Abstract:

The healthcare inequities in hard-to-reach (HTR) areas of developing countries, such as Nigeria, have significant implications for disease prevention and control, particularly in maternal and child health. The aim of this study is to look at how well mobile outreach and health facility outreach programs work to improve health outcomes in rural, underserved, and hard-to-reach (HTR) areas in Adamawa State, Nigeria. The focus is on key indicators of maternal, newborn, and child health. The key interventions include antenatal care (ANC), family planning, routine immunization, vitamin A supplementation, deworming of children under 5 years, and Diarrhea treatment. The study applied a cross-sectional design using before-and-after assessments to assess the outcome of the mobile outreach interventions using quantitative health facility-level data from the District Health Information System (DHIS 2.0) on the intervention. Following a successful intervention, the coverage of these indicators prior to and following the intervention was compared using the data. The study shows a cumulative improvement in ANC (21%), institutional delivery (18%), and Penta 3 coverage (28%). Mobile and hard-to-reach strategies utilizing community health workers and volunteers from the LGA, and health facilities can be effective in improving coverage of MNCH services and hold promise for better maternal and child survival in rural, HTR, and under-resourced parts of Adamawa State, Nigeria, and Sub-Saharan Africa at large. In addition, the mobile outreach interventions have contributed to improving MNCH services in hard-to-reach communities, so scaling up the strategy is highly recommended.

References:

[1] Haruna, U., Dandeebo, G., & Galaa, S. Z. (2019). Improving access and utilization of maternal healthcare services through focused antenatal care in rural Ghana: a qualitative study. Advances in Public Health, 2019.

[2] Esamai, F., Nangami, M., Tabu, J., Mwangi, A., Ayuku, D., & Were, E. (2017). A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol). Reproductive health, 14, 1-18.

[3] Hanif, M., Khalid, S., Rasul, A. & Mahmood, K. (2021). Maternal mortality in rural areas of Pakistan: challenges and prospects. Rural Heal, 27, 1040-1047.

[4] Blackwell, S., Louis, J. M., Norton, M. E., Lappen, J. R., Pettker, C. M., Kaimal, A., ... & Landis, R. (2020). Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. American Journal of Obstetrics & Gynecology, 222(4), B2-B18.

[5] McIntyre, D., Thiede, M., & Birch, S. (2009). Access as a policy-relevant concept in low- and middle-income countries. Health economics, policy, and law, 4(Pt 2), 179–193. https://doi.org/10.1017/S1744133109004836

[6] Oluwadare, C. (2009). The social determinants of routine immunisation in Ekiti State of Nigeria. Studies on Ethno-Medicine, 3(1), 49-56.

[7] DHS Program retrieved from: https://www.dhsprogram.com/pubs/pdfAssessed August 2023.

[8] Tsegaye, Z. T., Sinamo, T., Desta, B. F., Beshir, I. A.& Abawollo, H. S. (2022). Integrated Periodic Outreach Strategy to Improve Maternal and Child health Service Access Among Hard-to-Reach Areas in Ethiopia.

[9] Garchitorena, A., Miller, A. C., Cordier, L. F., Rabeza, V. R., Randriamanambintsoa, M., Razanadrakato, H. T. R., ... & Bonds, M. H. (2018). Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar. BMJ global health, 3(3), e000762.

[10] Roodenbeke, E. D., & World Health Organization. (2011). Outreach services as a strategy to increase access to health workers in remote and rural areas. World Health Organization.

[11] Mweemba, C., Mapulanga, M., Jacobs, C., Katowa-Mukwato, P., & Maimbolwa, M. (2021). Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design. Pan African Medical Journal, 40(1).

[12] DHIS 2 retrieved from: https://www.dhis2.0.org. Assessed January 2022

[13] Mweemba, C., Mapulanga, M., Jacobs, C., Katowa-Mukwato, P., & Maimbolwa, M. (2021). Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design. Pan African Medical Journal, 40(1).

[14] Partapuri, T., Steinglass, R., & Sequeira, J. (2012). Integrated delivery of health services during outreach visits: a literature review of program experience through a routine immunization lens. Journal of Infectious Diseases, 205(suppl_1), S20-S27.

[15] Yaya, S., Komlan K., Amos B., and Ghose B. (2019). “Antenatal Visits Are Positively Associated with Uptake of Tetanus Toxoid and Intermittent Preventive Treatment in Pregnancy in Ivory Coast.”: 1–12.

[16] Nuamah, G. B., Agyei-Baffour, P., Mensah, K. A., Boateng, D., Quansah, D. Y., Dobin, D., & Addai-Donkor, K. (2019). Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana. BMC pregnancy and childbirth, 19, 1-11.

[17] Tsegaw, Menen. 2022. “Modern Contraceptive Utilization and Associated Factors Among Married Women in Liberia: Evidence from the 2019 Liberia Demographic and Health Survey.” (February): 17–28.

