BU Study Finds Team Approach to Newborn Care Shows Promise.
A team approach that pairs community health workers with traditional birth attendants in rural Africa is a viable way to deliver child health interventions, a study led by BU School of Public Health researchers has found.
In a study published in BMC Health Services Research, a group of global health researchers found that teams composed of predominantly younger, male community health workers and older, female trained birth attendants worked together well to provide care to newborns and infants in rural Zambia. The teams were found to have high mutual trust, cohesion, comprehension of team goals and objectives, and communication. Teams whose members resided within one hour’s walking distance of each other were more likely to work well together.
Zambia has a strained health care system with limited facilities and resources, increasing the reliance on community-based providers who offer basic health services, especially in rural areas, to confront a high under-5 mortality rate. Two common volunteer cadres are community health workers (CHWs) and trained traditional birth attendants (TBAs). CHWs have been trained to provide a wide range of services, including preventive interventions, health education, and treatment of common childhood illnesses, while TBAs have been trained to provide maternal and newborn interventions.
Save the Children deployed teams of the workers, who were tracked over two years to gauge how well they provided care for children under 5, including newborns. The study was conducted in the Lufwanyama District in the Copperbelt Province of Zambia, where BU researchers have worked for years to combat child mortality.
About two-thirds of the active teams were categorized as “high performing,” the study found. Team scores on communication were high and improved over time. Especially encouraging to the researchers was that TBAs and CHWs made home visits jointly to mothers and newborns at 6-8 weeks of age, improving the usual handover of care from the birth attendants to community health workers.
“The joint home visits for handing over care of the young infant has the potential to . . . improve the use of facility-based postnatal services (where needed) and enhance the continuum of care,” the research team said.
One area of concern was low scores for “performance monitoring,” indicating that team members need help in identifying their partners’ lapses in care. Also of concern was a high attrition rate among the workers – about 30 percent over two years. Attrition is largely due to low pay and the movement of workers to higher positions in the health system or other fields, the authors said.
“If teaming is to be implemented, approaches to motivate and retain CHWs need to be adopted,” they said.
Dr. Davidson Hamer, co-author and professor of global health at BUSPH, said further analyses of team interventions are underway, adding, “These results look very promising.”
Other researchers from BUSPH and the BU Center for Global Health and Development included Kojo Yeboah-Antwi and Katherine Semrau. They were joined by researchers from Save the Children.
The study was funded under a USAID Child Survival and Health Grants Program Cooperative Agreement, with additional support from the ELMA Foundation, the Crown Family Philanthropies and other private donors.
Submitted by Lisa Chedekel