Background
Methods
Study setting
Intervention
Evaluation design
Facility-based intervention | |||
---|---|---|---|
Comparison | Intervention | ||
Community-based intervention | Comparison | No intervention | Facility intervention only |
Intervention | Community intervention only | Facility + community interventions |
Number of Health Facilities | Number of Communities | |
---|---|---|
Facility Yes; Community Yes | 10 | 20 |
Facility Yes; Community No | 10 | 40 |
Facility No, Community Yes | 9 | 17 |
Facility No, Community No | 9 | 36 |
Quantitative data collection
Quantitative data analysis
Qualitative data collection
Participants | Sample Size | |
---|---|---|
Baseline (Jan-Feb 2015) | Midline (July – August 2016) | |
Focus group discussion | # of FGDs (# of participants) | |
RBF Committee | 1 (6) | 1 (6) |
Project Implementation Committee | 1 (6) | 1 (8) |
Regional Health Directorate (RHD) | 3 (18) | 3 (17) |
Health workers | 3 (17) | 5 (22) |
Catchment Area Committee | 3 (18) | 3 (16) |
VDC/VSG | 5 (32) | 7 (45) |
Women who had delivered in the previous six months | 6 (51) | 13 (74) |
Men | 5 (35) | 6 (35) |
Total focus group discussions | 27 (193) | 39 (223) |
Key informant interview | # of interviews | |
Health Facility Officer-in-Charge | 3 | 3 |
Community Health Nurse | 3 | 3 |
TBA/CBC | 5 | 7 |
Vulnerable womena | 9 | 7 |
Total interviews | 20 | 20 |
Qualitative data analysis
Joint data analysis
Ethical approval
Results
Survey administration
Household survey findings
Round 1 | Round 2 | Test for Difference, Overall | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Control | Facility Only | Community Only | Facility and Community | Overall | Control | Facility Only | Community Only | Facility and Community | Overall | ||
Demographic Data | |||||||||||
Mean Maternal Age | 27.5 | 27.3 | 27.0 | 26.7 | 27.2 | 27.2 | 27.7 | 26.8 | 27.0 | 27.3 | 0.842 |
Mother’s age: < 20 | 11.9% | 11.1% | 11.5% | 11.8% | 11.5% | 11.8% | 9.2% | 10.8% | 12.8% | 10.9% | 0.645 |
Mother’s age:20–34 | 71.6% | 73.4% | 73.8% | 74.2% | 73.0% | 72.0% | 73.2% | 75.3% | 72.8% | 73.1% | 0.972 |
Mother’s age: > 34 | 16.5% | 15.6% | 14.7% | 14.0% | 15.5% | 16.2% | 17.5% | 13.9% | 14.4% | 16.0% | 0.721 |
Monogamously married | 56.2% | 57.0% | 61.3% | 58.4% | 57.7% | 57.8% | 56.4% | 65.7% | 54.4% | 57.9% | 0.946 |
Polygamously married | 42.6% | 41.2% | 38.7% | 41.0% | 41.2% | 40.5% | 41.6% | 33.7% | 43.6% | 40.4% | 0.712 |
Never married | 0.3% | 0.5% | 0.0% | 0.6% | 0.4% | 0.6% | 1.0% | 0.6% | 1.5% | 0.9% | 0.107 |
Widowed or divorced | 0.9% | 1.3% | 0.0% | 0.0% | 0.7% | 1.2% | 1.0% | 0.0% | 0.5% | 0.8% | 0.806 |
CRR | 42.3% | 46.7% | 44.0% | 55.1% | 46.2% | 47.4% | 47.0% | 45.2% | 55.9% | 48.4% | 0.300 |
NBR West | 10.5% | 8.8% | 7.9% | 7.9% | 9.0% | 10.1% | 10.9% | 11.4% | 9.2% | 10.5% | 0.251 |
URR | 47.2% | 44.5% | 48.2% | 37.1% | 44.8% | 42.5% | 42.1% | 43.4% | 34.9% | 41.1% | 0.083 |
Ethnicity: Mandinka/ Jahanka | 23.0% | 46.7% | 23.0% | 30.3% | 32.6% | 15.6% | 45.3% | 28.3% | 33.8% | 31.6% | 0.597 |
Ethnicity: Fula/Tukolor | 17.0% | 14.8% | 21.5% | 19.7% | 17.4% | 16.2% | 13.1% | 15.7% | 17.9% | 15.3% | 0.173 |
Ethnicity: Wolof | 20.7% | 9.8% | 31.4% | 24.7% | 19.3% | 28.9% | 14.6% | 34.9% | 28.2% | 24.4% | 0.003 |
