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Gauging the Impact of MomConnect on Maternal Health Service Utilisation by Women and Their Infants in Johannesburg, South Africa

Gauging the Impact of MomConnect on Maternal Health Service Utilisation by Women and Their Infants in Johannesburg, South AfricaSouth Africa faces several systemic access barriers to sustainable and comprehensive maternal and neonatal child health (MNCH) care (National Committee for Confidential Enquiries into Maternal Deaths, 2013). A United Nations Children’s Fund (UNICEF) report highlighted these barriers in South Africa, such as insufficient health-care infrastructure, staff, counselling, information, and communication within the health system and between health service providers and patients.

South Africa did not achieve Millennium Development Goals #4 and #5 aiming to reduce child mortality and improve maternal health by 2015. Improved retention in maternal health services is essential to meet these goals. This requires innovative retention solutions, such as increasing patient health knowledge and rights, to improve maternal health and related health systems strengthening indicators within the country.

Globally, health systems are expected to provide high-quality services to diverse populations (rural, peri-urban, and urban). Scalable services that are cost effective, reliable, and sustainable are in great demand.

Recognizing the need and potential for broader mHealth applications, South Africa’s National Department of Health (NDOH) initiated MomConnect, the world’s first nationwide mHealth intervention, in August 2014. The aim was to register all pregnant women into a national system to receive preventative health messages and ultimately improve MNCH services and outcomes.

Our hypothesis was that using MomConnect to send pregnant women bi-weekly, informative, and supportive direct SMS(s) timed to the month of pregnancy is a feasible and cost-effective strategy for increasing maternal health service utilisation by pregnant women and their infants attending public health facilities in Johannesburg, South Africa.

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Malaria control interventions protect against malaria parasitemia, severe anemia and all-cause mortality in children less than five years of age in Malawi, 2000–2010

Malaria control interventions protect against malaria parasitemia, severe anemia and all-cause mortality in children less than five years of age in Malawi, 2000–2010Malaria control intervention coverage increased nationwide in Malawi during 2000–2010. Trends in intervention coverage were assessed against trends in malaria parasite prevalence, severe anemia (hemoglobin < 8 g/dL), and all-cause mortality in children under 5 years of age (ACCM) using nationally representative household surveys. Associations between insecticide-treated net (ITN) ownership, malaria morbidity, and ACCM were also assessed.

Household ITN ownership increased from 27.4% (95% confidence interval [CI] = 25.9–29.0) in 2004 to 56.8% (95% CI = 55.6–58.1) in 2010. Similarly intermittent preventive treatment during pregnancy coverage increased from 28.2% (95% CI = 26.7–29.8) in 2000 to 55.0% (95% CI = 53.4–56.6) in 2010. Malaria parasite prevalence decreased significantly from 60.5% (95% CI = 53.0–68.0) in 2001 to 20.4% (95% CI = 15.7–25.1) in 2009 in children aged 6–35 months. Severe anemia prevalence decreased from 20.4% (95% CI: 17.3–24.0) in 2004 to 13.1% (95% CI = 11.0–15.4) in 2010 in children aged 6–23 months. ACCM decreased 41%, from 188.6 deaths per 1,000 live births (95% CI = 179.1–198.0) during 1996–2000, to 112.1 deaths per 1,000 live births (95% CI = 105.8–118.5) during 2006–2010. When controlling for other covariates in random effects logistic regression models, household ITN ownership was protective against malaria parasitemia in children (odds ratio [OR] = 0.81, 95% CI = 0.72–0.92) and severe anemia (OR = 0.82, 95% CI = 0.72–0.94). After considering the magnitude of changes in malaria intervention coverage and nonmalaria factors, and given the contribution of malaria to all-cause mortality in malaria-endemic countries, the substantial increase in malaria control interventions likely improved child survival in Malawi during 2000–2010.

