abstract: 'Background: Maternal and newborn health care intervention coverage has

  increased in many low-income countries over the last decade, yet poor

  quality of care remains a challenge, limiting health gains. The World

  Health Organization envisions community engagement as a critical

  component of health care delivery systems to ensure quality services,

  responsive to community needs. Aligned with this, a Participatory

  Community Quality Improvement (PCQI) strategy was introduced in

  Ethiopia, in 14 of 91 rural woredas (districts) where the Last Ten

  Kilometers Project (L10 K) Platform activities were supporting national

  Basic Emergency Obstetric and Newborn Care (BEmONC) strengthening

  strategies. This paper examines the effects of the PCQI strategy in

  improving maternal and newborn care behaviors, and providers'' and

  households'' practices.

  Methods: PCQI engages communities in identifying barriers to access and

  quality of services, and developing, implementing and monitoring

  solutions. Thirty-four intervention kebeles (communities), which

  included the L10 K Platform, BEmONC, and PCQI, and 82 comparison

  kebeles, which included the L10 K Platform and BEmONC, were visited in

  December 2010-January 2011 and again 48 months later. Twelve women with

  children aged 0 to 11 months were interviewed in each kebele. Propensity

  score matching was used to estimate the program''s average treatment

  effects (ATEs) on women''s care seeking behavior, providers'' service

  provision behavior and households'' newborn care practices.

  Results: The ATEs of PCQI were statistically significant (p < 0.05) for

  two care seeking behaviors - four or more antenatal care (ANC) visits

  and institutional deliveries at 14\% (95\% CI: 6, 21) and 11\% (95\% CI:

  4, 17), respectively - and one service provision behavior - complete ANC

  at 17\% (95\% CI: 11, 24). We found no evidence of an effect on

  remaining outcomes relating to household newborn care practices, and

  postnatal care performed by the provider.

  Conclusions: National BEmONC strengthening and government initiatives to

  improve access and quality of maternal and newborn health services,

  together with L10 K Platform activities, appeared to work better for

  some care practices where communities were engaged in the PCQI strategy.

  Additional research with more robust measure of impact and

  cost-effectiveness analysis would be useful to establish effectiveness

  for a wider set of outcomes.'
affiliation: 'Wereta, T (Corresponding Author), JSI Res \& Training Inst Inc, Last
  Ten Kilometers Project L10K 2020, Kebele 03-05,Hs 2111, Addis Ababa, Ethiopia.

  Wereta, Tewabech; Betemariam, Wuleta; Karim, Ali Mehryar; Zemichael, Nebreed Fesseha;
  Dagnew, Selamawit; Wanboru, Abera, JSI Res \& Training Inst Inc, Last Ten Kilometers
  Project L10K 2020, Kebele 03-05,Hs 2111, Addis Ababa, Ethiopia.

  Bhattacharya, Antoinette, London Sch Hyg \& Trop Med, Fac Infect \& Trop Dis, Dept
  Dis Control, Keppel St, London WC1E 7HT, England.'
article-number: '364'
author: Wereta, Tewabech and Betemariam, Wuleta and Karim, Ali Mehryar and Zemichael,
  Nebreed Fesseha and Dagnew, Selamawit and Wanboru, Abera and Bhattacharya, Antoinette
author-email: weretatewabech@gmail.com
author_list:
- family: Wereta
  given: Tewabech
- family: Betemariam
  given: Wuleta
- family: Karim
  given: Ali Mehryar
- family: Zemichael
  given: Nebreed Fesseha
- family: Dagnew
  given: Selamawit
- family: Wanboru
  given: Abera
- family: Bhattacharya
  given: Antoinette
da: '2023-09-28'
doi: 10.1186/s12884-018-1977-9
eissn: 1471-2393
files: []
journal: BMC PREGNANCY AND CHILDBIRTH
keywords: Maternal; Newborn; Quality improvement; Community engagement
keywords-plus: ALMA-ATA; NEWBORN; DELIVERY; LESSONS
language: English
month: SEP 24
number-of-cited-references: '44'
papis_id: 1ce3de3dbbd8bc1cb2937c21d02fbfa6
ref: Wereta2018effectsparticipatory
researcherid-numbers: Karim, Ali/AAX-4495-2021
times-cited: '17'
title: 'Effects of a participatory community quality improvement strategy on improving
  household and provider health care behaviors and practices: a propensity score analysis'
type: Article
unique-id: WOS:000460333600002
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '18'
web-of-science-categories: Obstetrics \& Gynecology
year: '2018'