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1. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens

Author

Ward, Victoria C, Weng, Yingjie, Bentley, Jason, Carmichael, Suzan L, Mehta, Kala M, Mahmood, Wajeeha, Pepper, Kevin T, Abdalla, Safa, Atmavilas, Yamini, Mahapatra, Tanmay, Srikantiah, Sridhar, Borkum, Evan, Rangarajan, Anu, Sridharan, Swetha, Rotz, Dana, Bhattacharya, Debarshi, Nanda, Priya, Tarigopula, Usha Kiran, Shah, Hemant, Darmstadt, Gary L, Carmichael, Suzan, Chaudhuri, Indrajit, Creanga, Andreea, Dutt, Priyanka, Irani, Laili, Mitra, Radharani, Munar, Wolfgang A, Raheel, Hina, Saggurti, Niranjan, Sastry, Padmapriya, Ward, Victoria, Walker, Dilys, and Wilhelm, Jess

Subjects
Public Health, Health Sciences, Pediatric, Clinical Research, Health Services, Reproductive health and childbirth, Good Health and Well Being, Child Health, Female, Health Behavior, Health Promotion, Healthcare Disparities, Humans, India, Infant, Infant Health, Infant, Newborn, Male, Maternal Health, Maternal Health Services, Nutritional Status, Pregnancy, Reproductive Health, Ananya Study Group, Public Health and Health Services, Public health
Abstract

BackgroundDespite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India.MethodsUtilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India.ResultsAt baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P

Published
2020

2. Impact of mHealth interventions for reproductive, maternal, newborn and child health and nutrition at scale: BBC Media Action and the Ananya program in Bihar, India

Author

Ward, Victoria C, Raheel, Hina, Weng, Yingjie, Mehta, Kala M, Dutt, Priyanka, Mitra, Radharani, Sastry, Padmapriya, Godfrey, Anna, Shannon, Melissa, Chamberlain, Sara, Kaimal, Rajani, Carmichael, Suzan L, Bentley, Jason, Abdalla, Safa, Pepper, Kevin T, Mahapatra, Tanmay, Srikantiah, Sridhar, Borkum, Evan, Rangarajan, Anu, Sridharan, Swetha, Rotz, Dana, Nanda, Priya, Tarigopula, Usha Kiran, Atmavilas, Yamini, Bhattacharya, Debarshi, Darmstadt, Gary L, Carmichael, Suzan, Chaudhuri, Indrajit, Creanga, Andreea, Irani, Laili, Munar, Wolfgang A, Saggurti, Niranjan, Shah, Hemant, Ward, Victoria, Walker, Dilys, and Wilhelm, Jess

Subjects
Public Health, Health Sciences, Networking and Information Technology R&D (NITRD), Clinical Research, Perinatal Period - Conditions Originating in Perinatal Period, Pediatric, Nutrition, Prevention, Reproductive health and childbirth, Good Health and Well Being, Child, Child Health, Female, Health Knowledge, Attitudes, Practice, Humans, India, Infant, Infant Health, Infant, Newborn, Male, Maternal Health, Nutritional Status, Pregnancy, Reproductive Health, Telemedicine, Ananya Study Group, Public Health and Health Services, Public health
Abstract

BackgroundMobile health (mHealth) tools have potential for improving the reach and quality of health information and services through community health workers in low- and middle-income countries. This study evaluates the impact of an mHealth tool implemented at scale as part of the statewide reproductive,maternal, newborn and child health and nutrition (RMNCHN) program in Bihar, India.MethodsThree survey-based data sets were analysed to compare the health-related knowledge, attitudes and behaviours amongst childbearing women exposed to the Mobile Kunji and Dr. Anita mHealth tools during their visits with frontline workers compared with those who were unexposed.ResultsAn evaluation by Mathematica (2014) revealed that exposure to Mobile Kunji and Dr. Anita recordings were associated with significantly higher odds of consuming iron-folic acid tablets (odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.8-3.1) as well as taking a set of three measures for delivery preparedness (OR = 2.8, 95% CI = 1.9-4.2) and appropriate infant complementary feeding (OR = 1.9, 95% CI = 1.0-3.5). CARE India's Community-based Household Surveys (2012-2017) demonstrated significant improvements in early breastfeeding (OR = 1.64, 95% CI = 1.5-1.78) and exclusive breastfeeding (OR = 1.46, 95% CI = 1.33-1.62) in addition to birth preparedness practices. BBC Media Action's Usage & Engagement Survey (2014) demonstrated a positive association between exposure to Mobile Kunji and Dr. Anita and exclusive breastfeeding (58% exposed vs 43% unexposed, P

Published
2020

3. Impact of the Ananya program on reproductive, maternal, newborn and child health and nutrition in Bihar, India: early results from a quasi-experimental study

Author

Darmstadt, Gary L, Weng, Yingjie, Pepper, Kevin T, Ward, Victoria C, Mehta, Kala M, Borkum, Evan, Bentley, Jason, Raheel, Hina, Rangarajan, Anu, Bhattacharya, Debarshi, Tarigopula, Usha Kiran, Nanda, Priya, Sridharan, Swetha, Rotz, Dana, Carmichael, Suzan L, Abdalla, Safa, Munar, Wolfgang, Atmavilas, Yamini, Carmichael, Suzan, Chaudhuri, Indrajit, Creanga, Andreea, Dutt, Priyanka, Irani, Laili, Mahapatra, Tanmay, Mitra, Radharani, Munar, Wolfgang A, Saggurti, Niranjan, Sastry, Padmapriya, Delhi, New, Shah, Hemant, Srikantiah, Sridhar, Ward, Victoria, Walker, Dilys, and Wilhelm, Jess

