Abstract
Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.
Highlights
Introduction conditions of the Creative CommonsGlobal evidence has demonstrated that short birth intervals are associated with adverse maternal and infant health outcomes
Reach analysis was conducted to assess whether the intervention was equitable; the analysis compared the wealth distribution of the population using the study facilities to the wealth quintile distribution of the regions as shown in the 2015–2016 Demographic and Health Survey (DHS) [6]
In Kagera, the distribution was generally similar to the recent DHS; while Q1 + Q2 combined was similar, the proportion in Q3 was smaller and Q4 larger compared to the DHS
Summary
Global evidence has demonstrated that short birth intervals are associated with adverse maternal and infant health outcomes.
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