Background
Methods
Intervention and evaluation theory
Design of the intervention
2009 | 2010 | 2011 | |||||||||||||||||||
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J | J | A | S | O | N | D | J | F | M | A | M | J | J | A | S | O | N | D | J | F | |
Implementation timeline
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Donation of equipment to health centres | ● | ||||||||||||||||||||
Donation of laboratory facilities | ● | ||||||||||||||||||||
Training of laboratory technicians | ● | ||||||||||||||||||||
Training of health staff, seminars | ● | ● | |||||||||||||||||||
Training of health staff at antenatal care facilities | ● | ||||||||||||||||||||
Development/revision of antenatal care guidelines | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||||||
Implementation of antenatal care guidelines | ● | ||||||||||||||||||||
Development/revision of health education material | ● | ● | ● | ● | ● | ||||||||||||||||
Implementation of health education material | ● | ● | |||||||||||||||||||
Seminars with traditional birth attendants | ● | ● | ● | ||||||||||||||||||
Supervision of antenatal care staff | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | ● | |||
Data collection timeline
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Before-intervention survey1 | ● | ● | |||||||||||||||||||
After-intervention survey2 | ● | ● |
Program theory
Input | Proximal project outcomes | Distal project outcomes | Long-term impact |
---|---|---|---|
Donation of equipment | Provision of: | Facility change: | Maternal and infant health and mortality |
- Physical examination | -Identification of health problems during pregnancy | ||
- Laboratory testing | |||
Trainings of health staff and laboratory technicians | - TT immunization | - Satisfaction with ANC | |
- Health education | |||
Behavioural change: | |||
ANC guidelines (incl. privacy) | Context: | - Number of ANC visits | |
- Waiting time | - Place of delivery | ||
Health education materials | - Conduct of health staff | - Breastfeeding | |
Supervisions | - Infant preventive health care |
Data collection
Implementation process
Effectiveness
Data analysis
Ethics
Results
Implementation process
Effectiveness
Before intervention (N = 1357) | After intervention (N = 2262) | p-value | |
---|---|---|---|
Maternal age, years, mean ± SD (N) | 24.5 ± 4.7 (1350) | 25.1 ± 4.8 (2258) | <0.001 |
Place of residence
| <0.001 | ||
Jimma | 71.6 (969) | 79.1 (1788) | |
Serbo | 6.3 (85) | 6.3 (143) | |
Agaro | 22.2 (300) | 14.6 (331) | |
Maternal education
| 0.094 | ||
No school | 20.0 (271) | 22.8 (514) | |
Primary school | 46.0 (623) | 43.0 (970) | |
Secondary or higher school | 34.1 (462) | 34.3 (774) | |
Marital status
| 0.228 | ||
Single | 2.8 (38) | 2.7 (61) | |
Widow/divorced | 5.1 (69) | 3.9 (88) | |
Cohabitating | 92.1 (1247) | 93.4 (2106) | |
Parity
| 0.707 | ||
Para I | 42.0 (563) | 40.3 (903) | |
Para II | 26.4 (354) | 26.7 (598) | |
Para III | 14.9 (199) | 16.0 (359) | |
Para IV+ | 16.7 (224) | 17.0 (380) | |
Outcome of last pregnancy
| 0.209 | ||
Singletons | 97.9 (1329) | 98.5 (2228) | |
Twins and triplets | 2.1 (28) | 1.5 (34) | |
ANC attendance
| 0.741 | ||
Yes | 83.0 (1125) | 82.1 (1856) | |
No | 17.0 (231) | 17.9 (405) |
Control sites | Intervention sites | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Agaro HC | Other | Jimma Town HC | Higher 2 HC | Serbo HC | Jimma Hospital | |||||||
Before | After | Before | After | Before | After | Before | After | Before | After | Before | After | |
