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It seems obvious - improving the survival of mothers and newborns depends on life-saving interventions reaching those in need. The reality of what works and why, however, doesn’t seem to be quite as simple.

Do we need to pay more attention to the quality of health care visits over how many visits are taking place in low resource settings? Is it an increase in the number of times a health care worker sees a family or an improvement in the care delivered that really makes the difference?

A paper published in PLOS ONE, authored by Dr Elizabeth Allen et al, points to the importance of increases in both the number of contacts and improvements in quality of care – not either or. Using data from household and health facility surveys in Ethiopia, the team found that for interventions that can be delivered at multiple visits such as antenatal vaccinations, increasing the number of contacts had the strongest association with increased coverage of life saving interventions. But for those relying on a single point of contact, such as those delivered at birth, the paper finds strong evidence for investment in both increasing contacts and improving quality of care.

Ethiopia is a country with ambitious targets to reduce maternal and newborn mortality. The government’s “Health Sector Transformation Plan” specifically targets improvement in the quality of care provided to mothers and newborns in addition to enhancing demand and increasing availability. Evidence from Ethiopia can therefore provide important insights into the relationship between changes in contacts, quality and intervention coverage for mothers and newborns. Using linked household survey data and skilled birth attendant interviews from four regions of Ethiopia collected in 2012 and in 2015, the study aimed to strengthen the evidence base on the importance of quality of contacts between families and health workers in addition to the role of the number of contacts alone.


Profile picture of Professor Elizabeth Allen
Professor Elizabeth Allen

Professor in Medical Statistics

Profile picture of Dr Della Berhanu
Dr Della Berhanu

Assistant Professor

Profile picture of Professor Tanya Marchant
Professor Tanya Marchant

IDEAS Principal Investigator and Professor

Professor Simon Cousens

Professor of Epidemiology and Medical Statistics

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