Subjects
Public Health, Health Sciences, Prevention, Pediatric, Reproductive health and childbirth, Good Health and Well Being, Child, Child Health, Female, Health Promotion, Humans, India, Infant Health, Infant, Newborn, Maternal Health, Nutritional Status, Pilot Projects, Pregnancy, Program Evaluation, Reproductive Health, Ananya Study Group, Public Health and Health Services, Public health
Abstract

BackgroundThe Government of Bihar (GoB) in India, the Bill and Melinda Gates Foundation and several non-governmental organisations launched the Ananya program aimed to support the GoB to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide. Here we summarise changes in indicators attained during the initial two-year pilot phase (2012-2013) of implementation in eight focus districts of approximately 28 million population, aimed to inform subsequent scale-up.MethodsThe quasi-experimental impact evaluation included statewide household surveys at two time points during the pilot phase: January-April 2012 ("baseline") including an initial cohort of beneficiaries and January-April 2014 ("midline") with a new cohort. The two arms were: 1) eight intervention districts, and 2) a comparison arm comprised of the remaining 30 districts in Bihar where Ananya interventions were not implemented. We analysed changes in indicators across the RMNCHN continuum of care from baseline to midline in intervention and comparison districts using a difference-in-difference analysis.ResultsIndicators in the two arms were similar at baseline. Overall, 40% of indicators (20 of 51) changed significantly from baseline to midline in the comparison districts unrelated to Ananya; two-thirds (n = 13) of secular indicator changes were in a direction expected to promote health. Statistically significant impact attributable to the Ananya program was found for 10% (five of 51) of RMNCHN indicators. Positive impacts were most prominent for mother's behaviours in contraceptive utilisation.ConclusionsThe Ananya program had limited impact in improving health-related outcomes during the first two-year period covered by this evaluation. The program's theories of change and action were not powered to observe statistically significant differences in RMNCHN indicators within two years, but rather aimed to help inform program improvements and scale-up. Evaluation of large-scale programs such as Ananya using theory-informed, equity-sensitive (including gender), mixed-methods approaches can help elucidate causality and better explain pathways through which supply- and demand-side interventions contribute to changes in behaviour among the actors involved in the production of population-level health outcomes. Evidence from Bihar indicates that deep structural constraints in health system organisation and delivery of interventions pose substantial limitations on behaviour change among health care providers and beneficiaries.Study registrationClinicalTrials.gov number NCT02726230.

Published
2020

4. Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India.

Author

Carmichael, Suzan, Srikantiah, Sridhar, Mahapatra, Tanmay, Chaudhuri, Indrajit, Balakrishnan, Ramkrishnan, Chaturvedi, Sharad, Raheel, Hina, Borkum, Evan, Trehan, Shamik, Weng, Yingjie, Kaimal, Rajani, Sivasankaran, Anitha, Sridharan, Swetha, Rotz, Dana, Tarigopula, Usha, Bhattacharya, Debarshi, Atmavilas, Yamini, Pepper, Kevin, Rangarajan, Anu, Darmstadt, Gary, and Mehta, Kala

Subjects
Child, Child Health, Community Health Workers, Female, Health Promotion, Humans, India, Infant Health, Infant, Newborn, Maternal Health, Maternal-Child Health Services, Nutritional Status, Pregnancy, Program Evaluation, Reproductive Health, Reproductive Health Services, Telemedicine
Abstract

BACKGROUND: mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hard-to-reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. METHODS: The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. RESULTS: The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P

Published
2019

5. Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India

Author

Carmichael, Suzan L, Mehta, Kala, Srikantiah, Sridhar, Mahapatra, Tanmay, Chaudhuri, Indrajit, Balakrishnan, Ramkrishnan, Chaturvedi, Sharad, Raheel, Hina, Borkum, Evan, Trehan, Shamik, Weng, Yingjie, Kaimal, Rajani, Sivasankaran, Anitha, Sridharan, Swetha, Rotz, Dana, Tarigopula, Usha Kiran, Bhattacharya, Debarshi, Atmavilas, Yamini, Pepper, Kevin T, Rangarajan, Anu, Darmstadt, Gary L, and Ananya Study Group

Subjects
and promotion of well-being, Maternal-Child Health Services, Maternal Health, Clinical Trials and Supportive Activities, Nutritional Status, India, Health Promotion, Reproductive health and childbirth, Pregnancy, Clinical Research, Behavioral and Social Science, Humans, Infant Health, Child, Community Health Workers, Pediatric, Prevention, Child Health, Infant, Health Services, Newborn, Prevention of disease and conditions, Ananya Study Group, Telemedicine, Reproductive Health, Good Health and Well Being, Public Health and Health Services, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Reproductive Health Services, Female, Program Evaluation
Abstract

BackgroundmHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hard-to-reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes.MethodsThe Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups.ResultsThe ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P

Published
2019

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