Cost-effectiveness and affordability of community mobilisation through women’s groups and quality improvement in health facilities (MaiKhanda trial) in Malawi

Colbourn, Tim; Pulkki-Brännström, Anni-Maria; Nambiar, Bejoy; Kim, Sung-Wook; Bondo, Austin; Banda, Lumbani; Makwenda, Charles; Batura, Neha; Haghparast‐Bidgoli, Hassan; Hunter, Rachael; Costello, Anthony; Baio, Gianluca; Skordis‐Worrall, Jolene

doi:10.1186/s12962-014-0028-2

Cited by 43 publications

(79 citation statements)

References 39 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PLA with women’s groups gave similar results in terms of reducing neo-natal mortality in other studies conducted in Nepal, Bangladesh and Malawi [7–11]. A pooled analysis of the randomised control trials conducted in four different country sites India, Bangladesh, Malawi and Nepal also showed significant reduction in maternal mortality through PLA intervention [12].…”

Section: Introductionsupporting

confidence: 54%

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Sinha

Haghparast‐Bidgoli²,

Tripathy

et al. 2017

Cost Eff Resour Alloc

Self Cite

View full text Add to dashboard Cite

BackgroundNeonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women’s groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention.MethodsCosts were estimated from the provider’s perspective and calculated separately for the women’s group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted.ResultsThe incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India’s Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective.ConclusionParticipatory learning and action with women’s groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.

show abstract

Section: Introductionsupporting

confidence: 54%

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Sinha

Haghparast‐Bidgoli²,

Tripathy

et al. 2017

Cost Eff Resour Alloc

Self Cite

View full text Add to dashboard Cite

show abstract

“…The relatively long death-to-interview time in MaiKhanda reflects the fact that a large number of VAs were not completed initially, but rather included as part of a verification exercise after the trial ended in May 2011. 30 Interview dates were not available for Makwanpur (Nepal). The average number of VA indicators per case was 12 for MaiKhanda, 13 for Makwanpur, 14 for Dhanusha, Ekjut and MaiMwana, 15 for SNEHA and 17 for PCP.…”

Section: Resultsmentioning

confidence: 99%

“…In MaiKhanda, Malawi, a simple algorithm was used to classify deaths as stillbirths or neonatal deaths from data pertaining to these reported signs of life. 30 …”

Section: Methodsmentioning

confidence: 99%

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India

Fottrell

Osrin

Alcock

et al. 2015

Arch Dis Child Fetal Neonatal Ed

Self Cite

View full text Add to dashboard Cite

ObjectiveUnderstanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data.DesignWe prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site.ResultsAnalysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting.ConclusionsPopulation-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care.

show abstract

“…However, one-third of all deaths are known to occur outside health facilities, either at the woman's home, the home of a traditional healer, or in transit to a facility, and these are presently not identified by the hospital-based notification system. 16 …”

Section: Methodsmentioning

confidence: 99%

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi

Bayley

Chapota²,

Kainja³

et al. 2015

BMJ Open

View full text Add to dashboard Cite

BackgroundIn Malawi, maternal mortality remains high. Existing maternal death reviews fail to adequately review most deaths, or capture those that occur outside the health system. We assessed the value of community involvement to improve capture and response to community maternal deaths.MethodsWe designed and piloted a community-linked maternal death review (CLMDR) process in Mchinji District, Malawi, which partnered community and health facility stakeholders to identify and review maternal deaths and generate actions to prevent future deaths. The CLMDR process involved five stages: community verbal autopsy, community and facility review meetings, a public meeting and bimonthly reviews involving both community and facility representatives.ResultsThe CLMDR process was found to be comparable to a previous research-driven surveillance system at identifying deaths in Mchinji District (population 456 500 in 2008). 52 maternal deaths were identified between July 2011 and June 2012, 27 (52%) of which would not have been identified without community involvement. Based on district estimates of population (500 000) and crude birth rate (35 births per 1000 population), the maternal mortality ratio was around 300 maternal deaths per 100 000 live births. Of the 41 cases that started the CLMDR process, 28 (68%) completed all five stages. We found the CLMDR process to increase the quantity of information available and to involve a wider range of stakeholders in maternal death review (MDR). The process resulted in high rates of completion of community-planned actions (82%), and district hospital (67%) and health centre (65%) actions to prevent maternal deaths.ConclusionsCLMDR is an important addition to the established forms of MDR. It shows potential as a maternal death surveillance system, and may be applicable to similar contexts with high maternal mortality.

show abstract

Cost-effectiveness and affordability of community mobilisation through women’s groups and quality improvement in health facilities (MaiKhanda trial) in Malawi

Cited by 43 publications

References 39 publications

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi

Contact Info

Product

Resources

About