Better Together:The effect of timed and targeted counselling by community health workers on pregnancy outcomes in pregnant women and newborns in rural Uganda

In Uganda, many pregnant and lactating women experience difficulties to ensure their health and health of their newborns, which might eventually lead to increase mortality amongst this group. The Community health workers in rural Uganda are providing counseling and health education to households at particular time frames with pregnant and lactating women to ensure they perform life- saving actions and go to the health facility for services for them and their newborns. This in turn contributes to the survival of pregnant and lactating women and their newborns. Furthermore, the Ministry of health in Uganda and other African countries will use the generated knowledge from this research to improve health care and effective counseling for their community

The 13 UN Life-saving Commodities for Maternal, Newborn and Child Health: Knowledge, Attitudes and Practices in Uganda

Background: Life Saving Commodities (LSC) are medicines, medical devices and health supplies that effectively address leading avoidable causes of death during pregnancy, childbirth and childhood. In 2012 the United Nations put priority on globally promoting 13 priority LSC across the reproductive, maternal, newborn and child health (RMNCH) continuum of care. We assessed barriers to demand, access and utilization of these 13 LSC. Methods: This was a mixed methods cross-sectional study using both quantitative and qualitative approaches. The quantitative component was a health facility survey while the qualitative one was community-based. A blend of simple random and purposive sampling was undertaken to recruit study participants in four regions of Uganda. A total of 125 health facilities were surveyed and 513 people interviewed. Descriptive and bivariate analysis was done for quantitative data while the qualitative strand employed thematic analysis. This paper presents descriptive findings on knowledge, attitudes and practices (KAP) pertaining to the 13 LSC. Results: There was a variation in knowledge of LSC. Knowledge on child health commodities (ORS and Zinc) was higher among community members compared to the other commodities which are largely hospital-based (injectable antibiotics, antenatal corticosteroids, chlorhexidine, oxytocin, misoprostol and magnesium sulphate). Although health workers were knowledgeable on most LSC they also demonstrated limited comprehensive knowledge some, particularly those relating to reproductive and newborn health (48% and 42.4% respectively). For instance only 37.6% had comprehensive knowledge on management of preterm labour; only 44.8% health facilities had health workers knowledgeable on use of antenatal corticosteroids for preterm labour and only 30.4% reported to give antibiotics. Perceptions on some commodities, particularly the female condom and emergency contraception, were largely negative and health workers practiced selective recommendation or use. Explanatory factors for this could be traced at individual, household, community, facility and macro levels. Constrained by system-related issues like medicine stock-outs, majority of health workers were improvising and using available alternatives to LSC. Conclusion: The concept “lifesaving commodities” for maternal, newborn and child health was not well understood by both health workers as caregivers and community as service users. As a result they have not been demanded for, made available or utilized as originally intended. Alongside improved LSC availability, their overlooked, complementary nature and efficacy should continuously be emphasized to the various stakeholders for optimum results

Effects of Implementing the Timed and Targeted Counselling Model on Pregnancy Outcomes and Newborn Survival in Rural Uganda: Protocol for a Quasi-Experimental Study

BACKGROUND: Although mortality rates have declined in Uganda over the last decade, maternal mortality is still high at 336 deaths per 100,000 live births, as is infant mortality at 43 deaths per 1000 live births. One in every 19 babies born in Uganda does not live to celebrate their first birthday. Many of these deaths occur within the first 28 days of life, forming the single largest category of death. Promising effects for preventing death are expected from timed and targeted counselling (ttC), an intervention package of key messages and actions that address integrated health and nutrition needs of the mothers and children, barriers and negotiation agreement, to cause sustainable behavioural change at specific timelines in the first 1000 days. METHODS: The study has a quasi-experimental design in order to evaluate the implementation and effectiveness of the ttC intervention. Participants are pregnant women who have been registered by village health team (VHT) members and who live in Hoima (intervention region) or Masindi (control region) districts, who will be monitored throughout their pregnancy up to at least six weeks after delivery. A multi-stage sampling technique will be employed to select participants, the study sites being purposively chosen. Sample size is determined using the pregnancy rate from the population estimates, resulting in a total required sample of 1218 (609 each in the intervention and control group). Study instruments that will be used include the Ugandan VHT household register (in which all mothers to be studied will be registered), the ttC register (an additional tool for the study area), and a study questionnaire, to collect data at outcome level. Univariate, bivariate and multivariate analyses will be performed using SPSS to evaluate intervention effects on outcomes (e.g., relationship between pregnancy outcomes and antenatal attendance). In addition, quantitative findings will be triangulated with qualitative data, and collected through interviews and focus group discussions with participants and implementers. DISCUSSION: The proposed study will examine the effectiveness of implementing ttC to improve maternal and child outcomes in Uganda. If ttC is effective, broader implementation of appropriate antenatal services can be advised as essential newborn care improvements. TRIAL REGISTRATION: PACTR, PACTR202002812123868. Registered on 25 February 2020