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A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal

Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers...

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Autores principales: Tiwari, Aparna, Thapa, Aradhana, Choudhury, Nandini, Khatri, Rekha, Sapkota, Sabitri, Wu, Wan-Ju, Halliday, Scott, Citrin, David, Schwarz, Ryan, Maru, Duncan, Rayamazi, Hari Jung, Paudel, Rashmi, Bhatt, Laxman Datt, Bhandari, Ved, Marasini, Nutan, Khadka, Sonu, Bogati, Bhawana, Saud, Sita, Kshetri, Yashoda Kumari Bhat, Bhatta, Aasha, Magar, Kshitiz Rana, Shrestha, Ramesh, Kafle, Ranjana, Poudel, Roshan, Gautam, Samiksha, Basnett, Indira, Shrestha, Goma Niroula, Nirola, Isha, Adhikari, Samrachana, Thapa, Poshan, Kunwar, Lal, Maru, Sheela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021605/
https://www.ncbi.nlm.nih.gov/pubmed/36963046
http://dx.doi.org/10.1371/journal.pgph.0001512
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author Tiwari, Aparna
Thapa, Aradhana
Choudhury, Nandini
Khatri, Rekha
Sapkota, Sabitri
Wu, Wan-Ju
Halliday, Scott
Citrin, David
Schwarz, Ryan
Maru, Duncan
Rayamazi, Hari Jung
Paudel, Rashmi
Bhatt, Laxman Datt
Bhandari, Ved
Marasini, Nutan
Khadka, Sonu
Bogati, Bhawana
Saud, Sita
Kshetri, Yashoda Kumari Bhat
Bhatta, Aasha
Magar, Kshitiz Rana
Shrestha, Ramesh
Kafle, Ranjana
Poudel, Roshan
Gautam, Samiksha
Basnett, Indira
Shrestha, Goma Niroula
Nirola, Isha
Adhikari, Samrachana
Thapa, Poshan
Kunwar, Lal
Maru, Sheela
author_facet Tiwari, Aparna
Thapa, Aradhana
Choudhury, Nandini
Khatri, Rekha
Sapkota, Sabitri
Wu, Wan-Ju
Halliday, Scott
Citrin, David
Schwarz, Ryan
Maru, Duncan
Rayamazi, Hari Jung
Paudel, Rashmi
Bhatt, Laxman Datt
Bhandari, Ved
Marasini, Nutan
Khadka, Sonu
Bogati, Bhawana
Saud, Sita
Kshetri, Yashoda Kumari Bhat
Bhatta, Aasha
Magar, Kshitiz Rana
Shrestha, Ramesh
Kafle, Ranjana
Poudel, Roshan
Gautam, Samiksha
Basnett, Indira
Shrestha, Goma Niroula
Nirola, Isha
Adhikari, Samrachana
Thapa, Poshan
Kunwar, Lal
Maru, Sheela
author_sort Tiwari, Aparna
collection PubMed
description Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers to achieving universal health coverage. Gaps remain, however, in understanding whether evidence-based interventions delivered by CHWs, closely aligned with WHO recommendations, are effective in Nepal’s context. We conducted a type II hybrid effectiveness-implementation, mixed-methods study in two rural districts in Nepal to evaluate the effectiveness and the implementation of an evidence-based integrated maternal and child health intervention delivered by CHWs, using a mobile application. The intervention was implemented stepwise over four years (2014–2018), with 65 CHWs enrolling 30,785 families. We performed a mixed-effects Poisson regression to assess institutional birth rate (IBR) pre-and post-intervention. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the implementation during and after the study completion. There was an average 30% increase in IBR post-intervention, adjusting for confounding variables (p<0.0001). Study enrollment showed 35% of families identified as dalit, janjati, or other castes. About 78–89% of postpartum women received at least one CHW-counseled home visit within 60 days of childbirth. Ten (53% of planned) municipalities adopted the intervention during the study period. Implementation fidelity, measured by median counseled home visits, improved with intervention time. The intervention was institutionalized beyond the study period and expanded to four additional hubs, albeit with adjustments in management and supervision. Mechanisms of intervention impact include increased knowledge, timely referrals, and longitudinal CHW interaction. Full-time, supervised, and trained CHWs delivering evidence-based integrated care appears to be effective in improving maternal healthcare in rural Nepal. This study contributes to the growing body of evidence on the role of community health workers in achieving universal health coverage.
