Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia.
Authors: Tessema Asressie Molla , Gebeyehu Abebaw , Mekonnen Solomon , Alemu Kassahun , Tigabu Zemene 
Published: October 2020

Abstract
Background: Rendering focused antenatal care activities are directed at sustaining the maternal health and improving the fetal wellbeing to ensure the delivery of a live healthy neonate. Failure to implement focused antenatal care package can results in inability to reduce maternal and neonatal morbidity and mortality, perinatal death and stillbirth in developing countries. However, due to evidence-practice gaps, thousands of maternal, fetal and neonatal lives are still losing every day mostly from preventable causes. This study aimed to assess focused antenatal care package intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods: A cross-sectional study design was employed and a total of 898 women who gave birth in the last six months prior to data collection were included. Also 16 health extension workers, working in the selected 10 health posts for facility audits, were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Facilities (Health posts) were audited to assess availability and functionality of drugs and supplies in the health posts to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational levels factors influencing focused antenatal care package intervention fidelity. Results: Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (0.498) (95% CI: 47.7 – 51.8); which means the average amount of focused antenatal care package intervention a mother received is 49.8% (0.498). Of which 55.1% was implemented by health extension workers and 44.9% by skilled providers (nurses, midwives, health officers or medical doctors). Overall antenatal care coverage, irrespective of frequency (at least one visit), was 752 women (83.7%; 95% CI: 81.3–86.1); 263 women (35.0%; 95% CI: of 31.6 – 38.4) of them received at least four antenatal visits and 46 women (6.1%, 95% CI: 4.4 - 7.8) received all recommended components of focused antenatal care. Previous pregnancy-related problems, paternal education, and implementation of supportive/facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity.Conclusion: Focused antenatal care package intervention fidelity in the study area was low; this may imply that the current level of maternal, perinatal, neonatal mortality and stillbirth might be partly due to the low level of focused antenatal care fidelity. Improving implementation of facilitation strategies is highly required to contribute to the reduction of those mortalities.