JSI staff regularly publish their research and results from work in peer-reviewed journals. This section provides a brief abstract with a link to the journal where you can read more and either download or order the article, depending on the journal.
Correlates of the Women’s Development Army strategy implementation strength with household reproductive, maternal, newborn and child healthcare practices: a cross-sectional study in four regions of Ethiopia in BMC Pregnancy and Childbirth, 2018, 18 (Suppl 1) :373
To address the shortfall in human resources for health, Ethiopia launched the Health Extension Program (HEP) in 2004, establishing a health post with two female health extension workers (HEWs) in every kebele (community). In 2011, the Women’s Development Army (WDA) strategy was added, using networks of neighboring women to increase the efficiency of HEWs in reaching every household, with one WDA team leader for every 30 households. Through the strategy, women in the community, in partnership with HEWs, share and learn about health practices and empower one another. This study assessed the association between the WDA strategy implementation strength and household reproductive, maternal, newborn and child health care behaviors and practices.
The potential of community engagement to improve mother and child health in Ethiopia — what works and how should it be measured? in BMC Pregnancy and Childbirth, 2018, 18 (Suppl 1):366
Summary of papers included in BMC Pregnancy and Childbirth supplement "Community-based strategies to improve maternal and newborn health in Ethiopia"
Effects of a participatory community quality improvement strategy on improving household and provider health care behaviors and practices: a propensity score analysis in BMC Pregnancy and Childbirth, 2018, 18 (Suppl 1):364
Maternal and newborn health care intervention coverage has increased in many low-income countries over the last decade, yet poor quality of care remains a challenge, limiting health gains. The World Health Organization envisions community engagement as a critical component of health care delivery systems to ensure quality services, responsive to community needs. Aligned with this, a Participatory Community Quality Improvement (PCQI) strategy was introduced in Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten Kilometers Project (L10 K) Platform activities were supporting national Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening strategies. This paper examines the effects of the PCQI strategy in improving maternal and newborn care behaviors, and providers’ and households’ practices.
Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study in BMC Pregnancy and Childbirth, 2018, 18 (Suppl 1):359
Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women’s Development Army (WDA), was added to extend Ethiopia’s Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA’s Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy.
Nepal Scale up Chlorhexidine as Part of Essential Newborn Care: Country Experience in Journal of Nepal Health Research Council, Vol 16 No 3 (2018), Issue 40
Traditionally, most Nepali babies have been born at home—their umbilical cords often cut with dirty household tools, such as knives or sickles used in the fields. Using information handed down to them for generations, mothers would treat these freshly cut cords with turmeric, mustard oil paste or even cow dung. Infections were rampant, and many infants would die. Between 2011 and 2017, Nepal completed a nationwide scale-up of the use of chlorhexidine, a low cost antiseptic gel for cleaning umbilical cords, by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division with ongoing support from JSI and other partners. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. This journal article documents how chlorhexidine was successfully integrated into Nepal's health system at scale, and provides a road map for other countries with high neonatal mortality seeking to introduce and scale up this life-saving intervention.
Authors: Bikash Lamichhane, Leela Khanal, Parashu Ram Shrestha, Penny Dawson, Samikshya Singh
Loneliness in middle age and biomarkers of systemic inflammation: Findings from midlife in the United States in Social Schience & Medecine, Vol 209, pps 174-181, July 2018
Middle-aged adults who are lonely have an elevated likelihood of death. Systemic inflammation may contribute to these increased odds. Using population-level data, this study tested if systemic inflammation is associated with loneliness in a broad age range of middle-aged adults in the United States.
This study used data from the Midlife in the US (LIDUS) survey Biomarker Project, which collected data on psychological, social, and physiological measures from a sample of middle-age adults. Biomarkers were obtained from a fasting blood sample. Self-reported loneliness was categorized as feeling lonely or not feeling lonely. Hierarchical regressions examined the association between biomarkers of systemic inflammation (interleukin-6, fibrinogen, C-reactive protein) and feeling lonely, adjusted for covariates.