N = 250 | N = 251 | N = 100 | N = 171 | N = 215 | N = 438 | N = 146 | N = 299 | N = 55 | N = 106 | N = 359 | N = 591 | |
Physical examination
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Blood pressure | 96.0 (240) | 94.7 (233) | 92.0 (92) | 93.6 (160) | 97.2 (209) | 96.1 (415) | 97.2 (140) | 96.6 (288) | 94.6 (52) | 94.3 (99) | 98.0 (350) | 96.4 (570) |
Weight measurement | 96.0 (240) | 94.4 (243) | 96.0 (96) | 96.4 (162) | 98.1(211) | 97.7 (426) | 99.3 (144) | 99.3 (296) | 94.6 (52) | 97.2 (103) | 98.3 (353) | 98.3 (578) |
Abdominal examination | 66.8 (167) | 89.9 (223) | 83.0 (83) | 94.1 (160) | 86.5 (185) | 97.7 (424) | 86.3 (126) | 93.7 (280) | 96.4 (53) | 99.1 (105) | 95.8 (344) | 97.3 (573) |
Laboratory tests
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HIV test | 92.8 (232) | 95.9 (233) | 82.0 (82) | 92.4 (157) | 95.8 (204) | 97.5 (425) | 95.2 (139) | 98.3 (294) | 76.4 (42) | 98.1 (104) | 96.9 (348) | 98.1 (576) |
Blood test, other | 41.5 (103) | 41.6 (87) | 65.7 (65) | 82.6 (138) | 79.3 (168) | 88.4 (381) | 69.7 (101) | 89.5 (265) | 7.4 (4) | 78.1 (82) | 80.6 (286) | 87.7 (511) |
Urine analysis | 42.8 (107) | 72.7 (178) | 69.7 (69) | 90.6 (155) | 81.9 (176) | 97.2 (423) | 71.9 (105) | 96.0 (287) | 34.6 (19) | 67.6 (71) | 93.6 (336) | 96.8 (571) |
TT immunization
| 95.2 (238) | 84.6 (208) | 91.0 (91) | 88.9 (157) | 97.2 (209) | 94.2 (408) | 95.2 (138) | 94.6 (282) | 76.4 (42) | 98.1 (104) | 85.7 (306) | 90.9 (531) |
Health education topics
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Danger signs during pregnancy | 30.8 (77) | 37.1 (89) | 46.5 (46) | 50.6 (85) | 38.9 (81) | 70.0 (298) | 29.9 (43) | 66.9 (196) | 18.5 (10) | 86.6 (90) | 44.1 (156) | 56.9 (327) |
Need for health facility delivery | 38.4 (96) | 55.3 (136) | 58.0 (58) | 73.1 (125) | 54.0 (115) | 82.6 (356) | 65.1 (95) | 83.4 (241) | 30.9 (17) | 90.6 (96) | 62.1 (223) | 68.7 (399) |
Nutritional needs during pregnancy | 39.8 (99) | 56.9 (140) | 66.0 (66) | 68.4 (117) | 59.4 (127) | 82.1 (357) | 71.2 (104) | 81.5 (242) | 47.3 (26) | 87.6 (96) | 64.1 (230) | 67.2 (394) |
Breastfeeding | 46.8 (117) | 61.4 (151) | 59.0 (59) | 71.2 (121) | 58.2 (124) | 83.8 (363) | 58.2 (85) | 83.6 (244) | 47.3 (26) | 90.6 (96) | 59.6 (214) | 66.8 (392) |
HIV/AIDS | 64.0 (151) | 55.2 (133) | 51.1 (48) | 67.3 (101) | 54.0 (114) | 77.8 (291) | 50.7 (74) | 84.3 (215) | 35.3 (12) | 86.5 (77) | 61.1 (206) | 71.6 (384) |
Health staff practices
| ||||||||||||
Discomfort caused by students | 26.0 (64) | 19.7 (49) | 13.3 (13) | 5.9 (10) | 23.0 (49) | 15.2 (66) | 15.2 (22) | 12.8 (38) | 25.5 (14) | 19.8 (21) | 36.8 (131) | 21.0 (123) |
Poor conduct of health staff | 5.3 (13) | 3.3 (8) | 4.0 (4) | 1.2 (2) | 3.7 (8) | 1.4 (6) | 0 | 2.0 (6) | 18.2 (10) | 0.9 (1) | 6.7 (24) | 2.0 (12) |
ANC surroundings
| ||||||||||||
Waiting less than 1 hour pre service | 83.7 (204) | 72.5 (182) | 89.0 (89) | 87.7 (149) | 83.3 (175) | 88.1 (384) | 72.6 (106) | 82.9 (247) | 98.2 (54) | 95.3 (101) | 56.1 (198) | 67.0 (394) |
Distal project outcomes
| ||||||||||||
Health problem identified | 13.3 (33) | 9.6 (24) | 15.6 (15) | 20.5 (35) | 12.6 (26) | 20.0 (87) | 12.6 (18) | 21.5 (64) | 11.1 (6) | 18.3 (19) | 14.9 (52) | 19.3 (113) |
Not satisfied with service | 17.2 (42) | 14.4 (35) | 6.1 (6) | 1.2 (2) | 6.1 (13) | 2.6 (11) | 2.2 (3) | 2.4 (7) | 25.9 (14) | 1.9 (2) | 9.9 (35) | 4.8 (27) |
