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. 2018 Sep 24;18(Suppl 1):359.
doi: 10.1186/s12884-018-1976-x.

Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study

Ali Mehryar Karim  1 , Nebreed Fesseha Zemichael  2 , Tesfaye Shigute  2 , Dessalew Emaway Altaye  2 , Selamawit Dagnew  2 , Firew Solomon  2 , Mulu Hailu  2 , Gizachew Tadele  2 , Bantalem Yihun  2 , Nebiyu Getachew  3 , Wuleta Betemariam  2
Affiliations

Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study

Ali Mehryar Karim et al. BMC Pregnancy Childbirth. .

Abstract

Background: Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women's Development Army (WDA), was added to extend Ethiopia's Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA's Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy.

Methods: Using data from cross-sectional surveys in 2010-11 and 2014-15 from 177 kebeles, we estimated self-reported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level random-effects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys.

Results: Kebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth.

Conclusions: This study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.

Keywords: Community engagement; Community health workers; Community-based information system; Health extension program of Ethiopia; Women’s development army of Ethiopia.

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Conflict of interest statement

Ethics approval and consent to participate

Verbal consent was sought and documented by the interviewers. If the respondent was under 18 years old, then consent was sought from her husband, parents or guardian. As it was expected that most of the respondents could not read or write, written consent was not sought. For the 2010–11 survey, ethical approval was obtained from the ethical review committee of the Ethiopian Public Health Association. For the 2014–15 survey, ethical approvals were obtained from the ethical review boards of the regional health bureaus of Amhara, Oromia, SNNP and Tigray regions and from the ethical review board of JSI Research & Training Institute, Inc.

Consent for publication

Not applicable.

Competing interests

All authors declared that they do not have any competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Activities involved in Community-Based Data for Decision-Making
Fig. 2
Fig. 2
CBDDM activities by CBDDM implementation strength score during 2014–15
See this image and copyright information in PMC

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