数字化赋能社区卫生和营养工作者能否改善向孕妇和婴幼儿母亲提供的服务？来自印度全国范围营养方案的准实验证据。

Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India.

机构信息

Center for Causal Research and Evaluations, NEERMAN, Mumbai, India

Center for Causal Research and Evaluations, NEERMAN, Mumbai, India.

出版信息

BMJ Glob Health. 2022 Jul;6(Suppl 5). doi: 10.1136/bmjgh-2021-007298.

BACKGROUND

India's 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes-(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months.

METHODS

We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5-9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages.

RESULTS

Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices.

CONCLUSION

The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers.

TRIAL REGISTRATION NUMBER

ISRCTN83902145.

背景

印度有 140 万社区卫生和营养工作者（CHNWs），在综合儿童发展服务（ICDS）计划下为 1.58 亿受益人提供服务。我们评估了为 CHNWs 开发的数据采集、决策支持和工作辅助移动应用程序对两个主要结果的影响：（1）家访的及时性；（2）针对孕妇和 12 个月以下儿童需求的适当咨询。

方法

我们使用准实验配对对照试验，使用重复的横断面调查，分别在比哈尔邦和中央邦（MP）使用意向治疗分析进行干预评估。该研究的目的是检测干预措施对孕妇和 12 个月以下儿童的母亲的影响，结果为 5-9 个百分点（pp），Ⅰ型错误为 0.05，Ⅱ型错误为 0.20，最终样本为 6635 名 12 个月以下儿童的母亲和 2398 名孕妇，样本来自 841 个村庄的面板。

结果

在孕妇和 12 个月以下儿童的母亲中，根据 ICDS 指南回忆特定于妊娠或儿童年龄的咨询内容的比例在 MP（11.5pp（95%CI 7.0pp 至 16.0pp））和比哈尔邦（8.0pp（95%CI 5.3pp 至 10.7pp））均更高。接受足够数量家访的 12 个月以下儿童的母亲比例也有显著差异（MP：8.3pp（95%CI 4.1pp 至 12.5pp），比哈尔邦：7.9pp（95%CI 4.1pp 至 11.6pp））。在比哈尔邦，接受生长监测的儿童人数有所增加（22pp（95%CI 0.18 至 0.25）），但在 MP 没有观察到这种效果。婴儿和幼儿喂养实践没有观察到影响。