Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study

Abstract

Background: Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. Objectives: This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda. Methods: The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre–post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs. Results: The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7–39% vs. 7–36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7–69% vs. 10–64%, 0–11% vs. 0–5%, and 9–14% vs. 9–13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs’ knowledge, respectively. Village health teams’ home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs’ knowledge. Conclusions: The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.

Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

“…Another study in northern Nigeria reported significantly greater improvements in the intervention communities that received additional demand-side interventions, as about 22% of the women knew at least 4 maternal danger signs compared with 10% at baseline [39]. This finding also corroborates a participatory multi-sectoral intervention study in Uganda which reported that the intervention significantly increased the knowledge of at least three obstetric danger signs [40]. Other studies have shown that community-based intervention on BP/CR were effective in raising women's knowledge of danger signs [9,41,42].…”

Unlocking community capabilities for addressing social norms/practices: Behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

“…Another study in northern Nigeria reported significantly greater improvements in the intervention communities that received additional demand-side interventions, as about 22% of the women knew at least 4 maternal danger signs compared with 10% at baseline (39). This finding also corroborates a participatory multi-sectoral intervention study in Uganda which reported that the intervention significantly increased the knowledge of at least three obstetric danger signs (40). Other studies have shown that community-based intervention on BP/CR were effective in raising women's knowledge of danger signs (9,41,42).…”

Maternal and neonatal implementation for equitable systems. A study design paper

“…In this supplement, we share a special issue of 10 different papers of which this paper is part. The rest of the nine papers share specific results [25–32]. In addition to this design paper, there is one more methodological paper that describes the PAR approach in more detail [33].…”

“…In addition to this design paper, there is one more methodological paper that describes the PAR approach in more detail [33]. Two of the papers [25,26] summarize the results of the intervention on some of the key outcomes of the study (knowledge about maternal and newborn danger signs, birth preparedness and utilization of maternal and newborn health services and newborn care practices). Two other papers describe the characteristics of saving groups and the saving practices of the community for maternal and newborn health, highlighting opportunities for promoting saving for maternal and newborn health [27,28].…”