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MCH Matters
Health Research Program

April 2020
EDITION
Reading Time: 8 minutes
A quarterly newsletter sharing the latest information and implementation research to inform maternal and child health and nutrition programs, practices, and policies.

In this edition, you will find links to upcoming events as well as articles and media reports from February 2020 - April 2020. To receive updates on the research we are following, subscribe to future editions of MCH Matters. 
Upcoming Events

Join our Communities of Practice: PSBICare-Seeking & Referral, and Urban Health
 
Special Feature: COVID-19 for pregnancy, childbirth, and breastfeeding

In light of the COVID-19 outbreak, we are sharing some key resources to inform and guide MCH efforts in this challenging environment. As additional research becomes available, we will share in subsequent issues of MCH Matters.
 
Peer-Reviewed Publications       FEB 2020 - APR 2020
*Wondering how we selected our featured articles? Learn more about our selection criteria at the end of this publication.
MATERNAL HEALTH
Evaluation of implementation of intermittent screening and treatment for control of malaria in pregnancy in Jharkhand, India
(American Journal of Tropical Medicine and Hygiene | March 9, 2020)
This study evaluated intermittent screening and treatment during pregnancy (ISTp) for malaria using rapid diagnostic tests (RDTs) at antenatal care (ANC) compared with passive case detection within the routine health system. The proportion of pregnant women who received an RDT for malaria at ANC at least once during pregnancy increased from pre- to post-implementation, and the proportion of women who had more than one RDT also increased. Post-implementation, however, only 8% of women who had completed their pregnancy received an RDT on each of three visits to ANC. In-depth interviews and focus groups with health workers and pregnant women offer key explanations for why ISTp during pregnancy was not sufficiently adopted by health workers to ensure the increased detection of malaria infections achievable with this strategy in this setting.
Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions
(PLOS ONE | March 26, 2020) 

Applying the Consolidated Framework for Implementation Research (CFIR) as a guide to analyzing a series of in-depth key informant interviews, this study identified key challenges and potential solutions for effective implementation of MNCH programs for refugees residing in camps of Cox’s Bazar, Bangladesh. High turnover and poor retention of staff, overlapping of service, weak referral mechanism, complex health information system, and lack of health provider security were some of the key challenges identified.  Potential solutions included motivating the health workers, task shifting, capacity building on emergency obstetric care, training community health workers and traditional birth attendants on danger signs, and ensuring the security of the workers.
Strategies discussed at the XIIth International Conference on Kangaroo Mother Care for implementation on a countrywide scale. (Acta Paediatrica | February 6, 2020) 
No longer perceived as an alternative for the poor, but as a universal best-care tool, kangaroo mother care (KMC) is an evidence-based method of caring for preterm and low birth weight infants.  In conjunction with the XIIth International  Conference on KMC (Bogota, Colombia, 2018), the International Network in KMC brought 172 KMC professionals from 33 economically diverse countries together for a 2‐day workshop. This paper presents the outcomes of that collaborative meeting including a proposed minimum set of indicators for KMC scale‐up; strategies for KMC integration and implementation at country level; approaches for convincing healthcare providers of the safety of KMC transportation; and the main aspects concerning KMC follow‐up and skin‐to‐skin care for term infants.
CHILD HEALTH
The fidelity of implementation of recommended care for children with malaria by community health workers in Nigeria. (Implementation Science | March 4, 2020) 
Studying intervention fidelity promises to identify the shortcomings of implementation and specific areas to target for improvement in future adoption or implementation.  This study sought to  assess the fidelity of implementation of a recommended protocol for malaria care by community health workers (CHWs) in a resource-poor setting in Nigeria. Of the four skill domains assessed, adherence to the intervention protocol was greatest for compliance with malaria treatment recommendations (94%) and lowest for post-treatment initiation counseling of home-based caregivers (69%). This study concludes that future training should emphasize clinical evaluation and post-treatment counseling of caregivers by CHWs to ensure the best outcome for children.
NEWBORN HEALTH
Implementation of the WHO guideline on treatment of young infants with signs of possible serious bacterial infection when hospital referral is not feasible in rural Zaria, Nigeria: Challenges and solutions. (PLOS ONE | March 10, 2020)
The authors conducted implementation research in selected communities in Zaria Local Government Areas of Kaduna State with an estimated population of 50,000 with the aim of understanding how to implement the WHO PSBI treatment guideline to achieve high coverage with low case fatality and treatment failure rates. In this article, the authors have demonstrated that the outpatient treatment strategy for young infants with PSBI when referral is not feasible is implementable within the programmatic settings, achieving very high population coverage and relatively low treatment failure and case fatality rates. 
Using benchmarks to assess progress towards operationalizing PSBI guidelines.
(Samira Aboubaker, PSBI Community of Practice Technical Lead | April 16, 2020)
The Health Research Program used the set of 23 benchmarks developed by WHO and partners to monitor national-level progress in implementation of a new guideline for possible serious bacterial infection (PSBI) in young infants when referral is not feasible. These benchmarks were designed to help countries assess their readiness to operationalize management of this new guideline and to track progress and scale up as they look at critical elements for planning and implementation.
NUTRITION
Leveraging an implementation– research partnership to improve effectiveness of nutrition-sensitive programs at the World Food Programme. (Food and Nutrition Bulletin | March 4, 2020)
The authors present the process, using principles of design thinking (a systematic, iterative analytical approach to problem solving), that the International Food Policy Research Institute and the World Food Programme (WFP) used to develop nutrition-sensitive program guidance and plans for improving program effectiveness and contributing to the evidence base through rigorous evaluations. Through iterative consultations, they created WFP’s nutrition-sensitive guidance that includes harmonized theories of change across WFP’s programs; seven opportunities to enhance the programs’ nutrition-sensitivity; and mapping of these opportunities to WFP programs and key evidence gaps.  The guidance has been rolled out to WFP’s offices worldwide, and several evaluation designs have been proposed to fill identified evidence gaps.
Media

