Impact of alternative community engagement strategies on MCH behaviors and outcomes in Northern Nigeria
Maternal and child mortality remain very high in the three northern Nigerian states of Katsina, Jigawa, and Yobe. Our partnership launched a comprehensive program to enhance availability and quality of MNCH services. This study assesses differences in the 2009-2013 MNCH outcomes according to level of exposure to community engagement (CE) activities.
MNCH behaviors and outcomes were assessed using population-based surveys in 2009 and 2013. Data were merged and restricted to women aged 15-49 with a birth in the past year (n=2489). They were categorized into intervention groups ( no-CE or control, low intensity CE, high intensity CE). Bi-variate and multi-variate analyses were used to assess the differential impact of the alternative CE models.
Under-five mortality declined from 160.0 to 102.2, infant mortality from 90.0 to 63.0, and maternal mortality ratio from 1,270 to 1,190, with all mortality declines and key MCH behaviors greater in the communities with high intensity CE. By 2013, ANC frequentation and skilled birth attendance were significantly greater in the high intensity CE communities, and women in the high intensity-CE communities were more likely to know the danger signs of pregnancy, delivery, and newborn distress, and to have prepared for their deliveries. Regression analysis (R-squared=0.23) identifies the following significant predictors of ANC visits: literate, well-maintained home, has cell-phone, has someone to rely on for help with children, speaks up at ceremonies, knows danger signs, recent clinic visit, satisfied with improvements in the clinic, and higher frequency of participation in CE activities. Somewhat parallel results were found for the predictors of skilled birth attendance, but lower overall explanatory power.
Conclusions: High intensity CE models increase the impact of other comprehensive health system improvements. These results suggest that the interventions are reaching the less vulnerable women. Additional interventions may be needed to reach the most vulnerable.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Identify alternative features of community engagement models which contribute to uptake of comprehensive MCH services and improved outcomes among low-income, vulnerable women in Northern Nigeria
Keyword(s): International MCH, Community Health Workers and Promoters
Qualified on the content I am responsible for because: I have planned and led in the design and implementation of the PRRINN baseline and end line surveys, have had lead responsibility for ensuring that they capture program delivery differences, and have led the analysis of both surveys. In addition, I have worked with the program teams in designing and evaluating alternative CHW models.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.