Embrace intervention to improve the continuum of care in maternal and newborn health in Ghana: The Re-Aim framework-based evaluation

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Study Justification:
– Improving maternal and newborn health is a critical public health challenge, especially in low- and lower-middle-income countries.
– Interventions to improve the continuum of care in real-world settings are needed.
– The Embrace intervention program in Ghana involved over 21,000 women and showed effectiveness in improving the continuum of care.
Highlights:
– The Embrace intervention program increased the completion rate of the continuum of care from 7.5% to 47.1%.
– The program reduced the number of newborns with danger signs immediately after birth.
– 94% of health facilities in the intervention area participated in the program.
– Mothers expressed willingness to use their continuum of care cards in future pregnancies.
– Logistical and human resource challenges were resolved through supervision and manual use.
– The government included continuum of care measures in their routine program and developed a new Maternal and Child Health Record Book.
Recommendations:
– Scale up the Embrace intervention program in real-world settings where the continuum of care needs improvement.
– Promote the use of continuum of care cards in future pregnancies.
– Provide supervision and support to address logistical and human resource challenges.
– Disseminate the new Maternal and Child Health Record Book nationwide.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Health Facilities: Provide the necessary infrastructure and resources for the intervention program.
– Health Workers: Deliver the intervention and provide support to women.
– Community Leaders: Engage and mobilize the community to participate in the program.
– Researchers and Evaluators: Monitor and evaluate the implementation process.
Cost Items for Planning:
– Training and Capacity Building: Budget for training health workers and community leaders.
– Supplies and Equipment: Allocate funds for necessary medical supplies and equipment.
– Monitoring and Evaluation: Set aside a budget for data collection and analysis.
– Communication and Awareness: Allocate funds for disseminating information about the intervention program.
– Program Management: Budget for administrative and coordination costs.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific context and requirements of the implementation.

Background Improving maternal and newborn health remains one of the most critical public health challenges, particularly in low- and lower-middle-income countries. To overcome this challenge, interventions to improve the continuum of care based on real-world settings need to be provided. The Ghana Ensure Mothers and Babies Regular Access to Care (Embrace) Implementation Research Team conducted a unique intervention program involving over 21 000 women to improve the continuum of care, thereby demonstrating an intervention program’s effectiveness in a real-world setting. This study evaluates the implementation process of the Embrace intervention program based on the RE-AIM framework. Methods A cluster-randomized controlled trial was conducted in 32 sub-district-based clusters in Ghana. Interventions comprised of four components, and to evaluate the implementation process, we conducted baseline and endline questionnaire surveys for women who gave birth and lived in the study site. The key informant interviews of health workers and intervention monitoring were conducted at the health facilities in the intervention area. The data were analyzed using 34 components of the RE-AIM framework and classified under five general criteria (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Results In total, 1480 and 1490 women participated in the baseline and endline questionnaire survey, respectively. In the intervention area, 83.8% of women participated (reach). The completion rate of the continuum of care increased from 7.5% to 47.1%. Newborns who had danger signs immediately after birth decreased after the intervention (relative risk = 0.82, 95% confidence interval = 0.68-0.99) (effectiveness). In the intervention area, 94% of all health facilities participated. Mothers willing to use their continuum of care cards in future pregnancies reached 87% (adoption). Supervision and manual use resolved the logistical and human resource challenges identified initially (implementation). The government included the continuum of care measures in their routine program and developed a new Maternal and Child Health Record Book, which was successfully disseminated nationwide (maintenance). Conclusions Following the RE-AIM framework evaluation, the Embrace intervention program was considered effective and as having great potential for scaling across in real-world settings, especially where the continuum of care needs to be improved.

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The Embrace intervention program, as described in the publication “Embrace intervention to improve the continuum of care in maternal and newborn health in Ghana: The Re-Aim framework-based evaluation,” offers a recommendation for improving access to maternal health. The program demonstrated effectiveness in a real-world setting and has the potential for scaling across similar contexts.

The key recommendation from this study is to implement interventions that focus on improving the continuum of care for maternal and newborn health. The Embrace intervention program consisted of four components aimed at enhancing access to care. These components were not explicitly mentioned in the provided information, but they were evaluated using the RE-AIM framework, which assesses Reach, Effectiveness, Adoption, Implementation, and Maintenance.

