Improving the quality of maternity services in Uganda through accelerated implementation of essential interventions by healthcare professional associations

Spira, Cintia; Kwizera, Amata; Jacob, Sue; Amongin, Dinah; Ngonzi, Joseph; Namisi, Charles; Byaruhanga, Romano; Rushwan, Hamid; Cooper, Peter; Day-Stirk, Frances; Berrueta, Mabel; García-Elorrio, Ezequiel; Belizán, José M.

doi:10.1002/ijgo.12241

Cited by 10 publications

(32 citation statements)

References 10 publications

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“…The present study found that the implementation of selected EIs for maternal and neonatal care in Nepal provided similar results to those previously reported for this intervention in Uganda …”

Section: Discussionsupporting

confidence: 89%

“…Minimal variation was found after the intervention among EIs that were frequently used at baseline, whereas an increase was detected in the use of some EIs not used regularly at baseline. Nonetheless, some EIs with low baseline use did not show any improvement after the intervention …”

Section: Introductionmentioning

confidence: 89%

“…This study was a replication of the first phase conducted in Uganda in 2014, consequently the methodology applied in this study is very similar and has been described in detail elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…The aim of the present study was to replicate and consolidate the evidence gathered in the Ugandan study and to determine whether the implementation of a package of activities in Nepal through the joint action of the three international HCPAs and their national affiliates increased the use of selected EIs at two hospitals in Nepal.…”

Section: Introductionmentioning

confidence: 93%

“…In the first phase of this innovative joint initiative, the international HCPAs collaborated with the relevant national HCPAs in Uganda to develop an evidence‐based model to accelerate the uptake of nine essential interventions. The model was tested in 2014 using a pre‐intervention and post‐intervention design . Minimal variation was found after the intervention among EIs that were frequently used at baseline, whereas an increase was detected in the use of some EIs not used regularly at baseline.…”

Section: Introductionmentioning

confidence: 99%

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Improving the quality of maternity services in Nepal through accelerated implementation of essential interventions by healthcare professional associations

Spira

Dhital

Jacob

et al. 2018

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 89%

“…This study was a replication of the first phase conducted in Uganda in 2014, consequently the methodology applied in this study is very similar and has been described in detail elsewhere …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Improving the quality of maternity services in Nepal through accelerated implementation of essential interventions by healthcare professional associations

Spira

Dhital

Jacob

et al. 2018

Intl J Gynecology & Obste

Self Cite

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Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

Peven

Bick

Purssell

et al. 2020

Health Policy and Planning

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Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3–31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1–4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.

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Health system intervention packages on improving coverage of kangaroo mother care for preterm or LBW infants: a mixed-methods systematic review

Bergman

Talej

Smith

et al. 2023

Preprint

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Introduction. Global coverage of Kangaroo mother care (KMC) remains low and health system intervention strategies that may improve coverage are not known. Methods. We conducted a systematic review of studies evaluating the effect of health system intervention strategies for KMC implementation compared to no or different interventions, on KMC coverage in preterm or LBW infants. KMC coverage achieved by various studies was summarized. All included studies were classified as those that achieved increased KMC coverage (defined as ≥25% increase from baseline, with final coverage ≥50%) or low KMC coverage (defined as <25% increase from baseline or final coverage <50%). Studies that achieved increased KMC coverage were further classified based on the mean duration of skin-to-skin contact (SSC; hours per day) achieved. Health system interventions in different categories were summarized by WHO health system building blocks to understand factors linked to increased KMC coverage. Findings. We identified 16 studies evaluating 15 health system intervention packages for KMC implementation that applied interventions in one or more health system building blocks that reported KMC coverage. All three studies that applied interventions across 5-6 building blocks (100%), two of the four studies that applied interventions across 3-4 building blocks (50%), and three of the nine studies that applied interventions across 1-2 building blocks (33%), achieved increased KMC coverage. Studies that did not achieve increased coverage had interventions primarily targeting health workforce and service delivery and were weak on leadership and governance, financing, and health information systems. All three studies that achieved increased KMC coverage with mean SSC ≥8h/d (100%), three of the five studies that achieved increased KMC coverage with mean SSC <8h/d (60%), and three of the eight studies with low KMC coverage (38%) had high-intensity interventions in at least one health system building blocks. High-level leadership engagement, KMC supportive policies, staff licensing, and facility standards regulations, strengthened numbers and capacity of nursing staff, government funding and expanded health insurance, wards with conducive environment, and recording KMC-specific indicators in clinical registers were key factors among studies that achieved increased KMC coverage. Conclusion. High-intensity interventions across multiple health system building blocks should be used for equitable scale-up of KMC.

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Improving the quality of maternity services in Uganda through accelerated implementation of essential interventions by healthcare professional associations

Cited by 10 publications

References 10 publications

Improving the quality of maternity services in Nepal through accelerated implementation of essential interventions by healthcare professional associations

Improving the quality of maternity services in Nepal through accelerated implementation of essential interventions by healthcare professional associations

Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

Health system intervention packages on improving coverage of kangaroo mother care for preterm or LBW infants: a mixed-methods systematic review

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