Dataset Information

Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.

ABSTRACT:

Objectives

To evaluate the impact of Newhints community-based surveillance volunteer (CBSV) assessments and referrals on access to care for sick newborns and on existing inequities in access.

Design

We evaluated a prospective cohort nested within the Newhints cluster-randomised controlled trial.

Setting

Community-based intervention involving more than 750 000, predominantly rural, population in seven contiguous districts in the Brong-Ahafo Region, Ghana.

Participants

Participants were recently delivered women (from more than 120 000 women under surveillance) and their 16 168 liveborn babies. Qualitative in-depth interviews with referral narratives (IDIs) were conducted with 92 mothers, CBSVs and health facility front-desk and maternity/paediatrics ward staff.

Interventions

Newhints trained and effectively supervised 475 CBSVs (existing within the Ghana Health Service) in 49 of 98 supervisory zones (clusters) to assess and refer newborns with any of the 10-key-danger signs to health facilities within the first week after birth; promote independent care seeking for sick newborns and problem-solve around barriers between November 2008 and December 2009.

Primary outcomes

The main evaluation outcomes were rates of compliance with referrals and independent care seeking for newborn illnesses.

Results

Of 4006 sampled, 2795 (69.8%) recently delivered women received CBSV assessment visits and 279 (10.0%) newborns were referred with danger signs. Compliance with referrals was unprecedentedly high (86.0%) with women in the poorest quintile (Q1) complying better than the least poor (Q5):87.5%(Q1) vs 69.7%(Q5); p=0.038. Three-quarters went to hospitals; 18% were admitted and 58% received outpatient treatment. Some (24%) mothers were turned away at facilities and follow-on IDIs showed that some of these untreated babies subsequently died. Independent care seeking for severe newborn illness increased from 55.4% in control to 77.3% in Newhints zones, especially among Q1 where care seeking almost doubled (95.0% vs 48.6%; RR=1.94 (1.32, 2.84); p=0.001). Rates were the highest among rural residents but urban residents complied quicker.

Conclusions

Home visits are feasible and a potentially pro-poor approach to link sick newborns to facilities. Its effectiveness in improving survival hinges on matched improvement in facility quality of care.

Trial registration number

NCT00623337.

SUBMITTER: Manu A

PROVIDER: S-EPMC4916576 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.

Manu Alexander A Hill Zelee Z Ten Asbroek Augustinus Ha AH Soremekun Seyi S Weobong Benedict B Gyan Thomas T Tawiah-Agyemang Charlotte C Danso Samuel S Amenga-Etego Seeba S Owusu-Agyei Seth S Kirkwood Betty R BR

BMJ open 20160613 6

<h4>Objectives</h4>To evaluate the impact of Newhints community-based surveillance volunteer (CBSV) assessments and referrals on access to care for sick newborns and on existing inequities in access.<h4>Design</h4>We evaluated a prospective cohort nested within the Newhints cluster-randomised controlled trial.<h4>Setting</h4>Community-based intervention involving more than 750 000, predominantly rural, population in seven contiguous districts in the Brong-Ahafo Region, Ghana.<h4>Participants</h4 ...[more]

PMID: 27297006

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Project description:ObjectiveTo evaluate the health-economic costs and benefits of a guided eHealth intervention (E-health module embedded in Collaborative Occupational healthcare (ECO)) encouraging sick-listed employees to a faster return to work.DesignA two-armed cluster randomised trial with occupational physicians (OPs) (n=62), clustered and randomised by region into an experimental and a control group, to conduct a health-economic investment appraisal. Online self-reported data were collected from employees at baseline, after 3, 6, 9 and 12 months.SettingOccupational health care in the Netherlands.ParticipantsEmployees from small-sized and medium-sized companies (≥18 years), sick-listed between 4 and 26 weeks with (symptoms of) common mental disorders visiting their OP.InterventionsIn the intervention group, employees (N=131) received an eHealth module aimed at changing cognitions regarding return to work, while OPs were supported by a decision aid for treatment and referral options. Employees in the control condition (N=89) received usual sickness guidance.Outcomes measuresNet benefits and return on investment based on absenteeism, presenteeism, health care use and quality-adjusted life years (QALYs) gained.ResultsFrom the employer's perspective, the incremental net benefits were €3187 per employee over a single year, representing a return of investment of €11 per invested Euro, with a break-even point at 6 months. The economic case was also favourable from the employee's perspective, partly because of QALY health gains. The intervention was costing €234 per employee from a health service financier's perspective. The incremental net benefits from a social perspective were €4210. This amount dropped to €3559 in the sensitivity analysis trimming the 5% highest costs.ConclusionsThe data suggest that the ECO intervention offers good value for money for virtually all stakeholders involved, because initial investments were more than recouped within a single year. The sometimes wide 95% CIs suggest that the costs and benefits are not always very precise estimates and real benefits could vary considerably.Trial registrationNTR2108; Results.

Dataset Information

Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.

Objectives

Design

Setting

Participants

Interventions

Primary outcomes

Results

Conclusions

Trial registration number

Publications

Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.

Similar Datasets

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