title: Influence of integrated community- and facility-based interventions on select maternal and neonatal outcomes in Northern Karnataka, India: Lessons for implementation and measurement.
abstract: Sukshema project provided technical assistance to National Health Mission of government of Karnataka to improve maternal, newborn and child health (MNCH) outcomes in eight districts of Karnataka between 2009 and 2015. The project designed tools, processes and provided mentoring to frontline workers, community structures, and facilities to improve demand generation and quality of MNCH services.
  
  
  
  To assess over time changes in selected MNCH care indicators among women who had delivered in the past 2 months in Bagalkot and Koppal districts.
  
  
  
  An innovative strategy was designed to collect routine monitoring data, namely community behavior tracking survey using mobile technology. The catchment area of an Accredited Social Health Activist (ASHA) was the primary sampling unit, and in each district 200, ASHA areas were selected. Women from these selected ASHA areas were interviewed and information collected on various MNCH care outcomes. Multivariate logistic regression was used to assess changes in selected MNCH care indicators.
  
  
  
  Gradual increase was noticed in institutional delivery, hospital stay for 48 or more hours, initiation of breastfeeding within 1 hour and continuum of MNCH care. Forty-eight hours stay and initiation of breastfeeding improved marginally possibly due to health systems and cultural norms.
  
  
  
  Results indicated that the interventions were successful in changing the critical MNCH care indicators and hence have potential for replication in similar high priority district settings.
authors.affiliation: Deputy Director, Karnataka Health Promotion Trust, Bengaluru, India.
authors.forename: Rajaram Subramanian
authors.initials: RS
authors.lastname: Potty
authors.affiliation: Senior Advisor, Programs, Community and Communications, University of Manitoba, Winnipeg, Canada; Managing Trustee, Karnataka Health Promotion Trust, Bengaluru, India.
authors.forename: Mohan Harnahalli
authors.initials: MH
authors.lastname: Lakkappa
authors.affiliation: Deputy Director, Monitoring and Evaluation, Karnataka Health Promotion Trust, Bengaluru, India.
authors.forename: Arin
authors.initials: A
authors.lastname: Kar
authors.affiliation: Deputy Director, Communication and Community Interventions, Karnataka Health Promotion Trust; Deputy Director, Communication and Community Interventions, Health Action Trust, Bengaluru, India.
authors.forename: Mallika
authors.initials: M
authors.lastname: Bidappa
authors.affiliation: Assistant Professor, Department of Community Health Sciences; Research Associate, Centre for Global Public Health, University of Manitoba, Winnipeg, Cananda.
authors.forename: Ramesh Banadakoppa
authors.initials: RB
authors.lastname: Manjappa
authors.affiliation: Assistant Professor, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Director, Karnataka Health Promotion Trust, Bengaluru, India.
authors.forename: Krishnamurthy
authors.initials: K
authors.lastname: Jayanna
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D019035:Rural Health Services / Q000458:organization & administration*