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

Elizabeth Ekirapa-Kiracho ,Lynn Atuyambe ,Ligia Paina ,Harriet Naiga ,Olico Okui ,Dinah Nakiganda-Busiku ,Rornald Muhumuza Kananura ,Ahmed Bumba ,Fred Makumbi ,Aloysius Mutebi ,Moses Lyagoba ,Asha George ,Peter Waiswa ,Agatha Kulwenza ,Moses Tetui ,Ayub Kakaire-Kirunda ,Gertrude Namazzi ,Judith Ajeani ,Godfrey Mulekwa ,Mary Putan ,Suzanne N Kiwanuka

doi:10.1080/16549716.2017.1363506

Abstract

ABSTRACTBackground: 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.

Highlights

The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services
Effect of the intervention on maternal and newborn health facility utilization The difference in differences (DiD) results revealed an 8% difference in early antenatal care (ANC) attendance (p < 0.01) with an increase of 8% in the intervention area and no change in the comparison area (29%) (p < 0.01)
These results have shown that a participatory multisectoral approach can lead to improvements in maternal and newborn service uptake and practices along the continuum of care during pregnancy, childbirth and the postnatal period

Summary

Introduction

The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Every year more than 303,000 women die because of pregnancy- and childbirth-related complications [1]. Of these deaths, 99% occur in developing countries and 66% in sub-Saharan Africa [1]. In Uganda, about 438 women die out of 100,000 live births each year because of pregnancy-related complications [2]. Most of these deaths could be averted using safe delivery care services [3]. About 40 million women worldwide give birth at home, putting their lives and the lives of their newborns at risk [4]. In Uganda, about 43% of women give birth at home [2]

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