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Where is the evidence? The use of routinely-collected patient data to retain adults on antiretroviral treatment in low and middle income countries–a state of the evidence review

Where is the evidence? The use of routinely-collected patient data to retain adults on antiretroviral treatment in low and middle income countries–a state of the evidence reviewRetention rates in antiretroviral treatment (ART) in low- and middle-income countries are suboptimal for meeting global “90-90-90” treatment targets. Interventions using routinely collected patient data to follow up with ART defaulters is recommended to improve retention; yet, little is documented on how these data are used in practice. This state of the evidence review summarizes how facilities and programmes use patient data to retain adults on ART in low- and middle-income countries, and what effect, if any, these interventions have on retention.

The authors searched peer-reviewed and grey literature in PubMed, POPLINE, OVID, Google Scholar, and select webpages; screened publications for relevance; and applied eligibility criteria to select articles for inclusion. Over 4,000 records were found, of which 19 were eligible. Interventions assessed within the studies were sorted into three categories: patient tracing (18), data reviews (3), and improved data capture systems (9). Nine studies demonstrated increased retention or reduced lost to follow-up; however, the quality of evidence was weak.

We recommend that future research investigates how various combinations of these interventions are being implemented and their effectiveness on ART retention across diverse country contexts, taking into account cultural, social and economic barriers and differences in countries’ HIV epidemics and health information systems.

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Evaluations of HIV programs and other health issues: Purposeful planning

World AIDS Day

MEASURE Evaluation has just published a workbook—Getting to an Evaluation Plan: A Six-Step Process from Engagement to Evidence. This will be of interest to any HIV program implementers to plan for evaluation of their work. And, although the workbook was developed for evaluation planning for HIV programs, many stakeholders involved come from other sectors—so the process can be applied successfully in any sector.

Full of practical advice and activities, the contents of the workbook are especially valuable in evaluations to measure performance when the data are owned by different stakeholders.

The workbook will assist implementers to identify existing and planned data sources; prioritize evaluation research questions; and determine the roles, responsibilities, and timelines for answering the research questions. The process of developing an evaluation plan in cooperation with a group of stakeholders will foster collaboration, shared purpose, and transparency, thereby ensuring that stakeholders are aligned regarding the purpose and use of evaluation findings. A plan also helps to avoid wasted effort and to ensure that information is available to answer the agreed-upon questions.

This workbook describes a six-step process for developing a written evaluation plan: (1) engage stakeholders; (2) know your program; (3) know your evaluation needs; (4) select the evaluation design; (5) draft the evaluation plan; and (6) ensure use. Extensive field testing of this process assures that that users will successfully produce a complete evaluation plan that is wholly owned by the stakeholders who participate in the planning process.

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Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Best Practices

Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Best PracticesAs funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President’s Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date.

On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs.

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Automatic analysis of neonatal video data to evaluate resuscitation performance

Automatic analysis of neonatal video data to evaluate resuscitation performanceApproximately 3% of births require neonatal resuscitation, which has a direct impact on the immediate survival of these infants. This report proposes an automatic video analysis method for neonatal resuscitation performance evaluation, which helps improve the quality of this procedure. More specifically, we design a deep learning based action model, which incorporates motion and spatial information in order to classify neonatal resuscitation actions in videos.

First, we use a Convolutional Neural Network to select regions containing infants and only keep those that are motion salient. Second, we extract deep spatial-temporal features to train a linear SVM classifier. Finally, we propose a pair-wise model to ensure consistent classification in consecutive frames. We evaluate the proposed method on a dataset consisting of 17 videos and compare the result against the state-of-the-art method for action classification in videos. To our best knowledge, this work is the first to attempt automatic evaluation of neonatal resuscitation videos and identifies several issues that require further work.

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Framework for Evaluating the Health Impact of the Scale-up of Malaria Control Interventions on All-cause Child Mortality in sub-Saharan Africa

Framework for Evaluating the Health Impact of the Scale-up of Malaria Control Interventions on All-cause Child Mortality in sub-Saharan AfricaConcerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria’s Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design.

This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.

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