'Yellow bindis' mean high-risk: India's new health map for women and children(The Guardian | March 3, 2020) Pioneering Rajasthan initiative helps health workers reach families in greatest need first, increasing identification of malnutrition and issues in pregnancy.

Maternal health and rights: When basic needs are not so basic. (The Globe Post | March 19, 2020) In this era of human-centered design and person-centered care, we have to rethink how we address reproductive, maternal, new-born, child, and adolescent health, not only in small villages but also in bustling capitals. Health systems around the world have indeed fallen short in providing respectful, dignified, and equitable maternal care.
 
Published Reports
State of the world’s nursing report - 2020. (WHO | April 6, 2020) The World Health Organization has designated 2020 the International Year of the Nurse and the Midwife. The State of the world’s nursing 2020 report provides the latest, most up-to-date evidence on and policy options for the global nursing workforce. It also presents a compelling case for considerable – yet feasible – investment in nursing education, jobs, and leadership.
Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease. (WHO | February 10, 2020) Women who are pregnant or breastfeeding in an Ebola outbreak face similar challenges as other population groups, but they have specific health needs which must be met. As the second largest Ebola outbreak in history continues in the Democratic Republic of Congo, WHO has released new clinical guidelines for healthcare providers supporting pregnant or breastfeeding women in the context of Ebola virus disease. 

Selection Criteria

Inclusion of the peer-reviewed articles in MCH Matters is guided by the following defining characteristics of implementation research (IR) in global health.1
  • Context specific
  • Relevant and agenda setting purpose
  • Methods fit for purpose
  • Demand-driven
  • Multi-stakeholder and multidisciplinary
  • Real world
  • Real time
  • Focuses on processes and outcomes
1. Theobald S, Brandes N, Gyapong M, et al. Implementation research: new imperatives and opportunities in global health. The Lancet 2018;392:2214–28.doi:10.1016/S0140-6736(18)32205-0.
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This newsletter is produced by the Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) project.