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Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol.

ABSTRACT: INTRODUCTION:Timely antenatal care (ANC) and postnatal care (PNC) attendance decrease maternal and child mortality by improving maternal and child health (MCH) outcomes. Mobile health or mHealth has been identified as an effective way of improving the uptake of MCH services. The MomConnect programme is an mHealth initiative launched by the National Department of Health of South Africa in August 2014 to support MCH. Although widely used, there is a limited understanding of how, why, for whom and under which health system conditions, the implementation of MomConnect improves the health-seeking behaviour of pregnant women and mothers of infants in ANC and PNC facilities. This paper describes the protocol for a realist evaluation of the MomConnect programme, to provide a theory-based understanding of how, why and under what healthcare conditions the MomConnect programme works or not. METHOD AND ANALYSIS:We will use the realist evaluation approach through its research cycle conducted in three phases. In phase I, a multimethod elicitation study design will be used, including a document review, key informant interviews and a scoping review to formulate an initial programme theory of the MomConnect intervention. Content and thematic analytic approaches will be used to analyse the data that will be fitted into a realist framework to formulate the initial programme theory. In phase II, a multi-case study design will be applied using a multimethod approach in two South African provinces. In each case, a theory-testing approach underpinned by the hypothetico-deduction analytic model will be used to test the initial programme theory. Surveys, interviews and focus group discussions will be conducted with various programme actors and analysed using appropriate methods. Phase III will entail refining the tested/modified programme theory through cross-case analysis. EXPECTED OUTCOMES:An improved understanding of how and why the MomConnect intervention improves the health-seeking behaviour of pregnant women and mothers of infants, and the health system conditions that influence its implementation. ETHICS AND DISSEMINATION:Ethics approval was granted by the Stellenbosch University Ethics Committee (S18/09/189). The protocol has been designed and the study will be conducted in line with the principles of the Declaration of Helsinki (1964).

SUBMITTER: Kabongo EM

PROVIDER: S-EPMC6609052 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol.

Kabongo Eveline M EM Mukumbang Ferdinand C FC Delobelle Peter P Nicol Edward E

BMJ open 20190701 7

<h4>Introduction</h4>Timely antenatal care (ANC) and postnatal care (PNC) attendance decrease maternal and child mortality by improving maternal and child health (MCH) outcomes. Mobile health or mHealth has been identified as an effective way of improving the uptake of MCH services. The MomConnect programme is an mHealth initiative launched by the National Department of Health of South Africa in August 2014 to support MCH. Although widely used, there is a limited understanding of how, why, for w ...[more]

PMID: 31266842

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Project description:BackgroundNepal has improved access and utilisation of routine maternal and newborn health (MNH) services. Despite improved access to routine MNH services such as antenatal care (ANC), and delivery and postnatal care (PNC) services, the burden of maternal and neonatal deaths in Nepal remains high. Most of those deaths could be prevented by improving utilisation of evidence-informed clinical MNH interventions. However, little is known on determinants of utilisation of such clinical MNH interventions in health facilities (HFs). This study investigated the determinants of utilisation of technical quality MNH services in Nepal.MethodsThis study used data from the 2015 Nepal Services Provision Assessment. A total of 523 pregnant and 309 postpartum women were included for the analysis of utilisation of technical quality of ANC, and delivery and PNC services, respectively. Outcome variables were utilisation of better quality i) ANC services, and ii) delivery and PNC services while independent variables included features of HFs and health workers, and demographic characteristics of pregnant and postpartum women. Binomial logistic regression was conducted to identify the determinants associated with utilisation of quality MNH services. The odds ratio with 95% confidence interval (CIs) were reported at the significance level of p < 0.05 (two-tailed).ResultsWomen utilised quality ANC services if they attended facilities with better HF capacity (aOR = 2.12;95% CI: 1.03, 4.35). Women utilised better quality delivery and PNC services from private HFs compared to public HFs (aOR = 2.63; 95% CI: 1.14, 6.08). Women utilised better technical quality ANC provided by nursing staff compared to physicians (adjusted odds ratio (aOR) =2.89; 95% CI: 1.33, 6.29), and from staff supervised by a higher authority compared to those not supervised (aOR = 1.71; 95% CI: 1.01, 2.92). However, compared to province one, women utilised poor quality delivery and PNC services from HFs in province two (aOR = 0.15; 95% CI: 0.03, 0.63).ConclusionsWomen utilised quality MNH services at facilities with better HF capacity, service provided by nursing staff, and attended at supervised HFs/health workers. Provincial and municipal governments require strengthening HF capacities (e.g., supply equipment, medicines, supplies), recruiting trained nurse-midwives, and supervising health workers.

