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Table 2 The research hypotheses and the research findings related to them

From: Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 10. Summary, cost effectiveness, and policy implications

Hypothesis

Outcomes

Location of details

The CBIO+ Approach improves the population coverage of interventions that are designed to address the epidemiological priorities for mothers and children relative to (a) baseline measures of these indicators, (b) measures in a comparison area (Area B), (c) measures in selected nearby municipalities where the Project was not in operation, and (d) the overall rural population of the Department of Huehuetenango

There was a statistically significant increase in the population coverage of 19 of the 24 indicators under the Project’s control in Area A and 19 of the 24 in Area B. Coverage improvements were greater in Area A than in Area B for 8 of these 24 indicators, but improvements in Area B were surprisingly strong given the shorter period of implementation. We were not able to locate appropriate comparable data for adjacent municipalities nor for the rural population of the Department of Huehuetenango. However, we were able to compare our findings for 17 indicators with those for the entire Department of Huehuetenango. For 7 of the 17 indicators, the levels of coverage were higher in the Project Area in spite of the fact that the Project Area was one of the most isolated and impoverished sections of the Department and the data for the Department as a whole included urban areas as well

Paper 3 [13]

The CBIO+ Approach improves the nutritional status of children relative to (a) baseline measures of these indicators, (b) measures in a comparison area (Area B), (c) measures in selected nearby municipalities where the Project was not in operation, and (d) the overall rural population of the Department of Huehuetenango

Significant improvements in stunting and underweight were observed in Area A. The improvements were greater in Area A than in Area B. Comparisons with the nutritional data for the rural population of the Department of Huehuetenango and for the Northwest Region of Guatemala revealed lower levels of stunting in the Project Area at endline

Paper 4 [14]

The CBIO+ Approach reduces under-5 mortality and maternal mortality relative to (a) baseline measures of these indicators, (b) measures in a comparison area (Area B), (c) measures in selected nearby municipalities where the Project was not in operation, (d) the overall rural population of the Department of Huehuetenango

The mortality impact assessment based on vital events data demonstrated a statistically significant decline in maternal mortality and in 12-<60-month mortality but  not in neonatal or infant mortality. It appears that the measured baseline levels were artificially low because of incomplete registration of deaths. However, when we applied the Lives Saved Tool, which estimates mortality impact based on changes in coverage of key evidence-based indicators, there was a 22% decline in under-5 mortality and 12% decline in maternal mortality relative to projected ongoing declines in the absence of the Project

Paper 5 [15]

The Birthing Center Approach provides mothers with a safe alternative to home delivery that is also culturally appropriate and attractive to mothers, their families, and to their comadronas (traditional midwives)

Review of the maternal mortality data and clinical records of patients giving birth at birthing centers all confirm the greater safety of a delivery at a birthing center compared to a home birth as well as its attraction for mothers and comadronas

Papers 1 and 7 [11, 17]

The CBIO+ Approach empowers women engaged as volunteers and as beneficiaries, and it improves self-esteem and decision-making autonomy. The CBIO+ Approach also builds social capital

Interviews with Care Group participants provided numerous examples in which their participation led to increased respect from others in the community, increased willingness and ability to make decisions, and even stronger bonds with other Care Group members, community members, and community leaders. Household survey data revealed increases in women’s active participation in community meetings and in health-related decision-making in the home

Papers 7 and 8 [17, 18]

Stakeholders, including Project beneficiaries, community leaders, Project staff, and MSPAS staff, consider the CBIO+ Approach to be effective and appropriate for improving the health and well-being of children and their mothers

Stakeholders were highly supportive of the CBIO+ Approach, the manner in which it was implemented, and the added value that it brought to the MSPAS health system. Among the many benefits mentioned was the value of engaging the community in the process of improving the health of mothers and children

Paper 9 [19]

  1. MSPAS Ministerio de Salud Pública y Asistencia Social (Ministry of Health and Social Assistance)