학술논문
A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal
Document Type
article
Author
Aparna Tiwari; Aradhana Thapa; Nandini Choudhury; Rekha Khatri; Sabitri Sapkota; Wan-Ju Wu; Scott Halliday; David Citrin; Ryan Schwarz; Duncan Maru; Hari Jung Rayamazi; Rashmi Paudel; Laxman Datt Bhatt; Ved Bhandari; Nutan Marasini; Sonu Khadka; Bhawana Bogati; Sita Saud; Yashoda Kumari Bhat Kshetri; Aasha Bhatta; Kshitiz Rana Magar; Ramesh Shrestha; Ranjana Kafle; Roshan Poudel; Samiksha Gautam; Indira Basnett; Goma Niroula Shrestha; Isha Nirola; Samrachana Adhikari; Poshan Thapa; Lal Kunwar; Sheela Maru
Source
PLOS Global Public Health, Vol 3, Iss 1 (2023)
Subject
Language
English
ISSN
2767-3375
Abstract
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