delivered, group-based Integrated Mothers and Babies Course and Early Childhood Development (iMBC/ECD) program on (1) the mental health of mothers of children under age 2; and (2) the socio-emotional development of their children. METHODS This cRCT randomized 32 women's groups - 16 received iMBC/ECD content (intervention) and 16 received general health education content (control). Surveys were administered at baseline, immediate post-intervention, and 8-month post-intervention. The primary outcome was maternal depression [Patient Health Questionnaire (PHQ-9)], and the secondary outcome was child's socio-emotional development [Ages and Stages Questionnaire: Social Emotional (ASQ:SE-2)]. Qualitative interviews with 33 stakeholders were also conducted. RESULTS In total, 374 participants were enrolled at baseline while pregnant with the index child, 19% endorsing moderate/severe depression. Of these, 266 (71.1%) completed the 8-month post-intervention survey (~19 months post-baseline). There were no significant effects of iMBC/ECD on PHQ-9 and ASQ:SE-2 scores. However, results favored the intervention arm in most cases. iMBC participants were highly satisfied with the program but qualitative feedback from stakeholders indicated some implementation challenges. CONCLUSIONS This real-world evaluation had null findings; however, post-intervention depression levels were very low in both arms (3%). Future research should examine the potential impact of women's groups on postpartum mental health more broadly with varying content.
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Affiliation(s)
- Joy Noel Baumgartner
- University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC27516, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mohammed Ali
- Catholic Relief Services Country Office, Tamale, Ghana
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Biostatistics and Bioinformatics, Durham, NC, USA
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Raymond Owusu
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | - Haliq Adam
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | - Elena McEwan
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
| | - Yunji Zhou
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Biostatistics and Bioinformatics, Durham, NC, USA
| | | | | | | | - John Hembling
- Catholic Relief Services Head Quarters, Baltimore, MD, USA
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