Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
The MANIFEST study in eastern Uganda employed a participatory multisectoral
approach to reduce barriers to access to maternal and newborn care services.
Objectives: This study analyses the effect of the intervention on the utilization of maternal
and newborn services and care practices.
Methods: The quasi-experimental pre- and post-comparison design had two main components:
community mobilization and empowerment, and health provider capacity building.
The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care,
and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected
from women of reproductive age. The data was analysed using difference in differences (DiD)
analysis and logistic regression.
Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and
facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention
area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results
also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in
delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were
attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17–
1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village
health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care.
Conclusions: The multisectoral approach had positive effects on early ANC attendance,
facility deliveries and newborn care practices. Community resources such as VHTs and savings
are crucial to maternal and newborn outcomes and should be supported. VHT-led health
education should incorporate practical measures that enable families to save and access
transport services to enhance adequate preparation for birth.
Description
Keywords
Maternal, Newborn, Participatory action research, Community health workers, Implementation science
Citation
Elizabeth Ekirapa-Kiracho, Rornald Muhumuza Kananura, Moses Tetui, Gertrude Namazzi, Aloysius Mutebi, Asha George, Ligia Paina, Peter Waiswa, Ahmed Bumba, Godfrey Mulekwa, Dinah Nakiganda-Busiku, Moses Lyagoba, Harriet Naiga, Mary Putan, Agatha Kulwenza, Judith Ajeani, Ayub Kakaire-Kirunda, Fred Makumbi, Lynn Atuyambe, Olico Okui & Suzanne Namusoke Kiwanuka (2017) Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasiexperimental study in three rural Ugandan districts, Global Health Action, 10:sup4, 1363506, DOI: 10.1080/16549716.2017.1363506