ABSTRACT
Objective: A community dialogue intervention with an appreciative inquiry approach was undertaken to improve institutional delivery and child immunisation coverage in a hard-to-reach province, namely, Kandahar, in Afghanistan. This study aimed to evaluate the intervention's effectiveness in promoting institutional delivery and child immunisation. Study design: A pre-post intervention evaluation study. Methods: An intervention and a non-intervention district were selected in Kandahar. Children aged under 5 years participated in surveys at baseline (October 2018) and follow-up (Post-intervention: November 2019). We analysed age, sex, place of birth, and confirmed immunisation coverage data concerning 1046 and 927 children pre- and post-interventions, respectively. Changes in institutional delivery and confirmed immunisation status were evaluated using net intervention effect and difference-in-difference (DID) analysis. Results: Institutional delivery rates increased from 66.3% to 83.6% (p = 0.016) in the intervention district and decreased from 71.3% to 46.7% (p < 0.001) in the non-intervention district, with a net intervention effect of 41.9%. Full immunisation coverage among children aged 12-23 months and 24-35 months significantly increased from 26.4% to 76.9% (p < 0.001) and from 40.0% to 78.6% (p < 0.001), respectively, in the intervention district, whereas coverage significantly decreased in the non-intervention district. The net intervention effects were 59.1% and 44.8% for children aged 12-23 months and 24-35 months, respectively. The DID analysis also revealed significant differences in outcomes after intervention at follow-up. The results concerning antigen-specific immunisation coverage indicated a significant increase in immunisation coverage in the intervention district. Conclusions: The appreciative inquiry-based community dialogue intervention considerably increased institutional delivery and child immunisation coverage, even in a hard-to-reach province in Afghanistan.
