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Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

Peven, Kimberly, Bick, Debra, Purssell, Edward, Rotevatn, Torill Alise, Nielsen, Jane and Taylor, Cath (2020) Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review Health Policy and Planning.

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Neonatal mortality remains a significant health problem in low income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990-2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact, and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the first day (community-based studies) of life. Implementation strategies and outcomes were categorised according to published frameworks (Powell et al (2015): Expert Recommendations for Implementing Change (ERIC), Proctor et al (2013): Outcomes for Implementation Research). The relationship between implementation strategies and outcomes was evaluated using standardised mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3-31 implementation strategies, , though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1-4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Peven, Kimberly
Bick, Debra
Purssell, Edward
Rotevatn, Torill Alise
Nielsen, Jane
Date : 2020
Funders : Alliance for Health Policy and Systems Research
Copyright Disclaimer : © The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords : Child health; Developing countries; Health systems research; Health workers; Infant mortality; International health; Maternal and child health; Strategy; Systematic reviews
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Additional Information : Part of the supplement “Innovations in Implementation Research in Low and Middle Income Countries”, a collaboration of the Alliance for Health Policy and Systems Research and Health Policy and Planning.
Depositing User : Clive Harris
Date Deposited : 02 Oct 2020 09:43
Last Modified : 02 Oct 2020 09:43

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