Integrated group antenatal and pediatric care in Haiti: A comprehensive care accompaniment model

Abstract

AbstractIntroductionThe J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes.MethodologyWe conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais. Quantitative data was collected retrospectively to compare dyads receiving J9 care to usual care. A secondary analysis of qualitative data described patient perspectives of J9 care.ResultsAntenatal care attendance was significantly higher among women in J9 (n=524) compared to usual care (n=523), with 490(93%) and 189(36%) having >4 visits, respectively; p <0.001, as was post-partum visit attendance [268(51%) compared to 82(16%), p<0.001] and use of post-partum family planning methods [99(19%) compared to 47(9%), p=0.003]. Incidence of severe pre-eclampsia was significantly lower in the J9 group [44(9%)] compared to the usual care group [74(14%)], p <0.001. Maternal and neonatal mortality and low birth weight did not differ across groups, but with earlier interventions, cesarean delivery [103(20%) and 82(16%), p<0.001] and preterm birth [169 (34%)] and 128 (27%), p=0.041] were higher in the J9 group compared to usual care, respectively. In the qualitative analysis, ease of access to high-quality care, meaningful social support, and maternal empowerment through education were identified as key contributors to these outcomes.ConclusionCompared to usual care, the J9 Plus maternal-child accompaniment model of care is associated with increased engagement in antenatal and postpartum care, increased utilization of post-partum family planning, and lower rates of severe pre-eclampsia, which remains a leading cause of maternal mortality in Haiti. The J9 accompaniment approach to care is an empowering model that has the potential to be replicated in similar settings to improve quality of care and outcomes globally.