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spelling pubmed-100216052023-03-17 A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal Tiwari, Aparna Thapa, Aradhana Choudhury, Nandini Khatri, Rekha Sapkota, Sabitri Wu, Wan-Ju Halliday, Scott Citrin, David Schwarz, Ryan Maru, Duncan Rayamazi, Hari Jung Paudel, Rashmi Bhatt, Laxman Datt Bhandari, Ved Marasini, Nutan Khadka, Sonu Bogati, Bhawana Saud, Sita Kshetri, Yashoda Kumari Bhat Bhatta, Aasha Magar, Kshitiz Rana Shrestha, Ramesh Kafle, Ranjana Poudel, Roshan Gautam, Samiksha Basnett, Indira Shrestha, Goma Niroula Nirola, Isha Adhikari, Samrachana Thapa, Poshan Kunwar, Lal Maru, Sheela PLOS Glob Public Health Research Article Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers to achieving universal health coverage. Gaps remain, however, in understanding whether evidence-based interventions delivered by CHWs, closely aligned with WHO recommendations, are effective in Nepal’s context. We conducted a type II hybrid effectiveness-implementation, mixed-methods study in two rural districts in Nepal to evaluate the effectiveness and the implementation of an evidence-based integrated maternal and child health intervention delivered by CHWs, using a mobile application. The intervention was implemented stepwise over four years (2014–2018), with 65 CHWs enrolling 30,785 families. We performed a mixed-effects Poisson regression to assess institutional birth rate (IBR) pre-and post-intervention. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the implementation during and after the study completion. There was an average 30% increase in IBR post-intervention, adjusting for confounding variables (p<0.0001). Study enrollment showed 35% of families identified as dalit, janjati, or other castes. About 78–89% of postpartum women received at least one CHW-counseled home visit within 60 days of childbirth. Ten (53% of planned) municipalities adopted the intervention during the study period. Implementation fidelity, measured by median counseled home visits, improved with intervention time. The intervention was institutionalized beyond the study period and expanded to four additional hubs, albeit with adjustments in management and supervision. Mechanisms of intervention impact include increased knowledge, timely referrals, and longitudinal CHW interaction. Full-time, supervised, and trained CHWs delivering evidence-based integrated care appears to be effective in improving maternal healthcare in rural Nepal. This study contributes to the growing body of evidence on the role of community health workers in achieving universal health coverage. Public Library of Science 2023-01-24 /pmc/articles/PMC10021605/ /pubmed/36963046 http://dx.doi.org/10.1371/journal.pgph.0001512 Text en © 2023 Tiwari et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tiwari, Aparna
Thapa, Aradhana
Choudhury, Nandini
Khatri, Rekha
Sapkota, Sabitri
Wu, Wan-Ju
Halliday, Scott
Citrin, David
Schwarz, Ryan
Maru, Duncan
Rayamazi, Hari Jung
Paudel, Rashmi
Bhatt, Laxman Datt
Bhandari, Ved
Marasini, Nutan
Khadka, Sonu
Bogati, Bhawana
Saud, Sita
Kshetri, Yashoda Kumari Bhat
Bhatta, Aasha
Magar, Kshitiz Rana
Shrestha, Ramesh
Kafle, Ranjana
Poudel, Roshan
Gautam, Samiksha
Basnett, Indira
Shrestha, Goma Niroula
Nirola, Isha
Adhikari, Samrachana
Thapa, Poshan
Kunwar, Lal
Maru, Sheela
A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title_full A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title_fullStr A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title_full_unstemmed A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title_short A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
title_sort type ii hybrid effectiveness-implementation study of an integrated chw intervention to address maternal healthcare in rural nepal
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021605/
https://www.ncbi.nlm.nih.gov/pubmed/36963046
http://dx.doi.org/10.1371/journal.pgph.0001512
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