scholarly journals Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045014
Author(s):  
Samantha Sabo ◽  
Patrick Wightman ◽  
Kelly McCue ◽  
Matthew Butler ◽  
Vern Pilling ◽  
...  
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
American Indian ◽  
Birth Outcomes ◽  
Maternal And Child Health ◽  
Home Visiting ◽  
Birth Certificate ◽  
Quasi Experimental ◽  
Programme Participation ◽  
And Child Health

ObjectiveTo test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB).DesignQuasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006–2016.SettingArizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans.Participants7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences.InterventionA statewide CHW MCH home visiting programme.Primary and secondary outcome measuresLBW, VLBW, ELBW and PTB.ResultsUsing Health Start Programme’s administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI −4.07 to –0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI −5.82 to –0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI −0.69 to –0.01) and ELBW (62%; ATT: 0.31; 95% CI (−0.52 to –0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI −4.71 to –0.91). Other results were not statistically significant.ConclusionA state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.

Intention to Engage in Maternal and Child Health Home Visiting

2020 ◽  
Vol 35 (4) ◽  
pp. 197-212
Author(s):  
Mallory Wolfe Turner ◽  
Ana Cabello-De la Garza ◽  
Ashley Kazouh ◽  
Adam J. Zolotor ◽  
J. Bart Klika ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Home Visiting ◽  
And Child Health ◽  
Health Home

scholarly journals Increasing the Knowledge and Confidence of Mothers in Caring for Low Birth Weight Babies Through Education from the Maternal and Child Health Handbook

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Sugiarti Sugiarti ◽  
Yeni Rustina ◽  
Defi Efendi
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
Low Birth Weight ◽  
Maternal And Child Health ◽  
Mobile Application ◽  
Instructional Medium ◽  
Audiovisual Media ◽  
Based Instruction ◽  
The Impact ◽  
And Child Health

<p>Having a Low Birth Weight (LBW) is one of the risk factors that may lead to stunting in children under five years old. An education program based on the Maternal and Child Health handbook (MCH) for the first 1000 days of a child’s life is one way to prevent the impact of stunting by improving the mothers’ knowledge and self-confidence to look after LBWB. The study is designed along the line of pre-post quasi-experimental research with a control group, involving 69 samples of mothers with LBWB that match the predetermined criteria. Twenty three of these mothers whose babies were cared for in the perinatology ward were provided with instructions from the MCH handbook, another group of 23 mothers received the same instructions with additional audiovisual media from a mobile application, and the remaining 23 mothers only received verbal instructions in the ward. The data were analyzed using the Paired t-test/Wilcoxon and Kruskall-Wallis tests. The analysis revealed that the MCH handbook based instruction provided a significant boost on the score of mother’s knowledge and confidence, before and after they have received the instructions, both in the group that received the MCH handbook based instruction (p&lt;0.001) and the group that received their instructions from a mobile application (p&lt;0.001). Additional instructions using audiovisual media from a mobile application also provided a significant boost to the knowledge score, and therefore the post-education score of the mothers in this group was higher than in the other two groups (p&lt;0.001). Mother’s knowledge of the provision of care for LBWB can therefore be optimized through education, discussion, and the use of technology as an instructional medium to complement the use of the MCH handbook.</p>

scholarly journals Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Karl W. le Roux ◽  
Ellen Almirol ◽  
Panteha Hayati Rezvan ◽  
Ingrid M. le Roux ◽  
Nokwanele Mbewu ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Maternal And Child Health ◽  
Home Visiting ◽  
Health Workers ◽  
Group Comparison ◽  
Comparison Study ◽  
Child Health Outcomes ◽  
The Impact ◽  
And Child Health

Abstract Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3–0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

scholarly journals Educational Strategy for Motherhood and Fatherhood: an Experience of Implementation in Soraca, Colombia

2021 ◽  
Author(s):  
Gina Paola Arocha Zuluaga ◽  
Paula Andrea Castro Prieto ◽  
Nancy Haydeé Millán Echeverría ◽  
Ana María Cárdenas ◽  
Zulma Yanira Fonseca Centeno ◽  
...  
Keyword(s):  
Child Health ◽  
Educational Intervention ◽  
Maternal And Child Health ◽  
Intervention Group ◽  
Well Being ◽  
Support Network ◽  
Control Group ◽  
Mother And Child ◽  
Quasi Experimental ◽  
And Child Health