[18] Lun, C. N., Aung, T., & Mya, K. S. (2021). Utilization of modern contraceptive methods and its determinants among youth in Myanmar: Analysis of Myanmar Demographic and Health Survey (2015-2016). Plos one, 16(10), e0258142.

[19] Hailu, S., Astatkie, A., Johansson, K. A., & Lindtjørn, B. (2019). Low immunization coverage in Wonago district, southern Ethiopia: a community-based cross-sectional study. PloS one, 14(7), e0220144.

[20] Animaw, W., Taye, W., Merdekios, B., Tilahun, M., & Ayele, G. (2014). Expanded program of immunization coverage and associated factors among children aged 12–23 months in Arba Minch town and Zuria District, Southern Ethiopia, 2013. BMC public health, 14(1), 1-10.

[21] Berihun, B., Chemir, F., Gebru, M., & GebreEyesus, F. A. (2023). Vitamin A supplementation coverage and its associated factors among children aged 6–59 months in West Azernet Berbere Woreda, Southwest Ethiopia. BMC pediatrics, 23(1), 1-13.

[22] Belay, D. G., Kibret, A. A., Diress, M., Gela, Y. Y., Sinamaw, D., Simegn, W., ... & Chilot, D. (2022). Deworming among preschool age children in sub-Saharan Africa: pooled prevalence and multi-level analysis. Tropical Medicine and Health, 50(1), 74.

[23] Forson, A. O., Abdul-Basit, S., Awusi, G. K., Taiwo, M. O., & Baidoo, I. A. (2023). A comparative study on the prevalence of intestinal hel-minths in dewormed and non-dewormed healthy persons in Ghana. J Clin Images Med Case Rep, 4(3), 2322.

[24] Zegeye, B., Ahinkorah, B. O., Idriss-Wheeler, D., Olorunsaiye, C. Z., Adjei, N. K., & Yaya, S. (2021). Modern contraceptive utilization and its associated factors among married women in Senegal: a multilevel analysis. BMC Public Health, 21(1), 1-13.

[25] Manyeh, A. K., Amu, A., Williams, J., & Gyapong, M. (2020). Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana. BMC pregnancy and childbirth, 20(1), 1-7.

[26] Ahuru, R. R. & Omon, I. J. (2019). Predictors of Antenatal Care Utilization in Primary Healthcare Centers in Eight Rural Communities in Delta State, Nigeria. African Journal of Health Economics, 8, 1-2.

[27] Nuamah, G. B., Agyei-Baffour, P., Mensah, K. A., Boateng, D., Quansah, D. Y., Dobin, D., & Addai-Donkor, K. (2019). Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana. BMC pregnancy and childbirth, 19, 1-11.

[28] Debebe, S., Miteku A. L. and Belete, B. (2017). “Modern Contraceptive Methods Utilization and Associated Factors among Reproductive Aged Women in Rural Dembia District, Northwest Ethiopia: Community Based Cross-Sectional Study.” International Journal of Reproductive BioMedicine 15(6): 367–74.

[29] Maxwell T. Kumbenia and Paschal A. Apangab. (2021). “Institutional Delivery and Associated Factors among Women in Ghana: Findings from a 2017 – 2018 Multiple Indicator Cluster Survey.”: 1–7.

[30] Asekun O E, Adebimpe W, Bamidele J, Odu O, Asekun O I, Ojofeitimi E. Barriers to use of modern contraceptives among women in an inner-city area of Osogbo metropolis, Osun state, Nigeria. Int J Women H. 2013;11(5):647–655

[31] Durowade KA, Omokanye LO, Elegbede OE, Adetokunbo S, Olomofe CO, Ajiboye AD, Adeniyi MA, Sanni TA. Barriers to Contraceptive Uptake
among Women of Reproductive Age in a Semi-Urban Community of Ekiti State, Southwest Nigeria. Ethiop J Health Sci. 2017 Mar;27(2):121-128.

[32] Haddrill, R., Jones, G. L., Mitchell, C. A., & Anumba, D. O. (2014). Understanding delayed access to antenatal care: a qualitative interview study. BMC pregnancy and childbirth, 14(1), 1-14.

[33] Modibbo, U. M., Ali, I., & Ahmed, A. (2021). Multi-objective optimization modelling for analysing sustainable development goals of Nigeria: Agenda 2030. Environment, Development and Sustainability, 23(6), 9529-9563.

[34] Galadima, A. N., Zulkefli, N. A. M., Said, S. M., & Ahmad, N. (2021). Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health, 21(1), 1-20.

[35] Nour, T. Y., Farah, A. M., Ali, O. M., & Abate, K. H. (2020). Immunization coverage in Ethiopia among 12–23-month-old children: systematic review and meta-analysis. BMC Public Health, 20(1), 1-12.