Effects of a four-year health systems intervention on the use of maternal and infant health services: results from a programme evaluation in two districts of rural Chad

Background Attendance of maternal and infant care services in rural Chad are consistently low. Our study aimed to assess the use of antenatal (ANC) and postnatal care (PNC) services, health facility delivery and infant health services after 4 years of a health systems intervention for improving the infrastructure, supplies, training and sensitization for maternal and infant health in two districts of rural Chad. Methods Data from a repeated cross-sectional household survey conducted in Yao and Danamadji in 2015 and in 2018 were analyzed. A stratified two-stage cluster sampling methodology was applied to achieve a representative sample of the rural settled and mobile population groups in the study area. A generalized linear model was applied to determine the health care utilization rates. Multivariate regression models were used to assess the association between the programme intervention and utilization outcomes of selected maternal and infant health services. Results Complete datasets were available for 1284 households at baseline. The endline analysis included 1175 households with complete survey data. The use of at least one ANC amongst pregnant women increased in both settled communities (from 80% in 2015 to 90% in 2018) and amongst mobile pastoralist communities (from 48% in 2015 to 56% in 2018). The rate of home delivery among settled communities and mobile pastoralists changed little between baseline and endline and remained high for both population groups. Individuals that were covered by the health systems intervention were however significantly more likely to attend ANC and less likely to give birth at home. PNC services only showed improvements amongst the settled communities (of 30%). Infants’ reported health outcomes and vaccination coverage considerably improved; the latter especially among mobile pastoralist (from 15% in 2015 to 84% in 2018). Conclusion A combination of health systems strengthening interventions was associated with an increased use of certain maternal and infant health services. However, to facilitate equitable access to and use of health care services in particular in times of increased vulnerability and by certain population groups in hard-to-reach areas, reinforced health education and culturally adapted communication strategies, including gender-specific messaging will be needed over a sustained period.

The Baltimore Urban food Distribution (BUD) App: Study Protocol for A Food Systems Intervention

Background: Low-income urban communities in the United States commonly lack ready access to healthy foods. This is due in part to a food distribution system that favors the provision of high-fat, high-sugar, high-sodium processed foods to small retail food stores, and impedes their healthier alternatives, such as fresh produce. Methods: The Baltimore Urban food Distribution (BUD) study is a multi-level, multi-component systems intervention that aims to improve healthy food access in low income neighborhoods of Baltimore, Maryland. The primary intervention is the BUD application (app), which uses the power of collective purchasing and delivery to affordably move foods from local producers and wholesalers to the city’s many corner stores. We will implement the app in a sample of 38 corner stores, randomized to intervention and comparison. Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures on suppliers, corner stores, and consumers. Discussion: BUD represents one of the first attempts to implement an intervention that engages multiple levels of a local food system. The design of the intervention and the evaluation plan of the BUD project are documented here.Trial registration #: #### (register since not yet recruiting)

Teorias de Sistemas Críticos para diagnóstico de grupos sociais no âmbito do Design

Este artigo tem como premissa principal investigar como designers podem aplicar as abordagens críticas do pensamento de sistemas (systems thinking) para o diagnóstico de grupos sociais. Para isso, faz-se primeiramente uma abordagem teórica sobre assuntos pertinentes como Design, Artesanato e teorias de sistemas interpretativistas e críticos como Total Systems Intervention (TSI) e a Critical Systems Heuristics (CSH). Depois, apresenta-se uma descrição do caso de projeto social investigado neste trabalho, o Rede de Mulheres, oferecido pela secretaria da Mulher e Assuntos da Família de Apucarana, no estado do Paraná. Então, caracteriza-se a coleta de dados no projeto e a relação das informações com as teorias de sistemas críticos. Ao final da aplicação da CSH, foram identificados três pontos para intervenção de design: (I) capacitação das artesãs para repassarem os conhecimentos a fim expandir e perpetuar o grupo; (II) rever os preços dos produtos e a estratégia de divulgação de procedência deles; e (III) intervenção do Design de Serviço no sistema a fim de mitigar desigualdades de poder.