Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan

Arch Dis Child. 2020 Jan;105(1):18-25. doi: 10.1136/archdischild-2019-316802. Epub 2019 Jul 3.

Abstract

Objective: To assess whether sustained, scheduled mobile health team (MHT) services increase antenatal care (ANC), postnatal care (PNC) and childhood immunisation in conflict-affected and remote regions of Afghanistan.

Design: Cross-sectional, population-based study from 2013 to 2017. Proportions were compared using multivariable linear regression adjusted for clustering and socio-demographic variables.

Setting: 54 intervention and 56 control districts in eight Afghanistan provinces.

Participants: 338 796 pregnant women and 1 693 872 children aged under 5 years.

Interventions: 'Intervention districts' that received MHT services for 3 years compared with 'control districts' in the same province without any MHT services over the same period.

Main outcome measures: District-level and clinic-level ANC, PNC, childhood immunisation (pentavalent 3, measles 1), integrated management of childhood immunisation services.

Results: Proportion of pregnant women receiving at least one ANC visit was higher in intervention districts (83.6%, 161 750/193 482) than control districts (61.3%, 89 077/145 314) (adjusted mean difference (AMD) 14.8%;95% CI: 1.6% to 28.0%). Proportion of children under 1 year receiving their first dose of measles vaccine was higher in intervention (73.8%, 142 738/193 412) than control districts (57.3%, 83 253/145 293) (AMD 12.8;95% CI: 2.1% to 23.5%). There was no association with PNC (AMD 2.8%;95% CI: -5.1% to 10.7%). MHTs did not increase clinic-level service provision for ANC (AMD 41.32;95% CI: -52.46 to 135.11) or any other outcomes.

Conclusions: Sustained, scheduled MHT services to conflict-affected and remote regions were associated with improved coverage of important maternal and child health interventions. Outreach is an essential service and not just an 'optional extra' for the most deprived mothers and children.

Keywords: health services research; maternal and child health.

MeSH terms

  • Afghan Campaign 2001-*
  • Afghanistan / epidemiology
  • Child Health Services* / organization & administration
  • Child Health Services* / statistics & numerical data
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility / organization & administration
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Immunization Programs / methods
  • Immunization Programs / statistics & numerical data
  • Infant
  • Infant, Newborn
  • Maternal Health Services* / organization & administration
  • Maternal Health Services* / statistics & numerical data
  • Measles Vaccine / therapeutic use
  • Mobile Health Units* / organization & administration
  • Mobile Health Units* / statistics & numerical data
  • Pregnancy
  • Vaccination Coverage / methods
  • Vaccination Coverage / statistics & numerical data

Substances

  • Measles Vaccine