Background: Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger.
Methods: This is a quasi experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. Each facility was matched to a control facility of the same level of care that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (up to 28 weeks of gestational age) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines. The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion).
Discussion: This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better understand the timeline and the factors influencing women's decision-making on the use of post-partum family planning services. The results will help to increase the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed.
RéSUMé: CONTEXTE: Bien que plusieurs interventions d’intégration des services de santé maternelle, néonatale et infantile, de nutrition, et de planification familiale aient été déjà mises en œuvre et évaluées, il existe encore peu de preuves de leur efficacité pour guider les efforts des programmes et des politiques visant l'intégration des dits services de santé. Cette étude vise à évaluer l'efficacité d'un modèle de prestation de services intégrant les services de santé maternelle et infantile, les services de nutrition et de planification familiale, en comparaison des prestations standards de soins au Burkina Faso, en Côte d'Ivoire et au Niger. MATéRIELS ET MéTHODES: Il s'agit d'une étude quasi expérimentale avec un groupe d'intervention et un groupe témoin de 3 à 4 établissements de santé par pays. Chaque établissement a été apparié à un établissement témoin de même niveau qui avait une couverture similaire sur certains indicateurs de santé reproductive tels que la planification familiale et la planification familiale du post-partum. Les participantes à l'étude sont des femmes enceintes (jusqu'à 28 semaines d'âge gestationnel) venant pour leur première consultation prénatale. Elles seront suivies jusqu'à 6 mois après l'accouchement, et seront interrogées à chaque consultation prénatale et également lors des visites de vaccination des nourrissons. Les analyses seront réalisées en intention de traiter, à l'aide de modèles linéaires généralisés (binomial log ou log Poisson) pour évaluer l'effet de l'intervention sur le ratio de prévalence de l'utilisation de la contraception entre les deux groupes de l'étude à un seuil de significativité de 5%, tout en tenant compte de l'effet de grappe et en ajustant les facteurs de confusion potentiels (caractéristiques socio-démographiques des femmes inégalement réparties à l'inclusion). DISCUSSION: Cette étude longitudinale, avec une offre de services de planification familiale intégrée à l'ensemble du continuum de soins maternels, un temps d'observation suffisamment long et des mesures répétées, permettra de mieux comprendre la chronologie et les facteurs influençant la prise de décision des femmes sur l'utilisation des services de planification familiale post-partum. Les résultats contribueront à accroître le corpus de connaissances sur l'impact de l’intégration des services de santé maternelle et infantile sur l'utilisation de la planification familiale post-partum en tenant compte du contexte spécifique des pays francophones d'Afrique subsaharienne où de telles informations sont plus que nécessaires.
Keywords: Integration of services; Maternal and infant health; Maternal-Child Health Services/organization & administration; Postpartum famly planning.
One strategy to improve the utilization of health services by mothers and their children is the integration of maternal and child health services. For instance, a pregnant woman coming for an antenatal care visit would also receive counseling on post-partum family planning services and maternal nutrition. Similarly, a woman coming for her infant’s vaccines would be offered counseling on post-partum family planning, maternal nutrition and breastfeeding. Although several interventions have been implemented and tested, there is still limited evidence on the conditions and factors required for successful maternal and child health services integration strategies. This study aims to assess the effectiveness of an intervention integrating maternal and child health services, nutrition and family planning services. For the purpose of the evaluation, 2 distincts groups of health facilities will be selected in each country, one group of 3 or 4 health facilities where the intervention will be implemented, and another group of 3 or 4 health facilities with the general standard of care. The study participants are pregnant women (up to 28 weeks of gestational age), coming for their first antenatal care visit, who will be followed up to 6 months after childbirth.The analyzes will be carried out to assess the effect of the intervention on contraceptive use prevalence between the two groups of health facilities. This study will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services.
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