Effect and feasibility of district level scale up of maternal, newborn and child health interventions in Pakistan: a quasi-experimental study

Abstract

Introduction: Pakistan has a high burden of maternal, newborn and child morbidity and mortality. Several factors including weak scale-up of evidence-based interventions within the existing health system; lack of community awareness regarding health conditions; and poverty contribute to poor outcomes. Deaths and morbidity are largely preventable if a combination of community and facility-based interventions are rolled out at scale.

Methods and analysis: Umeed-e-Nau (UeN) (New Hope) project aims is to improve maternal, newborn and child health (MNCH) in eight high-burden districts of Pakistan by scaling up of evidence-based interventions. The project will assess interventions focused on, first, improving the quality of MNCH care at primary level and secondary level. Second, interventions targeting demand generation such as community mobilisation, creating awareness of healthy practices and expanding coverage of outreach services will be evaluated. Third, we will also evaluate interventions targeting the improvement in quality of routine health information and promotion of use of the data for decision-making. Hypothesis of the project is that roll out of evidence-based interventions at scale will lead to at least 20% reduction in perinatal mortality and 30% decrease in diarrhoea and pneumonia case fatality in the target districts whereas two intervention groups will serve as internal controls. Monitoring and evaluation of the programme will be undertaken through conducting periodical population level surveys and quality of care assessments. Descriptive and multivariate analytical methods will be used for assessing the association between different factors, and difference in difference estimates will be used to assess the impact of the intervention on outcomes.

Ethics and dissemination: The ethics approval was obtained from the Aga Khan University Ethics Review Committee. The findings of the project will be shared with relevant stakeholders and disseminated through open access peer-reviewed journal articles.

Trial registration number: NCT04184544; Pre-results.

Keywords: community child health; public health; quality in health care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1

Project design of Umeed-e-Nau. CHW, community health worker; HCP, healthcare providers; LHW, lady health worker; MIS, management information system; MNCH, maternal, newborn and child health; MNC&AH, Maternal, Newborn, Child and Adolescent Health.

Figure 2

Umeed-e-Nau project timeline. LHW, lady health worker; M&E, Monitoring and Evaluation.

Figure 3

Map showing the geographic location of the programme districts in three provinces of Pakistan. GB, Gilgit-Baltistan; KPK, Khyber Pakhtunkhwa; PATA, Provincially Administered Tribal Areas.

Figure 4

Schema of intervention packages for the implementation of maternal and newborn interventions in Pakistan. AKU, Aga Khan University; ARI, acute respiratory infection; CHW, community health worker; LHW, lady health worker; ORS, oral rehydration salts; WASH, Water, Sanitation and Hygiene Education.