Assessing Combined Longitudinal Mentorship and Skills Training on Select Maternal and Neonatal Outcomes in Rural and Urban Health Facilities in Malawi

Abstract

Introduction: Despite successful efforts to improve clinical access and skilled birth attendance in Malawi, it still faces high rates of maternal and neonatal mortality. In 2017, the UCSF-GAIN partnership began a nurse-midwifery clinical education and longitudinal mentorship program. While it has received positive reviews, it is unclear whether routinely collected indicators can assess such a program’s impact. Method: A longitudinal review of the Malawian DHIS2 database explored variables associated with maternal and newborn care and outcomes before and after the intervention. Data were analyzed using generalized estimating equations (GEE) to account for facility-level correlations over time. Results: Quality issues with DHIS2 data were identified. Significant changes potentially associated with the GAIN intervention were noted. Discussion: The GAIN approach appears to be associated with positive trends in maternal and neonatal care. National summary databases are problematic, however, for evaluating targeted interventions and the provision of care to specific outcomes.