title: The effect of community maternal and newborn health family meetings on type of birth attendant and completeness of maternal and newborn care received during birth and the early postnatal period in rural Ethiopia.
abstract: BACKGROUND
  Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based interventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers.
  
  
  METHODS
  Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care-controlling for sociodemographic and health service utilization factors.
  
  
  RESULTS
  A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P < .001). A positive dose-response relationship existed between the number of meetings attended and greater care completeness (P < .001). Women with any antenatal care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P < .001).
  
  
  CONCLUSIONS
  MaNHEP's family meetings complemented routine antenatal care by engaging women and family caregivers in self-care and care-seeking, resulting in greater completeness of care and more highly skilled birth care.
authors.forename: Danika
authors.initials: D
authors.lastname: Barry
authors.forename: Aynalem Hailemichael
authors.initials: AH
authors.lastname: Frew
authors.forename: Hajira
authors.initials: H
authors.lastname: Mohammed
authors.forename: Binyam Fekadu
authors.initials: BF
authors.lastname: Desta
authors.forename: Lelisse
authors.initials: L
authors.lastname: Tadesse
authors.forename: Yeshiwork
authors.initials: Y
authors.lastname: Aklilu
authors.forename: Abera
authors.initials: A
authors.lastname: Biadgo
authors.forename: Sandra Tebben
authors.initials: ST
authors.lastname: Buffington
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Sibley
mesh_terms: D000328:Adult; D003150:Community Health Workers; D005002:Ethiopia; D005190:Family; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008880:Midwifery; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care; D011247:Pregnancy; D011295:Prenatal Care; D012111:Residence Characteristics; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population; D012648:Self Care; D055815:Young Adult
keywords: Ethiopia; community-based intervention; maternal and newborn health; participatory; skilled birth attendance