Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India

Mehta, Kala M.; Irani, Laili; Chaudhuri, Indrajit; Mahapatra, Tanmay; Schooley, Janine; Srikantiah, Sridhar; Abdalla, Safa; Ward, Victoria; Carmichael, Suzan L.; Bentley, Jason; Creanga, Andreea A.; Wilhelm, Jess; Tarigopula, Usha Kiran; Bhattacharya, Debarshi; Atmavilas, Yamini; Nanda, Priya; Weng, Yingjie; Pepper, Kevin T; Darmstadt, Gary L.

doi:10.7189/jogh.10.0201007

Cited by 11 publications

(19 citation statements)

References 24 publications

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“…This work is the latest in a series of analyses aimed to describe and explain the Ananya programme's impacts in Bihar [10][11][12][13][14][15][16][17][18][19][20][36][37][38][39]. Our intention was not to re-examine the already well-established links between health and social determinants, but to examine how these links are influencing the outcome of the programme scaleup over time and in different areas, and the need for approaches to be more conscious of the existing ecosystem in which health programmes are embedded.…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, it piloted a range of interventions through several initiatives by multiple partners to identify and support governmental scale-up of the most effective reproductive, maternal, newborn, and child health and nutrition (RMNCHN) interventions. The initiatives included interventions to increase the knowledge of frontline workers (FLW) and their interactions with beneficiaries, quality improvement (QI) efforts in public health facilities, the use of media campaigns and m-health tools to increase the adoption of priority health behaviours and to improve FLWs' communications with beneficiaries, and the integration of health modules into traditional self-help groups (SHGs) [14][15][16][17][18]. The first phase of the programme relied on intensive support for governmental implementation of initiatives in eight "focus" districts [11].…”

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confidence: 99%

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Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

et al. 2022

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Background There is a scarcity of research that comprehensively examines programme impact from a context-specific perspective. We aimed to determine the conditions under which the Bihar Technical Support Programme led to more favourable outcomes for maternal and child health in Bihar. Methods We obtained block-level data on maternal and child health indicators during the state-wide scale-up of the pilot Ananya programme and data on health facility readiness, along with geographical and sociodemographic variables. We examined the associations of these factors with increases in the levels of indicators using multilevel logistic regression, and the associations with rates of change in the indicators using Bayesian Hierarchical modelling. Results Frontline worker (FLW) visits between 2014-2017 were more likely to increase in blocks with better night lighting (odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.01-1.51). Birth preparedness increased in blocks with increasing FLW visits (OR = 3.43, 95% CI = 1.15-10.21), while dry cord care practice increased in blocks where satisfaction with FLW visits was increasing (OR = 1.52, 95% CI = 1.10-2.11). Age-appropriate frequency of complementary feeding increased in blocks with higher development index (OR = 1.55, 95% CI = 1.16-2.06) and a higher percentage of scheduled caste or tribe (OR = 3.21, 95% CI = 1.13-9.09). An increase in most outcomes was more likely in areas with lower baseline levels. Conclusions Contextual factors (eg, night lighting and development) not targeted by the programme and FLW visits were associated with favourable programme outcomes. Intervention design, including intervention selection for a particular geography, should be modified to fit the local context in the short term. Expanding collaborations beyond the health sector to influence modifiable contextual factors in the long term can result in a higher magnitude and more sustainable impact. Registration ClinicalTrials.gov: NCT02726230.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

et al. 2022

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“…Most studies focused on the early stages of assessment and preparation to identify adaptation needs and propose solutions. We found fewer examples where proposed adaptations had been actually implanted and refined in pilot projects (44,46,56,66,67), and fewer still that had been evaluated in larger-scale trials and integrated into programming at-scale (49,63).…”

Section: Updates and Refinements To Prior Adaptation Modelsmentioning

confidence: 99%

Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools

Anderson¹,

Birken²,

Bartram³

et al. 2022

Front.Health Serv.

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BackgroundSafe water, sanitation, and hygiene (WaSH) is important for health, livelihoods, and economic development, but WaSH programs have often underdelivered on expected health benefits. Underperformance has been attributed partly to poor ability to retain effectiveness following adaptation to facilitate WaSH programs' implementation in diverse contexts. Adaptation of WaSH interventions is common but often not done systematically, leading to poor outcomes. Models and frameworks from the adaptation literature have potential to improve WaSH adaptation to facilitate implementation and retain effectiveness. However, these models and frameworks were designed in a healthcare context, and WaSH interventions are typically implemented outside traditional health system channels. The purpose of our work was to develop an adaptation model tailored specifically to the context of WaSH interventions.MethodsWe conducted a scoping review to identify key adaptation steps and identify tools to support systematic adaptation. To identify relevant literature, we conducted a citation search based on three recently published reviews on adaptation. We also conducted a systematic database search for examples of WaSH adaptation. We developed a preliminary model based on steps commonly identified across models in adaptation literature, and then tailored the model to the WaSH context using studies yielded by our systematic search. We compiled a list of tools to support systematic data collection and decision-making throughout adaptation from all included studies.Results and ConclusionsOur model presents adaptation steps in five phases: intervention selection, assessment, preparation, implementation, and sustainment. Phases for assessment through sustainment are depicted as iterative, reflecting that once an intervention is selected, adaptation is a continual process. Our model reflects the specific context of WaSH by including steps to engage non-health and lay implementers and to build consensus among diverse stakeholders with potentially competing priorities. We build on prior adaptation literature by compiling tools to support systematic data collection and decision-making, and we describe how they can be used throughout adaptation steps. Our model is intended to improve program outcomes by systematizing adaptation processes and provides an example of how systematic adaptation can occur for interventions with health goals but that are implemented outside conventional health system channels.

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“…Hence, development and testing of alternate strategies to address the problem of inter-personal counseling for nutrition assumes huge relevance in vastly rural and populous environments with overwhelming physical and financial barriers [ 25 – 28 ]. In this context, layering of health and nutrition interventions on rapidly expanding platform of women self-help group (SHG) networks across low-income geographies is viewed as a unique opportunity to influence complementary feeding norms and practices [ 29 , 30 ]. This is largely attributable to the attractiveness of the SHG model as a cost-effective option for governments and donors to quickly transmit behavior change messages and use the social capital of the groups to reinforce these norms through peer-support as well as sanctioning of any deviant practices [ 31 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, in the context of Ethiopia, Kang et al (2018) suggest that maternal social capital via group memberships is associated with better dietary diversity among children. Whereas, a couple of studies [ 30 , 37 ] find that the effects of health layering on SHGs were relatively weaker on complementary feeding and nutrition. However, much of this evidence is context specific and given the increasing governmental attention on SHGs for women empowerment and livelihoods promotion, it is critical to further the understanding on effectiveness and impact of health layering initiatives on child diets and nutrition.…”

Section: Introductionmentioning

confidence: 99%

Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6–23 months)? Evidence from JEEViKA in Rural Bihar, India

Mondal¹,

Joe

Akhauri³

et al. 2023

PLoS ONE

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Objectives Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups. Methods The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6–23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase. Results During the pre-intervention phase, 19% of the children (6–23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events. Conclusion BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.

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Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India

Cited by 11 publications

References 24 publications

Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India

Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools

Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6–23 months)? Evidence from JEEViKA in Rural Bihar, India

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