Systematic Review Protocol: Assessment of Primary Health Care for improving quality and access to maternal, new-born and child health services in sub-Saharan African countries: A systematic review of published studies.

Systematic Review Protocol (using the PRIMA-P 2015 checklist)

Review Title: Assessment of Primary Health Care for improving quality and access to maternal, new-born and child health services in sub-Saharan African countries:  A systematic review of published studies

Draft – final

ADMINISTRATIVE INFORMATION

Title

Identification: Protocol for systematic review on Assessment of Primary Health Care for improving quality and access to maternal, new-born and child health services in sub-Saharan African countries:  A systematic review of published studies

 

Authors

 Contact: Name, affiliation and email addresses of protocol authors

Friday E. Okonofua^{1, 3, 4}, feokonofua@yahoo.co.uk Lorretta F. C. Ntoimo^{1, 2}, lorretta.ntoimo@fuoye.edu.ng;  Rosemary N. Ogu ^{1, 4, 5} dr.ogurosemary@gmail.com

Seun O Anjorin ¹aosanjorin@gmail.com

Affiliation

¹The Women’s Health and Action Research Centre, Benin City, Nigeria;

²Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, Nigeria;

³University of Medical Sciences, Ondo City, Ondo State, Nigeria;

⁴Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria

⁵University of Port Harcourt, Rivers State, Nigeria

Corresponding author: Lorretta F. C. Ntoimo

Mailing address: Department of Demography and Social Statistics, Federal University Oye-Ekiti, Nigeria

Contributions

FEO, LFCN, RNO and SOA contributed to all sections of the protocol

Review guarantor – Friday E. Okonofua

 Support

Sources: Research fund

Sponsor

This study was funded by the Publc Health Institute (USA) Champions for Change (C4C) project under grant number 1020971. The International Development Research Centre (IDRC), Canada also funds primary health care access project for the Women’s Health and Action Research Centre (WHARC) under grant number 108041

Role of sponsor/funder: None

INTRODUCTION

Rationale

Despite the promise of PHC, there has been limited documentation of its effectiveness

 in improving maternal, new-born and child health in sub-Saharan Africa, a region with the highest burden of maternal and child mortality and morbidity. Also, not adequately known are the best approaches for developing and implementing policies on PHC to enable them respond to the health needs of women and children. However, a few systematic reviews have been conducted on best practices in effective PHC delivery in sub-Saharan Africa but they are limited in focus. For instance, Christopher et al (2011) reviewed studies on the effectiveness of Community Health Workers in sub-Saharan Africa. Their study was limited in its coverage, focusing only on child health and on three countries in the region (Gambia, Ghana and Benin).

Objective

The objective of this review is to document the interventions aimed at addressing the improvement of PHC service delivery for reducing maternal, new-born and child mortality in sub-Saharan Africa. Specific evidence will be sought for facility-based and community-based interventions, strategies and approaches that have been implemented to improve quality and access to primary health care for maternal, new-born and child health in sub-Saharan Africa

METHODS

Eligibility Criteria

Studies will be included if they used quantitative design, written in English, conducted in sub-Saharan Africa between 2000 and 2017 and published in a peer-reviewed journal. The review was limited to 2000 and 2017.

Outcomes of interest in the review is improvement in quality and access to primary health care for maternal, new-born and child healthcare. Studies to be reviewed would include those that are PHC facility-based, community-based and related to the functions of a PHC, with outcomes designed to improve quality and access to PHC services for maternal, new-born and child health care. Quality of service is defined in terms of improvement in self-reported or otherwise tested competence of providers in providing PHC functions for MNCH.  Access is to be defined as improvement in utilization of PHC facility, community and outreach services for MNCH

Information sources

Intended sources of data – peer reviewed and published journal articles in bibliographic databases – African Journals Online (AJOL), PubMed/Medline, Popline, ScienceDirect, Google Scholar, WHO Repository (IRIS), Directory of Open Access Journals (DOAJ), Cochrane Library, reference lists of relevant systematic reviews and other articles.

10. Search strategy

Search strategy using controlled vocabulary, synonyms and free-text terms to identify studies on PubMED will be developed, and adapted for subsequent searches of other electronic sources. Search terms will include for maternal health, newborn health, child health, sub-Saharan African countries, and primary health care. Examples of synonyms that will be used: “utilization” OR “use” OR  “access” ;  “primary health care clinic” OR “health post” OR “first level facility”; “antenatal” OR “prenatal” OR “antepartum”;  “childbirth” OR “delivery” OR “intrapartum”; “postnatal” OR “postpartum”;” counselling” OR “ advise”; ” family planning” OR “contraceptives”,  “immunization” OR “vaccination”;  “intervention” OR “strategy” OR “approach”; “competence” OR “skill” OR “ability” OR “capacity”; “education” OR “training”; and “supportive supervision” OR “mentoring” etc.

STUDY RECORDS

Data management

Retrieved articles will be saved in a folder. References will be organized using Zotero.

Selection process

Accessed studies will be screened for eligibility and possible inclusion by at least two reviewers .

Data collection process

We will use a data extraction form. Two investigators will extract data from the selected studies. Data extracted by each author will be checked and confirmed by the other author. Data were extracted verbatim. Interventions and results were paraphrased in some cases. Interventions were organized according to emerging themes.  

Data items

The following items will be extracted from each study: author, date of publication, setting, study population, intervention or strategy employed, study conducted in a PHC facility or community-based, duration of follow-up, outcomes of interest, results (quantitative results only), and highlight significant results

Outcomes to look for include improvement in delivery of MNCH care services, improvement in maternal health (antenatal care utilization, delivery in a health facility, postnatal care, family planning, new-born and child health, and mortality.

 Risk of bias in individual studies

The included studies differed in study design, method of data collection, type of data collected and analytical strategies. A tool developed by Sirriyeh et al (2011) for quality assessment of studies with diverse designs will be used for assessment of the studies. The tool consists of 16 criteria which includes explicit theoretical framework, statement of aims/objectives, clear description of research setting, evidence of sample size, representativeness of sample of target group of a reasonable size, description of procedure for data collection, rationale for choice of data collection tool, detailed recruitment data, statistical assessment of reliability and validity of measurement tools, fit between research question and method of data collection, fit between research question and format and content of data collection tool, fit between research question and method of analysis, good justification for analytical method used, assessment of reliability of analytical process (for qualitative only), evidence of user involvement in design, and strengths and limitations critically discussed. Qualitative studies will not be included, so, we skip the criterion that applies to qualitative studies only.  15 criteria will be used. Each criterion will be scored 0 to 3 (0= not at all, 1=very slightly, 2=moderately, 3=complete) following the recommendations by Sirriyeh et al.

DATA

Synthesis

Studies varied in design, interventions,, use of control groups, methods of data collection, and outcome measures. So, meta-analysis was not feasible, a narrative synthesis was employed for each identified theme.

Meta-bias

The varying outcome measures means that checking for publication bias is not feasible.

Confidence in cumulative evidence

Using the 15 criteria from Sirriyeh et al (2011), the total score for each paper will be divided by the maximum possible score (45) to derive the overall quality score for the paper. Scores ≥ 70% will be considered of high quality, medium quality score will be from 50% to < 70%, and low-quality will be scores < 50%.