Project description:BackgroundRecent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa.MethodThis was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard.ResultsA total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 12% for infection prevention (95%CI: 7-17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3-13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7-20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3-14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28-42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22-35; p<0.001), leadership and planning 23%, (95%CI: 13-34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1-9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14-21; p<0.001).ConclusionThe overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards.

Project description:BackgroundThe World Health Organisation recommends that all mothers seek postnatal care (PNC) within the first two months after childbirth. This study examined PNC utilisation for babies within the first two months after childbirth.MethodsWe used data from the most recent Demographic and Health Surveys (DHS) (2018-2020) of eleven countries in SSA. Descriptive and a multivariate analysis were carried out, and presented in adjusted odds ratios. The explanatory variables included: age, place of residence, level of formal education, wealth quintile, antenatal care visits, marital status, frequency of watching TV, listening to radio and reading newspaper, getting permission to go medical help for self, getting money needed for treatment, and distance to facility.ResultsPNC utilisation was 37.5% and 33% in urban and rural residences, respectively. Higher level of education (Urban: AOR = 1.39, CI = 1.25, 1.56; Rural: AOR = 1.31, CI = 1.10, 1.58), 4 or more ANC visits (Urban: AOR = 1.32, CI = 1.23, 1.40; Rural: AOR = 1.49, CI = 1.43, 1.56 0.86), requiring permission to go to the health facility (Urban: AOR = 0.67, CI = 0.61, 0.74; Rural: AOR = 0.86, CI = 0.81, 0.91), listening to the radio at least once a week (Urban: AOR = 1.32, CI = 1.23, 1.41; Rural: AOR = 0.86, CI = 0.77, 0.95), and watching television at least once a week (Urban: AOR = 1.11, CI = 1.03, 1.21; Rural: AOR = 1.15, CI = 1.07, 1.24) were significantly associated with PNC service utilisation in both rural and urban areas. However, belonging to a richer wealth status (AOR = 1.11, CI = 1.02, 1.20) and having a problem with distance (AOR = 1.13, CI = 1.07, 1.18) were significant in only rural areas, while having a problem with money for treatment was significant only in urban areas (AOR = 1.15, CI = 1.08, 1.23).ConclusionIn this study, we conclude that the PNC service utilisation within the first 2 months after delivery was low across rural and urban residences. There is, therefore, a need for SSA countries to develop population tailored interventions such as advocacy and health education targeted at women with no formal education in both rural and urban areas. Our study also suggests that SSA countries must intensify radio programs and advertisements on the health benefits of PNC to improve maternal and child health.

Project description:IntroductionReduction of maternal and neonatal morbidity and mortality has continued to be a challenge in developing countries. The majority of maternal and neonatal mortality occurred during the early postpartum period. This is mostly due to low postnatal care service utilization. There is a discrepancy of evidence on the effect status of antenatal care on the improvement of postnatal care service utilization. Therefore, this review study is aimed at estimating the pooled effect of antenatal care on postnatal care service utilization.MethodsWe searched from PubMed and Cochrane library database, Google Scholar, and Google. Initially, we found 265 articles; after duplication was removed and screened by the relevance of the titles and abstracts, 36 studies were considered for assessment of eligibility. Finally, 14 articles passed the inclusion and exclusion criteria and are included in the meta-analysis. Study quality assessment was done using Janna Briggs Institute (JBI) critical appraisal tools. The main information was extracted from each study. Heterogeneity of studies was assessed using I 2 = 70% and more considered having high heterogeneity. The publication bias was checked using funnel plot and big test. Meta-analysis using a random effect model was conducted. A forest plot was used to show the estimated size effect of odds ratio with a 95% confidence interval.ResultsA total of 14 articles were included with 15,765 participants for synthesis and meta-analysis. We found that a pooled estimate of women who had antenatal care was 1.53 times more likely to have postnatal care compared with those who had no antenatal care (AOR = 1.53, 95% CI 1.38-1.70, I 2 = 0%).ConclusionsThis review results revealed a low utilization of postnatal care service. Antenatal care service utilization has a positive effect on postnatal care service utilization. Policymakers and programmers better considered more antenatal care service use as one strategy of enhancing the utilization of postnatal care service.

