Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia

Abstract

AbstractIntroductionCommunity-based newborn care (CBNC) is an effective and efficient public health intervention that has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn death. But Ethiopian neonatal mortality rate is among the highest in the world. “Why neonatal mortality still high despite the existence of such effective interventions?” is the question. Thus, authors hypothesize that whether the designed intervention is effectively implemented or not is not known. Therefore, the aim of this study is to investigate community-based newborn care intervention fidelity and its implementation drivers.MethodsMulticenter community-based cross-sectional study mixed with phenomenological qualitative design was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts were used to evaluate CBNC. 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.ResultCBNC intervention fidelity was 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.ConclusionThe CBNC intervention fidelity was too low to 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.