Effect of WASH/MNCH Integrated interventions on skilled birth attendance and incidence of neonatal Sepsis in Amuru District, Uganda; A quasi-experimental study

Abstract

Background Evidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance and neonatal sepsis remains unclear. We assessed the effect of WASH/MNCH integrated interventions on skilled birth attendance and incidence of neonatal Sepsis in a resource-constrained setting in Uganda. Methods A quasi-experimental study design was conducted in Amuru district. The package of interventions implemented included; training of health workers, facilitation of integrated outreach services, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and skilled birth attendance, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on the incidence of sepsis, ANC and skilled birth attendance, and WASH status was also obtained from 6 healthcare facilities. A total of 12 key informant interviews and 12 Focus group discussions were also conducted. Data were imported into STATA 15 for analysis. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative was analyzed using thematic content analysis. Results There was a significant increase in the number of women delivering at the health facilities that were supported by the project from 41.4% at baseline to 63.0% at endline (p= <0.0001). There was a reduction in the incidence of neonatal sepsis from 0.6% to 0.2% (p = 0.0687), although the difference was not significant. There was an increase in the percentage of households with sanitation facilities and improved hygiene practices. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% at baseline to 0.6% at endline, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline. Conclusion This study revealed that integrated WASH/MNCH interventions can significantly increase ANC and skilled birth attendance, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC in the maternity wards and the capacity of healthcare workers to deliver clean and safe MNCH services can also be realized. We recommend the integration of WASH/MNCH interventions for projects aimed at improving skilled birth attendance and WASH practices and reduction of childhood infections.