% Control | % Intervention (All sites) | % Intervention (HC only) | Odds ratio2 | |||||
---|---|---|---|---|---|---|---|---|
(All sites) | (HC only) | |||||||
Before | After | Before | After | Before | After | |||
N = 350 | N = 422 | N = 775 | N = 1434 | N = 416 | N = 843 | |||
Physical examination
| ||||||||
Blood pressure | 94.7 | 94.2 | 97.4 | 96.4 | 96.9 | 96.1 | 0.8 (0.4;1.8) | 0.9 (0.4;2.2) |
Weight measurement | 96.0 | 95.2 | 98.2 | 98.3 | 98.1 | 98.2 | 1.3 (0.5;3.3) | 1.3 (0.4;4.0) |
Abdominal examination | 71.4 | 91.6 | 91.5 | 96.8 | 87.7 | 96.4 | 0.7 (0.4;1.3) | 0.9 (0.5;1.7) |
Laboratory tests
| ||||||||
HIV test | 89.7 | 94.4 | 94.8 | 98.0 | 93.0 | 97.9 | 1.2 (0.6;2.6) | 1.6 (0.7;3.6) |
Blood test, other | 48.4 | 59.9 | 73.0 | 87.6 | 66.4 | 87.5 | 2.1 (1.4;3.1) | 2.9 (1.9;4.5) |
Urine analysis | 50.4 | 80.1 | 86.1 | 94.6 | 72.1 | 93.1 | 1.3 (0.8;2.1) | 1.8 (1.1;3.0) |
TT immunization
| 94.0 | 86.3 | 90.0 | 93.2 | 93.7 | 94.9 | 3.7 (2.0;6.9) | 3.1 (1.5;6.3) |
Health education topics
| ||||||||
Danger signs during pregnancy | 35.2 | 42.7 | 38.2 | 65.2 | 33.0 | 71.0 | 2.3 (1.6;3.3) | 3.9 (2.6; 5.7) |
Need for health facility delivery | 44.0 | 62.6 | 58.2 | 77.6 | 54.8 | 83.9 | 1.2 (0.9;1.8) | 2.2 (1.5;3.2) |
Nutritional needs during pregnancy | 47.3 | 61.6 | 62.9 | 76.3 | 61.9 | 82.6 | 1.1 (0.8;1.6) | 1.7 (1.2;2.6) |
Breastfeeding | 50.3 | 65.4 | 58.1 | 77.2 | 56.8 | 84.6 | 1.3 (0.9;1.9) | 2.3 (1.5;3.4) |
Health staff practices
| ||||||||
Discomfort caused by students | 22.4 | 14.1 | 28.1 | 17.4 | 20.6 | 14.9 | 0.9 (0.6;1.4) | 1.1 (0.7;1.8) |
Poor conduct of health staff | 4.9 | 2.4 | 5.4 | 1.8 | 4.3 | 1.6 | 0.6 (0.2;1.6) | 0.7 (0.2;2.1) |
ANC surroundings
| ||||||||
Waiting less than 1 hour pre service | 84.9 | 78.6 | 69.8 | 78.9 | 81.5 | 87.1 | 2.6 (1.7;4.1) | 2.6 (1.6;4.3) |
Distal project outcomes
| ||||||||
Health problem identified | 14.0 | 14.1 | 13.6 | 19.9 | 12.4 | 20.3 | 1.6 (1.0;2.5) | 1.8 (1.1;3.1) |
Not satisfied with service | 14.0 | 9.1 | 8.6 | 3.4 | 7.5 | 2.3 | 0.5 (0.3;1.0) | 0.4 (0.2;0.9) |
No school | Primary school | Secondary or higher school | p-value of interaction | |
---|---|---|---|---|
HIV testing | 2.3 (0.6;9.5) | 1.5 (0.4;6.0) | 2.3 (0.3;16.2) | p < 0.001 |
Blood test, other | 2.9 (1.1;7.7) | 2.2 (1.2;4.1) | 2.1 (1.0; 4.4) | p = 0.009 |
TT immunization | 5.3 (0.9;32.1) | 4.1 (1.4;12.2) | 1.8 (0.4;7.0) | p = 0.022 |
Waiting less than 1 hour pre service | 1.9 (0.5;6.4) | 2.4 (1.2; 4.9) | 4.4 (1.7;11.2) | p = 0.012 |
Health education topics | ||||
Danger signs during pregnancy | 3.4 (1.2;9.6) | 5.2 (2.9;9.4) | 2.8 (1.5;5.4) | p = 0.003 |
Need for health facility delivery | 1.0 (0.4;2.4) | 3.3 (1.8;6.1) | 2.0 (1.0;3.9) | p < 0.001 |
Nutritional needs during pregnancy | 0.5 (0.2;1.4) | 1.9 (1.0;3.4) | 2.7 (1.4;5.2) | p = 0.016 |
Breastfeeding | 1.1 (0.4;2.6) | 2.3 (1.5;5.2) | 3.1 (1.6;6.3) | p = 0.002 |
Health education provided during ANC
| No folder/pictogram1(N = 679) | Folder/pictogram1(N = 617) | OR 95% CI crude | OR 95% CI adjusted2 |
---|---|---|---|---|
Danger signs during pregnancy | 54.4 (358) | 77.7 (475) | 2.6 (2.0;3.4) | 2.6 (2.0;3.3) |
Need for health facility delivery | 70.1 (463) | 86.9 (532) | 2.4 (1.8;3.3) | 2.3 (1.7;3.2) |
Nutritional needs during pregnancy | 69.3 (467) | 86.0 (528) | 2.4 (1.8;3.2) | 2.3 (1.7;3.1) |
Breastfeeding | 69.3 (463) | 86.7 (533) | 2.4 (1.8;3.2) | 2.3 (1.7;3.2) |
Understanding the health education provided during ANC
| 82.3 (518) | 91.6 (546) | 2.2 (1.5;3.1) | 2.1 (1.4;3.0) |