The results of the evaluation showed positive outcomes. In the intervention area, 83.8% of women participated (reach), and the completion rate of the continuum of care increased from 7.5% to 47.1%. Additionally, the intervention led to a decrease in danger signs among newborns immediately after birth (effectiveness). The program also achieved high participation rates from health facilities (94%) and demonstrated successful implementation through supervision and manual use (implementation). The government incorporated the continuum of care measures into routine programs and developed a new Maternal and Child Health Record Book, which was disseminated nationwide (maintenance).

Based on these findings, the recommendation is to implement similar interventions that focus on improving the continuum of care for maternal and newborn health. This may involve strategies such as enhancing access to antenatal care, promoting skilled birth attendance, ensuring postnatal care, and providing education and support for mothers. By addressing the various components of the continuum of care, it is possible to improve access to maternal health services and ultimately reduce maternal and newborn mortality rates.
AI Innovations Description
The Embrace intervention program, as described in the publication “Embrace intervention to improve the continuum of care in maternal and newborn health in Ghana: The Re-Aim framework-based evaluation,” offers a recommendation for improving access to maternal health. The program demonstrated effectiveness in a real-world setting and has the potential for scaling across similar contexts.

The key recommendation from this study is to implement interventions that focus on improving the continuum of care for maternal and newborn health. The Embrace intervention program consisted of four components aimed at enhancing access to care. These components were not explicitly mentioned in the provided information, but they were evaluated using the RE-AIM framework, which assesses Reach, Effectiveness, Adoption, Implementation, and Maintenance.

The results of the evaluation showed positive outcomes. In the intervention area, 83.8% of women participated (reach), and the completion rate of the continuum of care increased from 7.5% to 47.1%. Additionally, the intervention led to a decrease in danger signs among newborns immediately after birth (effectiveness). The program also achieved high participation rates from health facilities (94%) and demonstrated successful implementation through supervision and manual use (implementation). The government incorporated the continuum of care measures into routine programs and developed a new Maternal and Child Health Record Book, which was disseminated nationwide (maintenance).

Based on these findings, the recommendation is to implement similar interventions that focus on improving the continuum of care for maternal and newborn health. This may involve strategies such as enhancing access to antenatal care, promoting skilled birth attendance, ensuring postnatal care, and providing education and support for mothers. By addressing the various components of the continuum of care, it is possible to improve access to maternal health services and ultimately reduce maternal and newborn mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations from the abstract on improving access to maternal health, you could consider the following methodology:

1. Study Design: Conduct a cluster-randomized controlled trial in a similar setting to the Embrace intervention program in Ghana. Select sub-district-based clusters as the units of randomization.

2. Intervention Components: Implement interventions that focus on improving the continuum of care for maternal and newborn health, similar to the Embrace program. These interventions could include:

a. Enhancing access to antenatal care: Implement strategies to increase the utilization of antenatal care services, such as community outreach programs, mobile clinics, or incentives for attending antenatal visits.

b. Promoting skilled birth attendance: Develop initiatives to encourage pregnant women to give birth in health facilities with skilled birth attendants. This could involve community education, transportation support, or improving the quality of care in health facilities.

c. Ensuring postnatal care: Implement interventions to improve postnatal care utilization, such as home visits by healthcare providers, postnatal support groups, or educational campaigns on the importance of postnatal care.

d. Providing education and support for mothers: Develop programs that provide comprehensive education and support to pregnant women and new mothers, including information on nutrition, breastfeeding, newborn care, and family planning.

3. Data Collection: Conduct baseline and endline questionnaire surveys for women who give birth and live in the study site. Collect data on various indicators related to access to maternal health services, such as antenatal care utilization, skilled birth attendance, postnatal care utilization, and knowledge and practices related to maternal and newborn health.

4. Analysis: Analyze the collected data using appropriate statistical methods to compare the baseline and endline results. Calculate indicators such as reach (percentage of women participating in the interventions), effectiveness (changes in the continuum of care completion rate and newborn danger signs), adoption (percentage of health facilities participating), implementation (logistical and human resource challenges resolved), and maintenance (integration of interventions into routine programs and dissemination of new health records).

5. Interpretation: Evaluate the impact of the interventions on improving access to maternal health by comparing the results with the baseline data. Assess the effectiveness of the interventions in achieving the desired outcomes and identify any challenges or limitations encountered during implementation.

6. Scaling and Generalization: Consider the potential for scaling the interventions across similar contexts based on the findings. Assess the feasibility and adaptability of the interventions to other settings, taking into account factors such as resource availability, cultural considerations, and health system infrastructure.

By following this methodology, you can simulate the impact of implementing similar interventions to improve access to maternal health and assess their effectiveness in a real-world setting.

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