Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

Kimberly Peven*, Debra Bick, Edward Purssell, Torill Alise Rotevatn, Jane Hyldgaard Nielsen, Cath Taylor

*Corresponding author

Research output: Contribution to journalReview articleResearchpeer-review

2 Downloads (Pure)

Abstract

Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3–31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1–4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.
Original languageEnglish
JournalHealth Policy and Planning
Volume35
Issue numberSuppl. 2
Pages (from-to)ii47–ii65
Number of pages19
ISSN0268-1080
DOIs
Publication statusPublished - Nov 2020

Keywords

  • Child health
  • developing countries
  • health systems research
  • health workers
  • infant mortality
  • international health
  • maternal and child health
  • strategy
  • systematic reviews

Fingerprint

Dive into the research topics of 'Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review'. Together they form a unique fingerprint.

Cite this