Changes in essential newborn care practice and maternal and newborn health commodity uptake following implementation of a community-based maternal and newborn care model in South Sudan and Somalia: pre-post study

Given high mortality rates and low access to health facilities, the International Rescue Committee introduced Community-based Maternal and Newborn Care (CBMNC) Programs in rural areas of Somalia and South Sudan. The programs included distribution of evidence-based commodities for maternal or newborn health as well as health counseling during home visits, delivered by low-literate community health workers.

The pre-post study used population-representative cross-sectional surveys among women who delivered in the twelve months preceding the program, conducted before and 18-24 months after the CBMNC program introduction (n=338 baseline, n=340 endline in South Sudan, n=351 baseline, n=302 endline in Somalia). The study employed rigorous statistical methods to adjust for potential confounding factors and strengthen inference regarding changes associated with the program despite the non-experimental study design.

Program enrollment was high (79.1% in South Sudan, 87.7% in Somalia). In South Sudan, Skin-to-skin care, clean cord care, early initiation of breastfeeding, and use of Fansidar were statistically significantly higher among those who received four or more visits, but marginally significantly lower uptake of institutional delivery and SBA. For Somalia, skin-to-skin care showed statistically significant positive change among those who received four or more visits, with early initiation of breastfeeding, no prelacteal feeding, and making four or more facility-based ANC visits demonstrated marginally significant higher uptake.

The positive change in uptake of evidence-based community-based MNH services showed promise in Somalia, but mixed results in South Sudan. This shows promise for change in service uptake even in a relatively short duration of program implementation, but also underscores that community health interventions do not operate in isolation and that parallel investment in facility strengthening and consistent messaging on the complementary roles of community and facility-based care remains essential.

• What is already known on this topic - summarise the state of scientific knowledge on this subject before you did your study and why this study needed to be done

Community-based maternal and newborn care programs have been proven to successfully reduce maternal and newborn mortality and morbidity in development contexts. However, there is limited programming and evidence of a similar type in humanitarian contexts.

• What this study adds - summarise what we now know as a result of this study that we did not know before

Despite a relatively short period of implementation (18-24 months) and delivery of the program by low-literate community health workers, those who received four or more visits from the program showed higher uptake of select maternal and newborn health-related commodities and behaviors. However, in South Sudan, there were marginally significant negative association of program visits with institutional delivery.

• How this study might affect research, practice or policy - summarise the implications of this study

The results show promise for CBMNC programs in humanitarian contexts to increase access and uptake to evidence-based interventions. However, increasing access to community-based services must occur in parallel to strengthening facility-based services to maximize the impact community-based service and counseling delivery can have.