Abstract
Background: Community-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia. Methods: This IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation. Results: This IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers’ care-seeking behavior for their sick young infants. The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings. Conclusions: The use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.
| Original language | English (US) |
|---|---|
| Article number | 1515 |
| Journal | BMC health services research |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| State | Published - Dec 2022 |
Funding
We thank the Bill & Melinda Gates Foundation for funding this implementation research. The implementation of this survey would not have been possible without the support of Ethiopia’s Ministry of Health, Amhara and Oromia Regional Health Bureaus, National Child Health Technical Working Group, National RMNCH-N Research Advisory Council Child Health and Immunization group, and other development partners (Transform Primary Health Care, Fenot project, UNICEF, KOICA, and USAID). We acknowledge the interviewers and the supervisors for their hard work, dedication, and for accomplishing the fieldwork on schedule. Finally, we take this opportunity to extend our gratitude to all study participants who took their time to respond to the survey questionnaires and provide us with invaluable information. Alexandra Kamberos is well-acknowledged for editing the manuscript. The article write-up and publication fee were supported by the Bill & Melinda Gates Foundation, Investment Number INV-024241. JSI Research & Training Institute, Inc. has helped us in the form of salaries for authors [GT]. However, none of the funders played a role in the study design, data collection, analysis, decision to publish, or manuscript preparation. There is limited evidence of the level of impact of the COVID-19 pandemic on care-seeking for neonatal sepsis programs in Ethiopia. Implementation research (IR) was conducted between November 2020-April 2022 in Dembecha and Lume districts of Amhara and Oromia regions, respectively. The research was carried out by JSI Research & Training Institute Inc./The Last Ten Kilometers (L10K) Project, funded by the Bill & Melinda Gates Foundation. The aim was to understand the demand- and supply-side challenges of delivery of PSBI treatment during the COVID-19 pandemic and to develop and test adaptative strategies to mitigate the impact of COVID-19 and other barriers on community-based management of PSBI implementation and uptake. Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, to improve the adoption, high-fidelity implementation, and maintenance of quality, effective, evidence-based practices in health care services []. The Implementation Research Logic Model (IRLM) combines a number of commonly used IR frameworks to help design or evaluate the implementation of evidence-based interventions by identifying determinants and selection strategies through mapping mechanisms and linking those implementation and effectiveness outcomes []. There is also emerging evidence from the United States that IRLM is an effective tool for stakeholder engagement critical for success in implementation work [], but not in Ethiopia or similar settings.
Keywords
- COVID-19
- Ethiopia
- Implementation challenges
- Implementation research logic model
- Implementation science
- Implementation strategies
- Neonatal sepsis
- Newborn
- Possible serious bacterial infection
- Young infants
ASJC Scopus subject areas
- Health Policy
