Evaluation of a comprehensive maternal newborn health intervention in rural Tanzania: single-arm pre-post coverage survey results.
Africa
Pregnancy
delivery
infant health
maternal health
obstetric
Journal
Global health action
ISSN: 1654-9880
Titre abrégé: Glob Health Action
Pays: United States
ID NLM: 101496665
Informations de publication
Date de publication:
31 12 2022
31 12 2022
Historique:
entrez:
12
11
2022
pubmed:
13
11
2022
medline:
16
11
2022
Statut:
ppublish
Résumé
In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions addressing demand and service-side care-seeking barriers are needed. Assess coverage survey indicators before and after a comprehensive maternal newborn health (MNH) intervention in Misungwi District, Tanzania. A prospective, single-arm, pre- (2016) and post-(2019) coverage survey (ClinicalTrials.gov #NCT02506413) was used to assess key maternal and newborn health (MNH) outcomes. The Mama na Mtoto intervention included district activities (planning, leadership training, supportive supervision), health facility activities (training, equipment, infrastructure upgrades), and plus community health worker mobilization. Implementation change strategies, a process model, and a motivational framework incorporated best practices from a similar Ugandan intervention. Cluster sampling randomized hamlets then used 'wedge sampling' protocol as an alternative to full household enumeration. Key outcomes included: four or more ANC visits (ANC4+); skilled birth attendant (SBA); PNC for mother within 48 hours (PNC-woman); health facility delivery (HFD); and PNC for newborn within 48 hours (PNC-baby). Trained interviewers administered the 'Real Accountability: Data Analysis for Results Coverage Survey to women 15-49 years old. Descriptive statistics incorporated design effect; the Lives Saved Tool estimated deaths averted based on ANC4+/HFD. Between baseline (n = 2,431) and endline (n = 2,070), surveys revealed significant absolute percentage increases for ANC4+ (+11.6, 95% CI [5.4, 17.7], p < 0.001), SBA (+16.6, 95% CI [11.1, 22.0], p < 0.001), PNC-woman (+9.2, 95% CI [3.2, 15.2], p = 0.002), and HFD (+17.2%, 95% CI [11.3, 23.1], p < 0.001). A PNC-baby increase (+6.1%, 95% CI [-0.5, 12.8], p = 0.07) was not statistically significant. An estimated 121 neonatal and 20 maternal lives were saved between 2016 and 2019. Full-district scale-up of a comprehensive MNH package embedded government health system was successfully implemented over a short time and associated with significant maternal care-seeking improvements and potential for lives saved.
Sections du résumé
BACKGROUND
In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions addressing demand and service-side care-seeking barriers are needed.
OBJECTIVE
Assess coverage survey indicators before and after a comprehensive maternal newborn health (MNH) intervention in Misungwi District, Tanzania.
METHODS
A prospective, single-arm, pre- (2016) and post-(2019) coverage survey (ClinicalTrials.gov #NCT02506413) was used to assess key maternal and newborn health (MNH) outcomes. The Mama na Mtoto intervention included district activities (planning, leadership training, supportive supervision), health facility activities (training, equipment, infrastructure upgrades), and plus community health worker mobilization. Implementation change strategies, a process model, and a motivational framework incorporated best practices from a similar Ugandan intervention. Cluster sampling randomized hamlets then used 'wedge sampling' protocol as an alternative to full household enumeration. Key outcomes included: four or more ANC visits (ANC4+); skilled birth attendant (SBA); PNC for mother within 48 hours (PNC-woman); health facility delivery (HFD); and PNC for newborn within 48 hours (PNC-baby). Trained interviewers administered the 'Real Accountability: Data Analysis for Results Coverage Survey to women 15-49 years old. Descriptive statistics incorporated design effect; the Lives Saved Tool estimated deaths averted based on ANC4+/HFD.
