1 / 18

Nompilo Study: Results of Evaluation

Nompilo Study: Results of Evaluation. Lisa M. Butler, PhD, MPH Division of General Pediatrics, Boston Children ’ s Hospital Department of Pediatrics, Harvard Medical School Presenting on behalf of the Nompilo Study Team: C. Horwood, W. Ngidi, M. Grant, J. Reddy, P. Barker, and N. Rollins.

morton
Download Presentation

Nompilo Study: Results of Evaluation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nompilo Study: Results of Evaluation Lisa M. Butler, PhD, MPH Division of General Pediatrics, Boston Children’s Hospital Department of Pediatrics, Harvard Medical School Presenting on behalf of the Nompilo Study Team: C. Horwood, W. Ngidi, M. Grant, J. Reddy, P. Barker, and N. Rollins

  2. Implementing integrated community case management training & QI support to CHWs: • Is it feasible? • Does it lead to gains in CHW knowledge, self-efficacy and practice? • What is the effect on infant feeding practices, and uptake of PMTCT and MCH services? Research Questions

  3. Setting and Design • Setting: • Ugu District, KwaZulu Natal, South Africa • Design: • Cluster randomized controlled trial • CHW supervisors (N=30), CHWs (N=120) • Mothers: ~8 mothers per CHW pre & post intervention

  4. Participants and Timelines • CHW: • > 18 years old • Grade 9 education or greater • Employed by Department of Health to provide home support to pregnant women, mothers and children in Ugu District, SA • Mothers • > 18 years old • Delivered live-born infant in past 12 months • Reside in household assigned to participating CHW CHW: Baseline 6 Months 12 Months Pre-Intervention Post-Intervention Mothers:

  5. Analytic Approach • Mixed-effects models • Interaction of treatment group with visit month tested for differences in rate of change between groups

  6. Results

  7. Participant Characteristics: CHW

  8. Self Efficacy • Significantly improved self efficacy at 6 and 12 months • (intervention vs control CHWs): • Talking to a pregnant woman about HIV • Advising a pregnant woman about her own nutrition • Assisting a mother with breastfeeding • Explaining services available for PMTCT • Doing a postnatal visit to check the mother’s health & newborn baby • Recognizing danger signs in pregnancy, newborn or postpartum mother

  9. CHW Knowledge P<0.0001 P=0.28 P<0.0001 Percent Correct

  10. Participant Characteristics: Mothers

  11. Mother report about CHW visits

  12. Exclusive Breastfeeding in First 6 Weeks P = 0.15 P = 0.02 N=298 N=305 N=256 N=231

  13. Care Seeking P=0.16 P=0.02 P=0.33 P=0.02 Did not seek care for self when needed in prior 6 months Did not seek care for child when needed in prior 6 months

  14. Receipt of ANC, PNC, HIV and PMTCT services (post-intervention)

  15. Summary • Compared to CHWs in control arm, CHWs in intervention arm: • Significantly greater level of self-efficacy • Significantly greater level of HIV and MCH-related knowledge • Knowledge regarding HIV/MCH content sustained over time • Compared to mothers in control catchment, mothers in intervention arm: • Reported more frequent CHW visits and discussion about HIV/MCHN • Significant improvement in exclusive breastfeeding in first 6 weeks • Significant improvement in care-seeking for mothers and infants • No change in receipt of HIV testing or receipt of PMTCT services – but prevalence overall was very high

  16. Conclusions • Training approach and materials were effective in knowledge transfer and highly appreciated even though demanding; • QI supervision and support of CHWs was feasible and valued; • Improved CHW knowledge, self-efficacy and practices were sustained over time; • Some maternal behavior change observed, despite short period of intervention

  17. Nompilo Study Team • World Health Organization • Dr. Nigel Rollins • Institute for Healthcare Improvement • Dr. Pierre Barker • Dr. Kedar Mate • Boston Children’s Hospital • Dr. Lisa M. Butler • 20,000+ Partnership • Dr. Jennifer Reddy (PI-intervention) • WilbrodaNgidi • KhumbuzileSishi • Ellen Ntswe • Lorraine Mkhize • Sandra Reid • Centre for Rural Health, U. KwaZulu-Natal • Dr. Christiane Horwood (PI-evaluation) • Merridy Grant • Lyn Haskins • SifisoPhakathi • NtokozoMntambo • Rosemary Brown

  18. Acknowledgements • Lenore Spies, Nutrition Manager, KwaZulu-Natal Department of Health • Janet Dalton, KwaZulu-Natal Primary Healthcare Manager • Victoria Mubaiwa, Maternal and Child Health Director, KwaZulu-Natal Department of Health • Dr. Charles McCulloch, University of California San Francisco • Dr. Henry Feldman, Boston Children’s Hospital • Funders: • US Centers for Disease Control and Prevention • World Health Organization

More Related