Authors: Peter Smittenaar, B.M. Ramesh, Mokshada Jain, James Blanchard, Hannah Kemp, Elisabeth Engl, Shajy Isac, John Anthony, Ravi Prakash, Vikas Gothalwal, Vasanthakumar Namasivayam, Pankaj Kumar, Sema K. Sgaier
Community health workers (CHWs) play a key role in the health of mothers and newborns in low- and middleincome countries. However, it remains unclear by what actions and messages CHWs enable good outcomes and respectful care.
We collected a uniquely linked set of questions on behaviors, beliefs, and care pathways from recently delivered women (n=5,469), their husbands (n=3,064), mothers-in-law (n=3,626), and CHWs (accredited social health activists; n=1,052) in Uttar Pradesh, India. We used logistic regression to study associations between CHW actions and household behaviors during antenatal, delivery, and postnatal periods.
Pregnant women who were visited earlier in pregnancy and who received multiple visits were more likely to perform recommended health behaviors including attending multiple checkups, consuming iron and folic acid tablets, and delivering in a health facility (ID), compared to women visited later or receiving fewer visits, respectively. Counseling the woman was associated with higher likelihood of attending 3þ checkups and consuming 100þ iron and folic acid tablets, whereas counseling the husband and mother-in-law was associated with higher rates of ID. Certain behavior change messages, such as the danger of complications, were associated with more checkups and ID, but were only used by 50%–80% of CHWs. During delivery, 57% of women had the CHW present, and their presence was associated with respectful care, early initiation of breastfeeding, and exclusive breastfeeding, but not with delayed bathing or clean cord care. The newborn was less likely to receive delayed bathing if the CHW incorrectly believed that newborns could be bathed soon after birth (which is believed by 30% of CHWs). CHW presence was associated with health behaviors more strongly for home than facility deliveries. Home visits after delivery were associated with higher rates of clean cord care and exclusive breastfeeding. Counseling the mother-in-law (but not the husband or woman) was associated with exclusive breastfeeding.
We identified potential ways in which CHW impact could be improved, specifically by emphasizing the importance of home visits, which household members are targeted during these visits, and what messages are shared. Achieving this change will require training CHWs in counseling and behavior change and providing supervision and modern tools such as apps that can help the CHW keep track of her beneficiaries, suggest behavior change strategies, and direct attention to households that stand to gain the most from support.
Under the Uttar Pradesh Routine Immunization Strengthening Project, UP TSU conducted a comprehensive community-based study to understand the coverage of routine immunization in 100 focused blocks of the state. This evidence brief highlights the findings from this rapid assessment survey to learn about the effective coverage, persisting gaps, and implementation opportunities to improve immunization coverage.
Under the Uttar Pradesh Routine Immunization Strengthening Project, UP TSU conducted a comprehensive community-based study to understand the coverage of routine immunization in 100 focused blocks of the state. This evidence brief brings out findings related to the impact on the progress of full immunization coverage with respect to the missed opportunities for co-administered vaccines.
Under the Uttar Pradesh Routine Immunization Strengthening Project, UP TSU conducted a comprehensive community-based study to understand the coverage of routine immunization in 100 focused blocks of the state. This evidence brief highlights the findings related to timeliness in vaccination using data from a rapid assessment survey to understand the timely coverage of the applicable vaccines included in the immunization schedule.