Evidence map›Paper›PMID 35835476›Full record

ArticleBMJ global health2022

Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India.

Sumeet R Patil, Sneha Nimmagadda, Lakshmi Gopalakrishnan, Rasmi Avula, Sumati Bajaj, Nadia Diamond-Smith, Anshuman Paul, Lia Fernald, Purnima Menon, Dilys Walker

Abstract readControlled Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sumeet R PatilCenter for Causal Research and Evaluations, NEERMAN, Mumbai, India srpatil@neerman.org.
Sneha NimmagaddaCenter for Causal Research and Evaluations, NEERMAN, Mumbai, India.
Lakshmi GopalakrishnanDepartment of Health Policy, School of Public Health, UC Berkeley, Berkeley, CA, USA.
Rasmi AvulaInternational Food Policy Research Institute, New Delhi, India.ORCID 0000-0003-0066-6964
Sumati BajajInternational Food Policy Research Institute, New Delhi, India.
Nadia Diamond-SmithEpidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Anshuman PaulCenter for Causal Research and Evaluations, NEERMAN, Mumbai, India.
Lia FernaldCommunity Health Sciences, School of Public Health, UC Berkeley, Berkeley, CA, USA.
Purnima MenonInternational Food Policy Research Institute, New Delhi, India.
Dilys WalkerDepartment of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIndia's 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes-(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months.

methodsWe used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5-9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages.

resultsAmong pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices.

conclusionThe at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers. TRIAL REGISTRATION NUMBER: ISRCTN83902145.

Indexed as

Pregnant PeoplePublic HealthChildCommunity Health WorkersCross-Sectional StudiesFemaleHumansInfantMothersPregnancychild healthhealth services researchhealth systems evaluationmaternal healthnutrition

Identifiers

PMID35835476
PMCPMC9296874

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.