A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa

Human Resources for Health

Research

Ntokozo Mntambo¹  Sifiso Phakathi¹  Merridy Grant¹  Christiane Horwood¹  Lyn Haskins¹  Nigel Rollins²  Lisa Butler³  Pierre Barker⁴ 

[1] Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa;Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland;Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States of America;Institute for Healthcare Improvement, Cambridge, MA, United States of America;Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America;

关键词: Community health worker;    Quality improvement;    Breastfeeding;    South Africa;    Maternal health;    Child health;    HIV;   

DOI  :  10.1186/s12960-017-0210-7

 received in 2017-01-05, accepted in 2017-05-31,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCommunity health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs.MethodsThis is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Four CHWs were randomly selected from those routinely supported by each supervisor (n = 60 per arm). In the intervention arm, these four CHWs and their supervisor formed a quality improvement team. Intervention CHWs received a 2-week training in WHO Community Case Management followed by CQI mentoring for 12 months (preceded by 3 months lead-in to establish QI processes). Baseline and follow-up surveys were conducted with mothers of infants <12 months old living in households served by participating CHWs.ResultsInterviews were conducted with 736 and 606 mothers at baseline and follow-up respectively; socio-demographic characteristics were similar in both study arms and at each time point.At follow-up, compared to mothers served by control CHWs, mothers served by intervention CHWs were more likely to have received a CHW visit during pregnancy (75.7 vs 29.0%, p < 0.0001) and the postnatal period (72.6 vs 30.3%, p < 0.0001). Intervention mothers had higher maternal and child health knowledge scores (49 vs 43%, p = 0.02) and reported higher exclusive breastfeeding rates to 6 weeks (76.7 vs 65.1%, p = 0.02). HIV-positive mothers served by intervention CHWs were more likely to have disclosed their HIV status to the CHW (78.7 vs 50.0%, p = 0.007). Uptake of facility-based interventions were not significantly different.ConclusionsImproved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers’ knowledge and infant feeding practices.Trial registrationClinicalTrials.Gov NCT01774136

【 授权许可】

CC BY   
© The Author(s). 2017