Project description:Although many countries are making progress towards achieving the global sustainable development goals, sub-Saharan Africa (SSA) lags behind. SSA bears a relatively higher burden of maternal morbidity and mortality than other regions despite existing cost-effective interventions. This paper assesses antenatal care (ANC) service utilisation among women in the Southern African Development Community (SADC) countries, one of the four SSA regions. Specifically, it assesses socioeconomic inequality in the number of ANC visits, use of no ANC service, between one and three ANC visits and at least four ANC visits, previously recommended by the World Health Organization (WHO). Data come from the most recent Demographic and Health Surveys in twelve SADC countries. Wagstaff's normalised concentration index (CI) was used to assess socioeconomic inequalities. Factors explaining these inequalities were assessed using a standard method and similar variables contained in the DHS data. A positive CI means that the variable of interest is concentrated among wealthier women, while a negative CI signified the opposite. The paper found that wealthier women in the SADC countries are generally more likely to have more ANC visits than their poorer counterparts. Apart from Zambia, the CIs were positive for inequalities in at least 4 ANC visits and negative for between 1 and 3 ANC visits. Women from poorer backgrounds significantly report no ANC visits than wealthier women. Apart from the portion that was not explainable due to limitations in the variables included in the model, critical social determinants of health, including wealth, education and the number of children, explain socioeconomic inequalities in ANC coverage in SADC. A vital policy consideration is not to leave any woman behind. Therefore, addressing access barriers and critical social determinants of ANC inequalities, such as women's education and economic well-being, can potentially redress inequalities in ANC coverage in the SADC region.

Project description:ObjectivesTo assess the health utilisation status and associated factors among African migrants in China.DesignA national cross-sectional study was conducted among African migrants in China in 2019.SettingParticipants were recruited online and offline to participate in a self-report survey. Online participants were recruited through WeChat across China, and offline participants were recruited in Guangzhou.ParticipantsWe recruited participants who were from an African country; had spent at least 1 month cumulatively in China; were at least 18 years old; were willing to provide informed consent. A total of 1025 participants were recruited online and offline, 19 of them were excluded due to invalid response and 1006 people were finally included in the analysis.Outcome measuresThe primary outcome was health service utilisation and associated factors among African migrants during their stay in China in the past 12 months. The potential factors include the predisposing factors (demographic characteristics and social structure variables), enabling factors (annual income, health insurance in China) and need factors (non-communicable chronic and infectious diseases, depression) which determined by Anderson framework were measured.ResultsEight hundred and seven online and 218 offline participants completed the survey, including 624 males and 382 females, with an average age of 26.4±8.9 years. Around 28.5% reported health utilization in the past 12 months. Results showed that longer duration in China, migration to China for business (aOR=2.23, 95% CI:1.13-4.40) and study (aOR=5.00, 95% CI:2.74-9.11), living in apartment (aOR=2.59, 95% CI:1.62-4.14) or dormitory (aOR=3.22, 95% CI:2.17-4.80) in China, suffering from chronic diseases, communicable diseases, and greater depressive symptoms (aOR=1.91, 95% CI:1.42-2.56) facilitated health service utilization.ConclusionsThe healthcare service that African migrants received in China is low. The existing public health policies and intervention measures need to be improved to make health utilisation more accessible and feasible for African migrants.

Dataset Information

Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol.

Publications

Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol.

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