title: Early results of an integrated maternal, newborn, and child health program, Northern Nigeria, 2009 to 2011.
abstract: BACKGROUND
  This paper describes early results of an integrated maternal, newborn, and child health (MNCH) program in Northern Nigeria where child mortality rates are two to three times higher than in the southern states. The intervention model integrated critical health systems changes needed to reinvigorate MNCH health services, together with community-based activities aimed at mobilizing and enabling women to make changes in their MNCH practices. Control Local Government Areas received less-intense statewide policy changes.
  
  
  METHODS
  The impact of the intervention was assessed using a quasi-experimental design, comparing MNCH behaviors and outcomes in the intervention and control areas, before and after implementation of the systems and community activities. Stratified random household surveys were conducted at baseline in 2009 (n = 2,129) and in 2011 at follow-up (n = 2310), with women with births in the five years prior to household surveys. Chi-square and t-tests were used to document presence of significant improvements in several MNCH outcomes.
  
  
  RESULTS
  Between baseline and follow-up, anti-tetanus vaccination rates increased from 69.0% to 85.0%, and early breastfeeding also increased, from 42.9% to 57.5%. More newborns were checked by trained health workers (39.2% to 75.5%), and women were performing more of the critical newborn care activities at follow-up. Fewer women relied on the traditional birth attendant for health advice (48.4% to 11.0%, with corresponding increases in advice from trained health workers. At follow-up, most of these improvements were greater in the intervention than control communities. In the intervention communities, there was less use of anti-malarials for all symptoms, coupled with more use of other medications and traditional, herbal remedies. Infant and child mortality declined in both intervention and control communities, with the greatest declines in intervention communities. In the intervention communities, infant mortality rate declined from 90 at baseline to 59 at follow-up, while child mortality declined from 160 to 84.
  
  
  CONCLUSIONS
  These results provide evidence that in the context of ongoing improvements to the primary health care system, the participatory and community-based interventions focusing on improved newborn and infant care were effective at changing infant care practices and outcomes in the intervention communities.
authors.affiliation: Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA. sef5@columbia.edu.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Findley
authors.forename: Omolara T
authors.initials: OT
authors.lastname: Uwemedimo
authors.forename: Henry V
authors.initials: HV
authors.lastname: Doctor
authors.forename: Cathy
authors.initials: C
authors.lastname: Green
authors.forename: Fatima
authors.initials: F
authors.lastname: Adamu
authors.forename: Godwin Y
authors.initials: GY
authors.lastname: Afenyadu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000379:methods / Q000458:organization & administration*; D046688:Child Mortality; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration*; D008875:Middle Aged; D009549:Nigeria; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration; D055815:Young Adult