This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Impact of A Maternal and Newborn Health Results Based Financing Intervention (RBF4MNH) On Stillbirth: A Cross-Sectional Comparison in Four Districts in Malawi.
Regina Makuluni
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9368-5456
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: A Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” was implemented by the Government of Malawi in four Districts, with the aim of improving health outcomes. We used this setting to examine the impact of this model on antepartum and intrapartum stillbirth, taking women’s risk factors into account.
Methods: We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. The result based finance for maternal and newborn health intervention was ongoing in two districts and two non-intervention districts were used for comparison. Data were extracted from the maternity registers and analyzed using STATA version 14. Logistic regression models were developed to determine crude and adjusted odds ratios for fresh and macerated stillbirth.
Results: In the study period there were 67 stillbirths among 2,772 deliveries representing 24.1 per 1,000 live births of which 52% (n=35) were fresh (intrapartum) stillbirths and 48% (n=32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P=0.01) and 7.27 (95%CI 2.74 to 19.25 P<0.001) respectively.Gestational age at delivery was significantly associated with stillbirths.
Conclusion: The study did not identify a positive impact of result based finance for maternal and newborn health on the reduction of both fresh and macerated stillbirths. There is a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care.
Keywords
RBF, RBF4MNH, Health
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 23 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 16 Jan, 2021
Review #2 received
Received 12 Jan, 2021
Review #1 received
Received 02 Jan, 2021
Reviewer #2 agreed
On 22 Dec, 2020
Reviewer #1 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 16 Nov, 2020
Editor assigned
On 17 Sep, 2020
First submitted
On 16 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
Learn more about our company.
This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Impact of A Maternal and Newborn Health Results Based Financing Intervention (RBF4MNH) On Stillbirth: A Cross-Sectional Comparison in Four Districts in Malawi.
Regina Makuluni
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9368-5456
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 23 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 16 Jan, 2021
Review #2 received
Received 12 Jan, 2021
Review #1 received
Received 02 Jan, 2021
Reviewer #2 agreed
On 22 Dec, 2020
Reviewer #1 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 16 Nov, 2020
Editor assigned
On 17 Sep, 2020
First submitted
On 16 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: A Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” was implemented by the Government of Malawi in four Districts, with the aim of improving health outcomes. We used this setting to examine the impact of this model on antepartum and intrapartum stillbirth, taking women’s risk factors into account.
Methods: We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. The result based finance for maternal and newborn health intervention was ongoing in two districts and two non-intervention districts were used for comparison. Data were extracted from the maternity registers and analyzed using STATA version 14. Logistic regression models were developed to determine crude and adjusted odds ratios for fresh and macerated stillbirth.
Results: In the study period there were 67 stillbirths among 2,772 deliveries representing 24.1 per 1,000 live births of which 52% (n=35) were fresh (intrapartum) stillbirths and 48% (n=32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P=0.01) and 7.27 (95%CI 2.74 to 19.25 P<0.001) respectively.Gestational age at delivery was significantly associated with stillbirths.
Conclusion: The study did not identify a positive impact of result based finance for maternal and newborn health on the reduction of both fresh and macerated stillbirths. There is a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care.