Adams Alayne M, Nababan Herfina Y, Hanifi S M Manzoor Ahmed
Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Dhaka, Bangladesh.
PLoS One. 2015 Apr 24;10(4):e0123817. doi: 10.1371/journal.pone.0123817. eCollection 2015.
The beneficial influence of social networks on health and wellbeing is well-established. In poor urban settlements in Bangladesh, BRAC's Manoshi programme trains community health workers (CHWs) to support women through pregnancy, delivery and postpartum periods. This paper test the hypothesis that the introduction of CHWs as weak ties into the social networks of Manoshi members mediates improvements in maternal and neonatal health (MNH) best practices by providing support, facilitating ideational change, connecting mother to resources, and strengthening or countering the influence of strong ties.
1000 women who had given birth in the last three months were identified and interviewed as part of ongoing monitoring of 5 poor urban settlements in Dhaka, Bangladesh. A social networks questionnaire was administered which elicited women's perceived networks around pregnancy, delivery and post-partum periods. Mediation analysis was performed to test the hypothesis that penetration of Manoshi CHWs into women's perceived networks has a beneficial effect on MNH best practises.
The presence and influence of Manoshi CHWs in women's networks significantly mediated the effect of Manoshi membership on MNH best practices. Respondents who were Manoshi members and who listed Manoshi CHWs as part of their support networks were significantly more likely to deliver with a trained birth attendant (OR 3.61; 95%CI 2.36-5.51), to use postnatal care (OR 3.09; 95%CI 1.83-5.22), and to give colostrum to their newborn (OR 7.51; 95%CI 3.51-16.05).
Manoshi has succeeded in penetrating the perceived pregnancy, delivery and post-partum networks of poor urban women through the introduction of trained CHWs. Study findings demonstrate the benefits of moving beyond urban health care delivery models that concentrate on the provision of clinical services by medical providers, to an approach that nurtures the power of social networks as a means to support the poorest and most marginalized in changing behaviour and effectively accessing appropriate maternal services.
社交网络对健康和幸福的有益影响已得到充分证实。在孟加拉国贫困的城市住区，孟加拉农村发展委员会（BRAC）的“玛诺希”项目培训社区卫生工作者（CHW），以在妇女孕期、分娩期及产后为其提供支持。本文检验了这样一个假设，即通过作为弱关系将社区卫生工作者引入“玛诺希”成员的社交网络，通过提供支持、促进观念转变、将母亲与资源联系起来以及加强或抵消强关系的影响，可介导孕产妇和新生儿健康（MNH）最佳实践的改善。
作为对孟加拉国达卡5个贫困城市住区正在进行的监测的一部分，识别并采访了过去三个月内分娩的1000名妇女。发放了一份社交网络问卷，以了解妇女在孕期、分娩期及产后感知到的社交网络。进行中介分析以检验“玛诺希”社区卫生工作者渗透到妇女感知到的社交网络对孕产妇和新生儿健康最佳实践有有益影响这一假设。
“玛诺希”社区卫生工作者在妇女社交网络中的存在和影响显著介导了“玛诺希”成员身份对孕产妇和新生儿健康最佳实践的影响。将“玛诺希”社区卫生工作者列为其支持网络一部分的“玛诺希”成员受访者更有可能由经过培训的助产士接生（比值比3.61；95%置信区间2.36 - 5.51）、使用产后护理（比值比3.09；置信区间1.83 - 5.22）以及给新生儿喂初乳（比值比7.51；95%置信区间3.51 - 16.05）。
“玛诺希”通过引入经过培训的社区卫生工作者，成功渗透到贫困城市妇女感知到的孕期、分娩期及产后社交网络中。研究结果表明，超越专注于由医疗服务提供者提供临床服务的城市医疗服务模式，转向培育社交网络的力量，以此作为支持最贫困和最边缘化人群改变行为并有效获得适当孕产妇服务的一种方式，是有益的。
