Dinis Aneth, Augusto Orvalho, Fernandes Quinhas, Birru Ermyas, Etzioni Ruth, Gimbel Sarah, Gloyd Stephen, Ramiro Isaías, Gremu Artur, John-Stewart Grace, Wagenaar Bradley H, Weiner Bryan J, Chicumbe Sérgio, Sherr Kenneth
National Department of Public Health, Ministry of Health, Maputo City, Mozambique.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLOS Glob Public Health. 2025 May 12;5(5):e0004216. doi: 10.1371/journal.pgph.0004216. eCollection 2025.
Limited evidence exists on audit and feedback(A&F) in low-resource contexts. We tested the Integrated District Evidence-to-Action (IDEAs), a multicomponent A&F strategy in Mozambique's maternal and child health (MCH) services. IDEAs include A&F meetings, readiness assessments, and facility support. We report the effectiveness results. IDEAs were implemented in 2016-2020 across two provinces, 12 districts, and 154 primary health facilities in Mozambique. We assessed 1) ten service delivery outcomes across antenatal, maternity, postpartum, childcare, and reproductive health services and 2) five service readiness outcomes (medicines, infrastructure, equipment, care, and staffing availability). We used propensity score matching to minimize bias and a controlled interrupted time series with a negative binomial mixed effects model for service delivery analysis, presenting incidence rate ratios (IRR) with 95% confidence intervals (95% CI). For service readiness outcomes, we created composite scores for each domain and a difference-in-difference analysis using an ordinal mixed effects model, reporting odds ratios (OR) and 95% CI. Significant associations were found with first at-risk child appointments (IRR = 1.06 [1.04, 1.07]), first polymerase chain reaction tests for HIV-exposed children (IRR = 1.02 [1.01, 1.03]), new contraceptive users (IRR = 0.95 [0.94, 0.96]), women starting long-lasting contraceptives (IRR = 0.94 [0.93, 0.95]), availability of infrastructure (OR = 5.84 [1.32, 25.88]) and essential care (OR = 0.13 [0.03, 0.54]). No significant associations were found between IDEAs and six of 10 service delivery outcomes (women with a fourth dose of preventive malaria treatment; women protected with tetanus vaccine; women with four+ antenatal visits; deliveries with active management of the third stage of labor; first postpartum consultations and fully vaccinated children) and on medicine, equipment, and staffing availability. We observed mixed effectiveness in implementing IDEAs, with null and sub-optimal effects suggesting the need to refine and adapt strategy components to more effectively address clinical and readiness outcomes.
在资源匮乏的环境中，关于审核与反馈（A&F）的证据有限。我们在莫桑比克的母婴健康（MCH）服务中测试了综合地区证据转化为行动（IDEAs），这是一种多组件的A&F策略。IDEAs包括A&F会议、准备情况评估和机构支持。我们报告有效性结果。2016 - 2020年期间，IDEAs在莫桑比克的两个省份、12个地区和154个初级卫生机构实施。我们评估了1）产前、产妇、产后、儿童保健和生殖健康服务的10项服务提供结果，以及2）5项服务准备情况结果（药品、基础设施、设备、护理和人员配备）。我们使用倾向得分匹配来最小化偏差，并使用负二项混合效应模型进行控制中断时间序列分析以进行服务提供分析，呈现发病率比（IRR）及95%置信区间（95%CI）。对于服务准备情况结果，我们为每个领域创建综合得分，并使用有序混合效应模型进行差异分析，报告优势比（OR）及95%CI。发现与首次高危儿童预约（IRR = 1.06 [1.04, 1.07]）、暴露于HIV儿童的首次聚合酶链反应检测（IRR = 1.02 [1.01, 1.03]）、新的避孕药具使用者（IRR = 0.95 [0.94, 0.96]）、开始使用长效避孕药具的女性（IRR = 0.94 [0.93, 0.95]）、基础设施可用性（OR = 5.84 [1.32, 25.88]）和基本护理（OR = 0.13 [0.03, 0.54]）存在显著关联。在IDEAs与10项服务提供结果中的6项（接受第四剂预防性疟疾治疗的女性；接种破伤风疫苗的女性；进行四次及以上产前检查的女性；第三产程积极管理的分娩；首次产后咨询和完全接种疫苗的儿童）以及药品、设备和人员配备可用性之间未发现显著关联。我们观察到实施IDEAs的效果参差不齐，存在无效和次优效果，这表明需要完善和调整策略组件，以更有效地解决临床和准备情况结果。
