Influence of newborn health messages on care-seeking practices and community health behaviors among participants in the Zambia Chlorhexidine Application Trial

Sivalogan, Kasthuri; Semrau, Katherine; Ashigbie, Paul G.; Mwangi, Sheila; Herlihy, Julie M.; Yeboah-Antwi, Kojo; Banda, Bowen; Grogan, Caroline; Biemba, Godfrey; Hamer, Davidson H.

doi:10.1371/journal.pone.0198176

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…Strategies to increase access to adequate services in low-income, high-burden settings are necessary as timely detection and appropriate case management can save hundreds of thousands of newborn lives [6]. Fortunately, 80% of newborn deaths are preventable through cost effective, evidence based interventions [7] such as skilled delivery, thermal care, hygienic cord care, early treatment for sepsis and promotion of breastfeeding [4,8].…”

Section: Introductionmentioning

confidence: 99%

Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya

Ocholla

Agutu

Ouma

et al. 2020

BMC Pregnancy Childbirth

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Background: Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers. Methods: Geographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour. Results: Approximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised. Conclusion: Our findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.

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Section: Introductionmentioning

confidence: 99%

Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya

Ocholla

Agutu

Ouma

et al. 2020

BMC Pregnancy Childbirth

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“…Such adaptation—often including such steps as formative qualitative research, application of contextual frameworks, and human-centered design (HCD)—is often very expensive relative to delivery of the intervention itself. For example, implementation of even apparently simple interventions such as umbilical chlorhexidine may require qualitative research, ethnographic inquiry, and community engagement—often at great cost [ 40 , 41 ]. As another illustrative example, the estimated cost of HCD for a tuberculosis contact investigation strategy was $356,000, versus a delivery cost of $0.41 per client reached [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review

et al. 2022

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Background Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. Methods We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. Results Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. Conclusion A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs. Trial registration The protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ).

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Section: Methodsmentioning

confidence: 99%

“…The aim of the qualitative study was to identify context-specific information to aid the design and implementation of the trial, particularly around newborn care messaging, household visitation in the neonatal period, and acceptable characteristics of data collectors to the community for home visitation. A detailed study protocol, main study outcomes, perceptions of newborn care messaging, and of cord health and illness were previously published [10,[16][17][18]. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted to determine knowledge, attitudes, and practices of mothers, traditional birth attendants (TBAs), community members, and facility-based health workers from February to April 2010.…”

Section: Methodsmentioning

confidence: 99%

Impact of beliefs on perception of newborn illness, caregiver behaviors, and care-seeking practices in Zambia’s Southern province

Sivalogan

Banda²,

Wagner

et al. 2023

PLoS ONE

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Despite reductions in the number of under-five deaths since the release of the Sustainable Development Goals, the proportion of neonatal deaths among all under-five deaths has remained high. Neonatal health is linked to newborn care practices which are tied to distinct cultural perceptions of health and illness. We assessed how community beliefs in Zambia’s Southern Province influence newborn care behaviors, perception of illness, and care-seeking practices, using qualitative data collected between February and April 2010. A total of 339 women participated in 36 focus group discussions (FGDs), with 9 FGDs conducted in each of the four study districts. In addition, 42 in-depth interviews (IDIs) were conducted with various key informants, with 11 IDIs conducted in Choma, 11 IDIs in Monze, 10 IDIs in Livingstone, and 10 IDIs in Mazabuka. The FGDs and IDIs indicate that beliefs among the Tonga people regarding postnatal illness prevention and management influence perceptions of newborn illness and care-seeking practices. Care seeking behaviors including when, why, and where parents seek newborn care are intimately tied to perception of disease among the Tonga people. These beliefs may stem from both indigenous and Western perspectives in Zambia’s Southern Province. Findings are consistent with other analyses from Southern Province that highlighted the benefit of integrating local practices with Western biomedical care. Health systems models, led by policy makers and program designers, could aim to find synergies between community practices and formal health systems to support positive behavior change and satisfy multiple stakeholders.

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Influence of newborn health messages on care-seeking practices and community health behaviors among participants in the Zambia Chlorhexidine Application Trial

Cited by 6 publications

References 7 publications

Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya

Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya

Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review

Impact of beliefs on perception of newborn illness, caregiver behaviors, and care-seeking practices in Zambia’s Southern province

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