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Community-based health programs in parts of rural Nigeria, Ethiopia and India were successful in improving health care for mothers and newborns but inequities still exist, according to a new study in CMAJ (Canadian Medical Association Journal).

“Our findings have a both optimistic and pessimistic interpretation, in that families from all socioeconomic status groups benefited, but inequities have also persisted,” writes Dr. Tanya Marchant with coauthors.  Underlying inequities in these rural settings mean that more work is needed to reach the poorest families who bear the greatest burden of maternal and newborn mortality.

To assess the impact of community-based health interventions linked to the United Nations’ Sustainable Development Goals, an international team of researchers looked at eight essential maternal and newborn health indicators in rural Nigeria, Ethiopia and India, representing more than 22 million people. Indicators included antenatal and postnatal care, births in health care facilities, hygienic umbilical cord care, breastfeeding initiation and more. The researchers found some improvements, such as more women in Ethiopia and Uttar Pradesh, India, had access to maternity care in 2015 compared with 2012. In Gombe, Nigeria, socioeconomic issues as well as the Boko Haram threat prevented the majority of women from receiving adequate care, although some positive family behaviours showed marked improvement, such as hygienic cord care.

Despite this progress, it was striking that in all three settings the number of newborns receiving early postnatal care did not improve.

“Improving outcomes for mothers and newborns requires not only structural changes in the provision of care, but also behavior changes by individuals, communities and health care providers,” write the authors. “Such changes may take considerable time – longer than this study’s duration – to achieve.”

Researchers from the London School of Hygiene & Tropical Medicine, Ethiopian Public Health Institute, and JaRco Consulting, Ethiopia; Sambodhi Research and Communications Pvt. Ltd., India; and Data Research and Mapping Consult, Nigeria conducted the study.

 

Authors

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Dr Tanya Marchant

IDEAS Principal Investigator and Associate Professor

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Emma Beaumont

Research Fellow in Medical Statistics

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Dr Della Berhanu

Former IDEAS Ethiopia Country Coordinator and Research Fellow

Profile picture of Dr Meenakshi Gautham
Dr Meenakshi Gautham

IDEAS India Country Coordinator and Research Fellow

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Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Research Fellow

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Keith Tomlin

IDEAS Data Manager 2012 - 2017

Professor Simon Cousens

Professor of Epidemiology and Medical Statistics

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Professor Elizabeth Allen

Professor in Medical Statistics

Profile picture of Professor Joanna Schellenberg
Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor