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Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east
Asressie Molla1, Solomon Mekonnen2, Kassahun Alemu3
1Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Insights
Community-based newborn care (CBNC) in Ethiopia showed very low intervention fidelity at 4.5%, indicating a significant implementation gap. Key barriers included lack of feedback, training, and resources, hindering efforts to reduce high newborn mortality rates.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Services Research
Background:
- Ethiopia faces high neonatal mortality rates despite implementing community-based newborn care (CBNC).
- The effectiveness of CBNC interventions is questioned due to potential implementation gaps.
- Understanding intervention fidelity and its drivers is crucial for improving newborn survival.
Purpose of the Study:
- To investigate the fidelity of the community-based newborn care (CBNC) intervention in Ethiopia.
- To identify factors that facilitate or hinder the effective implementation of CBNC.
Main Methods:
- A multicenter, community-based mixed-method study involving 898 postpartum women and 16 health extension workers (HEWs).
- Quantitative data collected via questionnaires and facility audits; qualitative data from in-depth interviews with HEWs.
- Intervention fidelity calculated as a composite index; multilevel linear regression and interpretative phenomenological analysis used.
Main Results:
- CBNC intervention fidelity was critically low at 4.5%, with only two women receiving full fidelity care.
- Overall CBNC coverage was 38.4%; only 8.1% received recommended frequency and 1.5% recommended content.
- HEW knowledge of danger signs facilitated fidelity, while lack of feedback, training, support, and supplies were significant barriers.
Conclusions:
- The CBNC intervention in Ethiopia is not being implemented as intended, resulting in a substantial implementation gap.
- Low fidelity suggests that current strategies are insufficient to achieve desired reductions in newborn mortality.
- Addressing identified barriers, including improving support systems and resource availability, is essential for enhancing CBNC effectiveness.
Abstract:
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.
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