RESULTS
Between baseline (n = 2,431) and endline (n = 2,070), surveys revealed significant absolute percentage increases for ANC4+ (+11.6, 95% CI [5.4, 17.7], p < 0.001), SBA (+16.6, 95% CI [11.1, 22.0], p < 0.001), PNC-woman (+9.2, 95% CI [3.2, 15.2], p = 0.002), and HFD (+17.2%, 95% CI [11.3, 23.1], p < 0.001). A PNC-baby increase (+6.1%, 95% CI [-0.5, 12.8], p = 0.07) was not statistically significant. An estimated 121 neonatal and 20 maternal lives were saved between 2016 and 2019.
CONCLUSIONS
Full-district scale-up of a comprehensive MNH package embedded government health system was successfully implemented over a short time and associated with significant maternal care-seeking improvements and potential for lives saved.
Identifiants
pubmed: 36369729
doi: 10.1080/16549716.2022.2137281
pmc: PMC9665093
doi:
Banques de données
ClinicalTrials.gov
['NCT02506413']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2137281Références
Health Policy Plan. 2018 Jan 1;33(1):e26-e33
pubmed: 29304252
Glob Health Action. 2015 Oct 22;8:28567
pubmed: 26498576
Lancet. 2006 Sep 30;368(9542):1189-200
pubmed: 17011946
BMC Pregnancy Childbirth. 2019 Aug 13;19(1):293
pubmed: 31409278
Implement Sci. 2016 Mar 23;11:43
pubmed: 27005280
Glob Health Action. 2022 Jun 30;15(sup1):2006423
pubmed: 36098952
BMJ Open. 2019 Feb 19;9(2):e020608
pubmed: 30782861
Glob Health Action. 2022 Jun 30;15(sup1):2006419
pubmed: 36098955
Lancet. 2014 Aug 2;384(9941):438-54
pubmed: 24853600
BMC Public Health. 2013 Sep 13;13:847
pubmed: 24034792
Lancet Glob Health. 2015 Jul;3(7):e387-95
pubmed: 26004775
Glob Health Sci Pract. 2019 Mar 29;7(1):20-40
pubmed: 30926736
Glob Health Action. 2017 Aug;10(sup4):1363506
pubmed: 28871853
Int J Equity Health. 2014 Jun 16;13:48
pubmed: 24934657
PLoS One. 2021 Jun 30;16(6):e0250646
pubmed: 34191800
Glob Health Sci Pract. 2019 Mar 13;7(Suppl 1):S27-S47
pubmed: 30867208
J Glob Health. 2017 Jun;7(1):010902
pubmed: 28685040
Int Health. 2010 Sep;2(3):228
pubmed: 24037704
Matern Child Health J. 2016 Aug;20(8):1726-34
pubmed: 27194528
Med Care. 2012 Mar;50(3):217-26
pubmed: 22310560
PLoS One. 2019 Sep 13;14(9):e0222566
pubmed: 31518365
Health Policy Plan. 2004 Mar;19(2):69-79
pubmed: 14982885
BMC Pregnancy Childbirth. 2016 Aug 19;16:236
pubmed: 27543002
BMC Pregnancy Childbirth. 2014 Aug 12;14:268
pubmed: 25112432
BMC Pregnancy Childbirth. 2021 Jan 28;21(1):93
pubmed: 33509124
Am J Public Health. 1999 Sep;89(9):1322-7
pubmed: 10474547
J Glob Health. 2017 Jun;7(1):010903
pubmed: 28685041
Reprod Health. 2018 Jan 27;15(1):14
pubmed: 29374486
BMC Pregnancy Childbirth. 2021 Jun 28;21(1):452
pubmed: 34182949
BMC Health Serv Res. 2017 Dec 21;17(Suppl 3):829
pubmed: 29297352
BMC Health Serv Res. 2018 Dec 5;18(1):944
pubmed: 30518357
BMC Public Health. 2013;13 Suppl 3:S1
pubmed: 24564438