Impact evaluation of the Tamani project to improve maternal and child health in Tanzania
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BACKGROUND: The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient-provider communication. METHODS: Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects. RESULTS: Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient-provider communication. CONCLUSION: Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes
Attendance · Birth attendant · Environmental health · Family medicine · Health care · Health facility · Health services · Intervention (counseling) · Maternal health · Population · Postnatal Care · Pregnancy · Program evaluation · Psychological intervention · Tanzania · Child Nutrition and Water Access · Global Health and Surgery · Global Maternal and Child Health · Medicine · Nursing
Doubly robust difference-in-differences estimators
The stepped wedge cluster randomised trial
Semiparametric Difference-in-Differences Estimators
Matching As An Econometric Evaluation Estimator
Difference-in-differences with variation in treatment timing
Difference-in-Differences with multiple time periods
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Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania
Scaling up in international health
Disrespectful and abusive treatment during facility delivery in Tanzania
Too far to walk
Eye of the beholder? Observation versus self-report in the measurement of disrespect and abuse during facility-based childbirth
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