Improving Maternal and Newborn Health Care Delivery in Rural Amhara and Oromiya Regions of Ethiopia Through the Maternal and Newborn Health in Ethiopia Partnership

Abstract

Introduction:In Ethiopia, rural residence and limited access to skilled providers and health services pose challenges for maternal and newborn survival. The Maternal Health in Ethiopia Partnership (MaNHEP) developed a community-based model of maternal and newborn health focusing on birth and the early postnatal period and positioned it for scale-up. MaNHEP's 3-pronged intervention included community-and facility-based community maternal and newborn health training, continuous quality improvement, and behavior change communications.Methods: Evaluation included baseline and endline surveys conducted with random samples of health extension workers, community health development agents, traditional birth attendants (TBAs), and women who gave birth the year prior to the survey; pretraining, posttraining, and postintervention clinical skills assessments conducted with health extension workers, community health development agents, and traditional birth attendants; endline surveys conducted with quality improvement teams; and a perinatal verbal autopsy study.Results: There were significant improvements in the completeness of maternal and newborn health care provided by the team of health extension workers, community health development agents, and TBAs in their demonstrated capacity and confidence to provide care and a sense of being part of a maternal and newborn health care team. There were also significant improvements in women's awareness of and trust in the ability of these team members to provide maternal and newborn health care, in the completeness of care that women received, and in the use of skilled providers and health extension workers for antenatal and postnatal care. In addition, a shift occurred toward the use of providers with a higher level of skills for birth care. Successful local solutions for pregnancy identification, antenatal care registration, labor-birth notification, and postnatal follow-up were adopted across 51 project communities. The number of days between perinatal deaths increased over the duration of the project.Discussion: MaNHEP was associated with more, and more complete, coverage of maternal and newborn health care and improved perinatal outcomes.

Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

“…41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned. 43,52,55,67 Two of the studies with refresher courses showed an actual increase in knowledge and skills at 1 year and 18 months after training, respectively, compared with immediately after training. 52 Of note, the 2 educational interventions from Ethiopia provided refresher training, but they also sought to educate women in the community and increase their demand for skilled maternal and newborn care, which may have been an important incentive for birth attendants to maintain their knowledge and skills.…”

“…37,38,48,56,66 Three studies (30.0%) showed no falloff 41,43,52 ; the 2 remaining studies (20.0%), both from Ethiopia, found varying levels of retention in different groups of birth attendants, with higher levels of training associated with less falloff. 55,67 These latter 5 studies showing either no falloff or mixed results included the 4 longest running studies in our literature review, ranging from 9 months to 2 years. 41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned.…”

“…55,67 These latter 5 studies showing either no falloff or mixed results included the 4 longest running studies in our literature review, ranging from 9 months to 2 years. 41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned. 43,52,55,67 Two of the studies with refresher courses showed an actual increase in knowledge and skills at 1 year and 18 months after training, respectively, compared with immediately after training.…”

“…52 Of note, the 2 educational interventions from Ethiopia provided refresher training, but they also sought to educate women in the community and increase their demand for skilled maternal and newborn care, which may have been an important incentive for birth attendants to maintain their knowledge and skills. 55,67 The 1 study that found no falloff of skills over 9 to 12 months after training despite having no refresher training was conducted in 1 of Ghana's main referral institutions. 41 The high birth volume at this center may have prevented falloff by providing birth attendants with frequent clinical practice.…”

Event-based surveillance in north-western Ethiopia: experience and lessons learnt in the field

“…7 The team created a network structure of one volunteer per five households 7 and collected health-related information from these households. For EBS, the community health extension workers (HEWs) instructed HDAs to report any communicable disease outbreaks and unusual health events to health posts (HPs) and HCs, particularly events with multiple deaths from unknown causes.…”