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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Published in:PLOS global public health 2023, Vol.3 (1), p.e0001512-e0001512
Main Authors: 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
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Language:English
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Summary: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
ISSN:2767-3375
2767-3375
DOI:10.1371/journal.pgph.0001512