Twenty-nine percent of the sample reported feeling lonely most or some of the time. There was a positive significant relationship between loneliness and the three systemic inflammation biomarkers after controlling for covariates. The conclusion was that feeling lonely is associated with systemic inflammation in middle-aged community dwelling US adults.
Authors: Paula Nersesian, Hae-Ra Han, Gayane Yenokyan, Roger Blumenthal, Marie Nolan, Melissa Hladek, Sarah Szanton
Food Access and Its Relationship to Perceived Walkability, Safety, and Social Cohesion in Health Promotion Practice, June 2018
Understanding social inequalities in terms of neighborhood characteristics and the context to which individuals belong is important for reducing disparities. This article describes how perceptions of food access are related to three physical and social environmental factors: perceived neighborhood walkability, safety, and social cohesion. A cross-sectional survey was conducted of a random sample of 1,500 households in Springfield, Missouri. The main outcome measures were ease of purchase, affordability of fresh fruits and vegetables (FVs) and low-fat products (LFPs). Overall 63% of respondents reported consuming less than five serving of FVs daily in the past month. Most did agree is was easy to purchase FVs and LFPs. High walkability, low crime, and high social cohesion were significantly associated with having greater selection of FVs. Given that healthy food access is an important component to improving health outcomes, understanding how to alter environmental features that influence behaviors like eating is important.
Authors: Tamara Calise, Wendy Chow, Amanda Ryder, Chloe Wingerter
Lessons Learned from Implementing Screening, Brief Intervention, and Referral to Treatment for Youth and Young Adults in Primary Care Settings in Integrative Pediatrics and Child Care
Screening, Brief Intervention, and Referral to Treatment (S·BI·RT) in pediatric practices normalizes conversations between youth and healthcare providers about alcohol and other substance use, and supports guidance about healthy behaviors. S·BI·RT also identifies youth ages 12-22 whose current use of addictive substances places them at risk for developing substance use disorders, prompting provider brief intervention and referral for further assessment or treatment before a substance use disorder develops. From May 2014 to June 2017, S·BI·RT was implemented as a standard of care in 23 pediatric practices in three cohorts across 10 organizations in New Hampshire—including academic medical centers and FQHCs—serving over 74,000 youth. This case study focuses on strategies associated with operationalizing S·BI·RT, specifically training and technical assistance related to clinical workflow, for youth and young adults.
Authors: Lea LaFave, Martha Bradley, Adelaide Murray, Amy Pepin, Kara Sprangers, Kathleen Thies.
The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia in BMC Pregnancy and Childbirth, 2018, 18:123
Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC.
Interpersonal communication regarding pregnancy-related services- friends versus health professionals as conduits for information in BMC Pregnancy and Childbirth (2018) vol 18, issue 97
Social network characteristics influence a wide range of health behaviors but few studies examine the relationship between social network characteristics and pregnancy-related outcomes. Using a baseline survey from a behavior change pilot project in the Upper West region of Ghana, we examine four outcomes: (1) early antenatal care, (2) having at least four antenatal care visits, (3) skilled birth attendance, and (4)postpartum care. We collected demographic and network data from 1606 women of reproductive age who had a child in the five years preceding the survey. We estimated associations by regressing the four pregnancy-related outcomes on the demographic and network characteristics. The results suggest that there is little interpersonal communication about pregnancy-related issues, as 60.2% of respondents reported talking to no one. For those women who did talk to someone, communication with a health professional had the strongest association with accessing services. Communicating with friends was also significantly associated with outcomes.
This study provides evidence that there was little social communication about pregnancy-related issues in these communities at that time, indicating that an intervention to promote such communication could be successful. In addition, women who reported discussing pregnancy-related issues with friends or a health professional were more likely to access a birth facility and have a skilled birth attendant than those who reported discussing the same topics with their partner.
