Molla Asressie, Mekonnen Solomon, Alemu Kassahun, Tigabu Zemene, Gebeyehu Abebaw
Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
PLOS Glob Public Health. 2023 Aug 11;3(8):e0001168. doi: 10.1371/journal.pgph.0001168. eCollection 2023.
Community-based newborn care (CBNC) has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn mortality. However, neonatal mortality rate in Ethiopian is among the highest in the world. Why neonatal mortality remains high in the face of such effective interventions is the issue. As a result, the authors claim that it is unknown whether the planned intervention is carried out effectively or not. The purpose of this study was to investigate the fidelity of community-based newborn care intervention and its implementation drivers. Multicenter community-based mixed method study was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts to evaluate CBNC intervention fidelity. Structured questionnaire and facility audit checklist was used to collect quantitative data. In-depth interview technique was used to explore lived experiences of HEWs on CBNC implementation. CBNC intervention fidelity was computed as a composite index of the product of program coverage, frequency and contents. Multilevel linear regression model with adjusted β-coefficients at P-value of 0.05 and a 95% confidence interval (CI) were used to declare a significant relation between CBNC intervention fidelity and its implementation drivers. Interpretative phenomenological analysis was employed for qualitative data analysis. CBNC intervention fidelity was found to be 4.5% (95% CI: 3.6-5.4) with only two women received the intervention with full fidelity. The overall CBNC intervention coverage was 38.4% (95% CI: 35.2-41.6). Only 8.1% and 1.5% of women received all CBNC interventions with recommended frequency and content, respectively. HEWs knowledge of danger sign was significant facilitator while lack of: health center's feedback, related short-term training, health development army support, health center staff's technical assistance to HEWs and shortage of medical equipment supply were barriers for CBNC intervention fidelity. In conclusion the CBNC intervention fidelity was too low in this study. This indicates that CBNC intervention package was not implemented as envisioned implying an implementation gap. All implementation drivers were poorly implemented to result in improved fidelity and intervention outcomes.
埃塞俄比亚已在孕产妇、新生儿和儿童健康连续护理过程中实施了基于社区的新生儿护理（CBNC），目标是降低新生儿死亡率。然而，埃塞俄比亚的新生儿死亡率位居世界前列。面对如此有效的干预措施，新生儿死亡率为何仍然居高不下，这才是问题所在。因此，作者声称，尚不清楚计划中的干预措施是否得到有效实施。本研究的目的是调查基于社区的新生儿护理干预措施的保真度及其实施驱动因素。对898名产后妇女、16名健康推广工作者（HEW）和10个卫生站进行了多中心基于社区的混合方法研究，以评估CBNC干预措施的保真度。使用结构化问卷和机构审核清单收集定量数据。采用深入访谈技术来探究健康推广工作者在实施CBNC方面的实际经历。CBNC干预保真度通过项目覆盖率、频率和内容乘积的综合指数来计算。使用具有调整后β系数（P值为0.05）和95%置信区间（CI）的多级线性回归模型来表明CBNC干预保真度与其实施驱动因素之间的显著关系。采用解释性现象学分析进行定性数据分析。发现CBNC干预保真度为4.5%（95%CI：3.6 - 5.4），只有两名妇女完全按照保真度接受了干预。CBNC干预的总体覆盖率为38.4%（95%CI：35.2 - 41.6）。分别只有8.1%和1.5%的妇女按照推荐的频率和内容接受了所有CBNC干预措施。健康推广工作者对危险信号的了解是重要的促进因素，而缺乏健康中心的反馈、相关短期培训、健康发展军的支持、健康中心工作人员对健康推广工作者的技术援助以及医疗设备供应短缺是CBNC干预保真度的障碍。总之，本研究中CBNC干预保真度过低。这表明CBNC干预方案并未按预期实施，意味着存在实施差距。所有实施驱动因素的实施效果都很差，无法提高保真度和干预效果。