Abstract Background Preconception education is one of the challenges in maternal and child health in Latin America, in countries such as Colombia. That is why the objective of the following research was to develop a pilot educational intervention aimed at pregnant and breastfeeding women, and their support network, to strengthen practices, skills and knowledge, for informed decision-making and the strengthening of self-care behaviors of women and childcare, beyond childbirth preparation in the municipality of Soraca, located in Boyacá, Colombia in 2017. Methods Quasi-experimental study with an intervention group (municipality of Soraca) and a control group (municipalities of Oicata and Sotaquira) which linked a process and impact evaluation to assess prioritized indicators in terms of maternal and child health and nutrition, before, during and after an educational intervention. Results The main results found that women considered the methodologies used in the educational sessions to be appropriate and relevant and recognized the importance of the call and home visit postpartum nurse. The strategy increased the involvement of the support network in training processes. In turn, the proportion of children who were breastfed was higher in the intervention group than in the control group (88% vs. 60% p = 0.037). The proportion of children who received a bottle was higher in the control group compared to the intervention group (57.1% vs. 16% p = 0.006). Conclusion Strategies such as the one developed in Soraca allow for improved health outcomes for the mother and child and their support network. The strategy 123 in Soraca was a clear example of how a prenatal educational intervention generates positive outcomes for mothers, infants, and their support networks in the areas of food and nutrition, emotional well-being, and physical health.

scholarly journals Birhan Maternal and Child Health cohort: a study protocol

2021 ◽  
Author(s):  
Grace J. Chan ◽  
Bezawit Mesfin Hunegnaw ◽  
Kimiko Van Wickle ◽  
Yahya Mohammed ◽  
Mesfin Hunegnaw ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Child Health ◽  
Birth Outcomes ◽  
Maternal And Child Health ◽  
Morbidity And Mortality ◽  
List Type ◽  
Child Morbidity ◽  
Laboratory Test Results ◽  
And Child Health ◽  
Pregnancy And Birth

ABSTRACTIntroductionReliable estimates on maternal and child morbidity and mortality are essential for health programs and policies. Data are needed in populations which have the highest burden of disease but also have the least evidence and research, to design and evaluate health interventions to prevent illnesses and deaths that occur worldwide each year.Methods and analysisThe Birhan Maternal and Child Health (MCH) cohort is an open prospective pregnancy and birth cohort nested within the Birhan health and demographic surveillance system (HDSS). An estimated 2500 pregnant women are enrolled each year and followed through pregnancy, birth, and the postpartum period. Newborns are followed through two years of life to assess growth and development. Baseline medical data, signs and symptoms, laboratory test results, anthropometrics, and pregnancy and birth outcomes (stillbirth, preterm birth, low birthweight) are collected from both home and health facility visits. We will calculate the period prevalence and incidence of primary morbidity and mortality outcomes.Ethics and DisseminationThe cohort has received ethical approval. Findings will be disseminated at scientific conferences, peer-reviewed journals, and to relevant stakeholders including the ministry of health.Strengths and limitations of this studyThis cohort collects longitudinal data at multiple time points from pregnancy through birth and childhood in a setting where there are limited data.Data from this study provide estimates for birth outcomes such as stillbirths, preterm birth, and low birth weight.Results will inform risk profiles for maternal, neonatal, and child morbidity and mortality.Similar to all observational studies, there are potential confounders that are unmeasurable.Evidence from this study will support policies and programs to improve maternal and child health.

scholarly journals Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Janak Kumar Thapa ◽  
Doris Stöckl ◽  
Raj Kumar Sangroula ◽  
Dip Narayan Thakur ◽  
Suresh Mehata ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Maternal And Child Health ◽  
Regression Coefficient ◽  
Control Area ◽  
Child Health Outcomes ◽  
Intervention Area ◽  
Quasi Experimental ◽  
The Impact ◽  
And Child Health

Abstract Background Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal. Methods The study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05. Results The results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group. Conclusion The IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.

scholarly journals Evaluation protocol to assess maternal and child health outcomes using administrative data: a community health worker home visiting programme

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031780 ◽  
Author(s):  
Samantha Sabo ◽  
Matthew Butler ◽  
Kelly McCue ◽  
Patrick Wightman ◽  
Vern Pilling ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Community Health ◽  
Administrative Data ◽  
Maternal And Child Health ◽  
Home Visiting ◽  
Health Workers ◽  
Control Group ◽  
And Child Health ◽  
Start Program

IntroductionEmerging evidence suggests community health workers (CHWs) delivering preventive maternal and child health (MCH) interventions through home visiting improve several important health outcomes, including initiation of prenatal care, healthy birth weight and uptake of childhood immunisations.Methods and analysisThe Arizona Health Start Program is a behavioral-based home visiting intervention, which uses CHWs to improve MCH outcomes through health education, referral support, and advocacy services for at-risk pregnant and postpartum women with children up to 2 years of age. We aim to test our central hypothesis that mothers and children exposed to this intervention will experience positive health outcomes in the areas of (1) newborn health; (2) maternal health and healthcare utilisation; and (3) child health and development. This paper outlines our protocol to retrospectively evaluate Health Start Program administrative data from 2006 to 2015, equaling 15 576 enrollees. We will use propensity score matching to generate a statistically similar control group. Our analytic sample size is sufficient to detect meaningful programme effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunisation and hospitalisation rates.Ethics and disseminationThis work is supported through an inter-agency contract from the Arizona Department of Health Services and is approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802, approved 25 January 2017). Evaluation of the three proposed outcome areas will be completed by June 2020.

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