Ethnicity: Sarahule | 35.8% | 26.4% | 20.4% | 19.7% | 27.3% | 37.0% | 22.9% | 18.1% | 17.4% | 25.6% | 0.369 |
Ethnicity: Other | 3.4% | 2.3% | 3.7% | 5.6% | 3.4% | 2.3% | 4.1% | 3.0% | 2.6% | 3.1% | 0.724 |
Average Number of Children Ever Born | 3.9 | 4.0 | 3.9 | 3.9 | 3.9 | 4.0 | 4.2 | 3.8 | 4.2 | 4.1 | 0.146 |
Average Number of Children Surviving | 3.6 | 3.6 | 3.6 | 3.7 | 3.6 | 3.7 | 3.8 | 3.5 | 3.9 | 3.8 | 0.180 |
Outcome Variables of Interest | |||||||||||
Referred to Delivery | 15.5% | 14.4% | 14.3% | 14.1% | 14.7% | 24.2% | 27.8% | 31.5% | 44.6% | 30.2% | 0.000 |
Accompanied to Delivery | 12.9% | 17.0% | 14.3% | 20.3% | 15.8% | 26.5% | 32.5% | 38.2% | 48.2% | 34.2% | 0.000 |
Transported to delivery | 4.3% | 6.9% | 6.3% | 4.0% | 5.5% | 12.5% | 11.1% | 18.2% | 23.8% | 14.8% | 0.000 |
Institutional Delivery | 56.2% | 57.3% | 55.0% | 66.7% | 58.1% | 55.7% | 57.9% | 64.2% | 63.4% | 59.1% | 0.620 |
Skilled birth attendence | 43.0% | 47.0% | 45.0% | 48.0% | 45.6% | 61.7% | 61.8% | 66.1% | 63.4% | 62.7% | 0.000 |
Community birth companion | 43.8% | 42.4% | 43.4% | 45.2% | 43.5% | 28.7% | 31.0% | 26.7% | 27.8% | 29.1% | 0.000 |
Skilled delivery at facility | 21.2% | 20.1% | 20.1% | 15.8% | 19.7% | 51.0% | 45.8% | 54.5% | 54.6% | 50.3% | 0.000 |
N | 352 | 398 | 191 | 178 | 1119 | 346 | 411 | 166 | 195 | 1118 |
Variables | Referred to delivery | Accompanied to delivery | Transported to delivery |
---|---|---|---|
Facility-based intervention only | 0.0401 | 0.015 | −0.0468 |
(0.053) | (0.052) | (0.039) | |
Community-based intervention only | 0.0783* | 0.0947** | 0.029 |
(0.038) | (0.037) | (0.047) | |
Facility-based intervention plus community-based intervention | 0.198** | 0.114 | 0.102** |
(0.083) | (0.068) | (0.045) | |
Time trend (midline dummy) | 0.0974*** | 0.144*** | 0.0894*** |
(0.027) | (0.031) | (0.029) | |
Constant (mean at baseline in control area) | 0.145*** | 0.158*** | 0.0545*** |
(0.014) | (0.013) | (0.009) | |
Observations | 2211 | 2211 | 2211 |
R-squared | 0.152 | 0.161 | 0.13 |
Variables | Community birth companion | Facility delivery | Skilled delivery at facility |
---|---|---|---|
Facility-based intervention only | 0.0541 | 0.0025 | −0.0496 |
(0.073) | (0.055) | (0.083) | |
Community-based intervention only | 0.0122 | 0.0644 | 0.00254 |
(0.062) | (0.076) | (0.080) | |
Facility-based intervention plus community-based intervention | −0.00747 | −0.0504 | 0.0686 |
(0.092) | (0.086) | (0.094) | |
Time trend (midline dummy) | −0.163*** | 0.00987 | 0.322*** |
(0.055) | (0.045) | (0.053) | |
Constant (mean at baseline in control area) | 0.434*** | 0.580*** | 0.192*** |
(0.018) | (0.013) | (0.020) | |
Observations | 2214 | 2214 | 2214 |
R-squared | 0.185 | 0.243 | 0.231 |
Understanding factors affecting each ‘delay’
Baseline Only | Baseline and Midline | Midline Only | |
---|---|---|---|
Delay 1 | • Concealment of labor | • Preference for home delivery • Limited knowledge of delivery indications • Delay in informing others after labor onset | • Reluctance to be delivered by a male midwife |
Delay 2 | • Lengthy care seeking processa • Commencement of labor at night or after rain • Lack of effective available transportation • Cost of transportation • Long transport times | ||
Delay 3 | • Inattentive staff | • Drug stock outs | • Minimal delays • Improved quality of care |