A clustered randomized control trial to assess feasibility, acceptability, and impact of implementing the birth companion intervention package in Ethiopia, Kenya, and Nigeria: study protocol.

BACKGROUND: A birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions. METHODS: This two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang'a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country. DISCUSSION: Ample evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings. TRIAL REGISTRATION: Trial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022.

Quality and use of IMNCI services at health center under-five clinics after introduction of integrated community-based case management (ICCM) in three regions of Ethiopia.

BACKGROUND: The Integrated Management of New born and Childhood Illness (IMNCI) and the related Integrated Community Case Management (iCCM) are evidence-based strategies to reduce childhood mortality in Ethiopia at health centres and community health posts, respectively. The effect of introducing iCCM on IMNCI is not known. OBJECTIVE: To assess the caseload and quality of lMNCI service in under-five clinics in health centres after iCCM implementation. METHODS: This cross-sectional study used register review to assess the IMNCI service use (before and after iCCM, in 2010 and 2012, respectively) and quality throughout the period in randomly selected health centers in three regions of the Integrated Family Health Program (Oromia, SNNPR [Southern Nations and Nationalities and Peoples Region] and Tigray). RESULTS: Caseload of sick children at 28 health centers increased by 16% after iCCM implementation (21,443 vs. 24,882 children in 2010 and 2012, respectively. The consistency of IMNVCI treatment with classification for pneumonia, diarrhea and malaria was low (78, 45, and 67%, respectively) compared to iCCM treatment (86, 80, and 91%, respectively). CONCLUSION: Health center case load increased modestly after iCCM was introduced, but was lower than expected, even when combined with health post use from other studies. The demand strategy for sick children needs review. The quality of IMNCI needs improving even to bring it to the quality of iCCM at health posts, as measured by the same methods. Successful quality assurance approaches from iCCM, e.g., the Performance Review and Clinical Mentoring Meeting, could be adapted for IMNCI.

Effect of integrated community case management of common childhood illnesses on the quality of malaria case management provided by health extension workers at health posts.

INTRODUCTION: The Integrated Family Health Program supported the government of Ethiopia to implement the Integrated Community Case Management (iCCM) strategy to control childhood illness of which malaria is a major cause. OBJECTIVE: To assess the effect of ICCM training on quality of malaria case management at health posts. METHODS: . A comparative cross-sectional study was conducted among 170 Health Extension Workers (HEW) providing either integrated or vertical malaria case management for children less than five years of age in 14 woredas (districts) of West Hararghe Zone using a multi-stage sampling procedure. HEWs in seven intervention woredas were trained in malaria case management and rapid diagnostic test (RDT) procedures through iCCM, and HEWs in comparison woredas were trained vertically through the national malaria control program. Performance was assessed using interview, review of registers, and observation of RDT procedure. RESULTS: Intervention HEWs performed better than their counterparts in correct drug prescription (90.8 vs. 81.0%, p = 0.03), treatment duration (97.7 vs. 89.9%, p = 0.001), and treatment schedule (95.4 vs. 75.9%, p = 0.000). Intervention HEWs recorded case management with more consistency than their counterparts (≥ 80% consistency between: classification and assessment [23.0 vs. 3.8%; p = 0.000], classification and treatment [24.1 vs. 7.6%; p = 0.003], and classification and follow up [24.1% vs. 0.0%; p = 0.000]); however, there is room for improvement. CONCLUSION: ICCM training has a positive effect on the quality of malaria case management at the community level.

A descriptive study of the changes in coverage of preventive and promotive interventions before and after the introduction of integrated community case management (ICCM) in Ethiopia.

BACKGROUND: The effect of integrated community case management (iCCM) of common childhood illness on use of vital preventive services is not known. OBJECTIVE: To measure the coverage of maternal and child health preventive and promotive interventions before and after scaling up iCCM. METHODS: In 2011 and 2013, we conducted cross-sectional, population-based, household coverage surveys in four Integrated Family Health Program target regions: Amhara, Oromia, SNNP, and Tigray. RESULTS: Coverage increased for 10 of 15 indicators, mainly for maternal, immunization, and nutrition services. In some cases, we observed dramatic increases, i.e., for ≥ 4 antenatal care visits, antenatal iron and folate, and exclusive breastfeeding. Some increase occurred even when 2011 levels were already high, i.e., for immunization. Three indicators remained high and unchanged (bednet ownership, children sleeping under bednets, and any latrine). Two indicators decreased (tetanus toxoid and households with ≥ 2 bednets). CONCLUSION: Scale-up of iCCM was consistent with increased coverage of most preventative and promotive interventions, which may contribute to the life-saving effect of iCCM.