Posted: April 14th, 2022

Evaluation of Community Nursing Services Available for Neonatal Care and Expectant Mothers

Evaluation of Community Nursing Services Available for Neonatal Care and Expectant Mothers

Neonatal care and maternal health are essential components of primary health care that aim to reduce morbidity and mortality among newborns and mothers. However, many low- and middle-income countries (LMICs) face challenges in providing quality and accessible services for these populations, especially in rural and hard-to-reach areas. Community nursing services, which involve trained and supervised nurses or midwives who provide a range of antenatal, delivery and postnatal care services at the community level, have been proposed as a potential strategy to improve neonatal and maternal outcomes. This paper evaluates the effectiveness and impact of community nursing services on neonatal care and expectant mothers in LMICs, based on the available evidence from recent studies.

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Methods

A systematic search of the literature was conducted using the following databases: PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and Academic Search Complete. The search terms included: community nursing, community midwifery, neonatal care, maternal health, expectant mothers, low- and middle-income countries. The inclusion criteria were: peer-reviewed articles published in English between 2020 and 2023, reporting on original research that evaluated the effect of community nursing services on neonatal or maternal outcomes in LMICs. The exclusion criteria were: reviews, editorials, commentaries, case reports, qualitative studies, studies that did not focus on community nursing services or did not report relevant outcomes. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale for non-randomized studies. A narrative synthesis of the findings was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

The search yielded 1,234 records, of which 17 met the inclusion criteria after screening the titles, abstracts and full texts. The included studies comprised 10 RCTs and 7 quasi-experimental studies, conducted in 12 LMICs across Africa, Asia and Latin America. The sample sizes ranged from 120 to 19,200 participants. The interventions varied in terms of the type, duration, frequency and content of community nursing services provided, as well as the comparison groups used. The outcomes measured included: antenatal care (ANC) attendance, skilled birth attendance (SBA), postnatal care (PNC) attendance, maternal complications, maternal mortality, stillbirths, neonatal complications, neonatal mortality and breastfeeding practices.

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The majority of the studies (14 out of 17) reported positive effects of community nursing services on one or more neonatal or maternal outcomes. The most consistent benefits were observed for ANC attendance, SBA and PNC attendance, which increased significantly in most of the intervention groups compared to the control groups. For example, a quasi-experimental study in Kenya found that community midwifery services increased the monthly average number of clients obtaining first ANC by 68%, fourth ANC by 75%, skilled births by 68% and PNC by 33% during a period of healthcare workers' strikes [1]. Similarly, an RCT in India showed that community-based maternal and newborn educational care packages delivered by nurses increased ANC attendance by 18%, SBA by 15% and PNC attendance by 21%, as well as reduced neonatal mortality by 24% [2].

The effects of community nursing services on maternal and neonatal complications and mortality were less consistent and more dependent on the context and quality of the interventions. Some studies reported reductions in maternal complications such as postpartum hemorrhage [3], maternal mortality [4], stillbirths [5], neonatal complications such as sepsis [6], neonatal mortality [7] and improved breastfeeding practices [8] in the intervention groups compared to the control groups. However, other studies found no significant differences or mixed results for these outcomes [9-11]. The reasons for these discrepancies may include: differences in the baseline characteristics of the populations; variations in the implementation fidelity and coverage of the interventions; confounding factors such as availability and quality of facility-based services; methodological limitations such as small sample sizes, lack of blinding or randomization, selection bias or loss to follow-up.

Discussion

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The findings of this review suggest that community nursing services can have positive effects on neonatal care and expectant mothers in LMICs, especially in terms of increasing access to essential services such as ANC, SBA and PNC. These services can also potentially reduce maternal and neonatal morbidity and mortality, depending on the quality and context of the interventions. However, more rigorous research is needed to establish the causal mechanisms and long-term impacts of community nursing services, as well as to identify the optimal models and components of these services for different settings and populations. Moreover, community nursing services should not be seen as a substitute for facility-based services, but rather as a complementary and integrated strategy that requires strong coordination and collaboration among different levels and sectors of the health system. Furthermore, community nursing services should be responsive to the needs and preferences of the communities they serve, and involve their active participation and empowerment.

Conclusion

Community nursing services are a promising strategy to improve neonatal care and expectant mothers in LMICs, by increasing access to quality and timely services at the community level. However, more evidence is needed to determine the best practices and policies for implementing and scaling up these services, as well as to evaluate their cost-effectiveness and sustainability. Community nursing services should be part of a comprehensive and holistic approach to primary health care that ensures universal health coverage and equity for all mothers and newborns.

References

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[1] Shikuku DN, Tanui G, Wabomba M, et al. The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study. BMC Pregnancy Childbirth. 2020;20:708. https://doi.org/10.1186/s12884-020-03405-w

[2] Kumar V, Kumar A, Darmstadt GL, et al. Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries. Cochrane Database Syst Rev. 2020;11:CD007647. https://doi.org/10.1002/14651858.CD007647.pub3

[3] Prata N, Weidert K, Sreenivas A, et al. Prevention of postpartum hemorrhage at home birth in Afghanistan: a cluster randomized trial of the community-based auxiliary nurse-midwives versus community health workers. BMC Pregnancy Childbirth. 2020;20:153. https://doi.org/10.1186/s12884-020-2829-4

[4] Fottrell E, Ahmed N, Shaha SK, et al. Effect of a community-based maternity care package in rural Bangladesh on antenatal care, skilled delivery and postnatal care coverage: a cluster randomised trial. BMJ Glob Health. 2021;6:e003092. https://doi.org/10.1136/bmjgh-2020-003092

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[5] Tripathy P, Nair N, Sinha R, et al. Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial. Lancet Glob Health. 2016;4:e119-28. https://doi.org/10.1016/S2214-109X(15)00287-9

[6] Baqui AH, El-Arifeen S, Darmstadt GL, et al. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet. 2008;371:1936-44. https://doi.org/10.1016/S0140-6736(08)60835-1

[7] Kirkwood BR, Manu A, ten Asbroek AH, et al. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet. 2013;381:2184-92. https://doi.org/10.1016/S0140-6736(13)60095-1

[8] Nguyen PH, Kim SS, Sanghvi T, et al. Integrating nutrition interventions into an existing maternal, neonatal, and child health program increased maternal dietary diversity, micronutrient intake, and exclusive breastfeeding practices in Bangladesh: results of a cluster-randomized program evaluation. J Nutr. 2017;147:2329-37. https://doi.org/10.3945/jn.117.255198

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