Authors: Leanne Dougherty, Emily Stammer, and Thomas W. Valente
The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia in BMC Pregnancy and Childbirth, (2018) 18:123
Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Before and after data was collected from a two year period from 2013-2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. From 2013 to 2015 the BEmONC implementation strength index score increased statistically significantly, as well as the corresponding health center delivery rate.
Authors: Gizachew Tiruneh, Ali Karim, Bilal Avan, Nebreed Zemichael, Tewabech Wereta, Deepthi Wickremasinghe, Zinar Keweti, Zewditu Kebede, Wuleta Betemariam
Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial in Trials, 2018, 19:176
Maternal and child under-nutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality. This study reports on a four-arm cluster randomised controlled trial in Odisha, India. Interventions included an agricultural extension platform of women’s groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; women’s groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and women’s groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions.
This paper contributes evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts.
Authors: Suneetha KadiyalaEmail, Audrey Prost, Helen Harris-Fry, Meghan O’Hearn, Ronali Pradhan, Shibananth Pradhan, Naba Kishore Mishra, Suchitra Rath, Nirmala Nair, Shibanand Rath, Prasantha Tripathy, Sneha Krishnan, Peggy Koniz-Booher, Heather Danton, Diana Elbourne, Joanna Sturgess, Emma Beaumont, Hassan Haghparast-Bidgoli, Jolene Skordis-Worrall, Satyanarayan Mohanty, Avinash Upadhay and Elizabeth Allen
Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia in Health Policy and Planning, Volume 33, Issue 3, 1 April 2018
Disrespect and abuse (D&A) experiences by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity.
This study aimed to quantify the frequency and categories of D&A experienced by women in four health centers in two rural regions of Ethiopia for the purposes of developing a community-led intervention. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction and exit interview at time of discharge. During exit interviews, 21% of respondents reported at least one occurrence of D&A. Failure to ask woman for preferred birth position most commonly observed during client-provider interactions. Complications during childbirth and time of delivery were significantly associated with reported D&A. Addressing D&A in health centers in Ethiopia will require a shift in priorities towards improving the experience and quality of care, a sustained effort to improve health care centers' infrastructure and greater support of the rural health workforce.
Authors: Kathleen Banks, Ali Karim, Hannah Ratcliffe, Wultea Betemariam, Ana Langer
Learning from implementation setbacks: Identifying and responding to contextual challenges in Learning Health Systems, March 2018.
This article addresses organizational learning about implementation context during set backs to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. It was expected to improve care efficiency, prevention and continuity through system-wide changes and program adjustments.
It was found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics. Team redesign did lead to improvements in chronic care and prevention, eased provider burden and helped to support more organization learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health. This case points to benefits for both healthcare researchers and change practitioners of paying closer attention to how context for learning from setbacks during change.
Authors: Michael I. Harrison and Sue Grantham.
Review of differentiated approaches to antiretroviral therapy distribution in Journal of AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, February 2018
In response to global trends of maximizing the number of patients receiving antiretroviral therapy (ART), this review summarizes literature describing differentiated models of ART distribution at facility and community levels in order to highlight promising strategies and identify evidence gaps. Findings suggest that differentiated models of ART distribution contribute to higher retention, lower attrition, and less loss to follow-up (LTFU). These models also reduced patient wait time, travel costs, and time lost from work for drug pick-up. Facility- and community-level ART distribution models have the potential to extend treatment availability, enable improved access and adherence among people living with HIV (PLHIV), and facilitate retention in treatment and care. Gaps remain in understanding the desirability of these models for PLHIV, and the need for more information the negative and positive impacts of stigma, and identifying models to reach traditionally marginalized groups such as key populations and youth. Replicating differentiated care so efforts can reach more PLHIV will be critical to scaling these approaches across varying contexts.
Authors: Nicole Davis, Natasha Kanagat, Melissa Sharer, Sabrina Eagan, Jennifer Pearson & Ugochukwu “Ugo” Amanyeiwe