Browsing by Author "SAFFA, PHILIP AMARA"

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    Assessing CommCare’s Impact on Antenatal, Postnatal, and Immunization Uptake: Evidence from Falaba Community Health Center, Sierra Leone
    (2025-10-01) SAFFA, PHILIP AMARA
    Background Rural districts in Sierra Leone struggle with timely and complete maternal–child health service use. CommCare, a mobile health (mHealth) platform deployed through partnerships with government and NGOs, supports tracking, reminders, and follow-up. Methods A cross-sectional quantitative study at Falaba CHC (Sulima Chiefdom) assessed CommCare’s effects on (i) timeliness and frequency of ANC, (ii) PNC follow-up and care quality, and (iii) immunization uptake among children <2 years. Data were collected from n=288 participants using a structured CommCare questionnaire aligned with five sections (A–E) and extracted CommCare indicators; analysis used descriptive statistics and chi square χ² tests (α=0.05), with effect sizes where applicable. Results First-trimester ANC initiation increased from 45% to 65% (χ²=8.34, p =0.004); completion of ≥4 ANC visits rose 55%→78% (χ²=7.72, p =0.009). PNC improved: first-week postpartum follow-up 40%→80% (χ²=6.12, p =0.014). Immunization adherence increased 60%→82% (χ²=11.34, p =0.002); missed vaccination appointments declined by 24%. CommCare reminders showed strong associations with timely attendance (e.g., PNC χ²=28.451, p <0.001) and fewer missed immunization appointments (χ²=55.524, p <0.001; Φ=−0.439, Cramér’s V=0.439). Conclusion CommCare substantially improved timeliness and continuity of maternal and child health services at Falaba CHC. Findings support CHW-mediated, reminder-driven mHealth as an effective strategy in similar rural settings. Author Summary This study evaluates the role of CommCare , a mobile health (mHealth) platform, in improving maternal and child health service uptake at Falaba Community Health Center in Sierra Leone—a rural district marked by logistical, cultural, and infrastructural barriers to care. Using a cross-sectional quantitative design with 288 participants, the study assessed CommCare’s effect on antenatal care (ANC), postnatal care (PNC), and immunization adherence. Findings demonstrate consistent and significant gains across the continuum of care. First-trimester ANC initiation improved from 45% to 65%, and completion of at least four visits rose from 55% to 78%. PNC attendance within the first week postpartum doubled from 40% to 80%. Immunization adherence increased from 60% to 82%, while missed appointments declined by nearly a quarter. Strong associations were observed between CommCare reminders and timely service use, with most respondents rating the reminders as “extremely useful.” Importantly, the intervention’s impact was mediated through community health workers (CHWs), meaning phone ownership was not a barrier to equitable reach. These results highlight CommCare’s potential as a scalable, CHW-mediated digital tool to strengthen rural health systems by enhancing timeliness, continuity, and confidence in maternal–child healthcare. However, persistent gaps such as transport barriers, socio-economic constraints, and limited health system capacity suggest that digital reminders must be complemented by structural supports for sustained impact. The study contributes to the evidence base on mHealth in low-resource settings, underscoring that digital interventions are most effective when embedded into health system workflows and coupled with investments in CHWs, logistics, and culturally attuned communication strategies.
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    Growth Monitoring and Promotion Model Quality, Regularity of Utilisation, and Child Nutritional Outcomes in High-Burden Communities: Evidence from a Convergent Parallel Mixed-Methods Study in Sulima Chiefdom, Falaba District, Sierra Leone
    (Heighten Science Publications, 2026-06-29) SAFFA, PHILIP AMARA
    **Background:** Worldwide, an estimated 149 million children below the age of five are stunted and a further 45 million are wasted, with the heaviest concentration of this burden falling on Sub Saharan Africa. In Sierra Leone, where national stunting stands at 29% and climbs considerably higher across isolated northern districts, a pressing evidence gap remains that the existing crosssectional literature has not resolved using rigorous multivariable methods. **Methods:** We carried out a convergent parallel mixed-methods study made up of (1) a communitybased cross-sectional survey of 617 mother–child dyads and (2) twelve (12) key informant interviews (KIIs) examined through Framework Analysis in NVivo 14 (kappa = 0.82). Fieldwork took place in Sulima Chiefdom, Falaba District, between January and March 2026. Anthropometric indices were derived from the WHO 2006 Child Growth Standards using the WHO Anthro (igrowup) macro, after which the computed z-scores were transferred to SPSS for analysis. Independent correlates of regular GMP attendance (≥4 sessions/6 months) were established through bivariable and multivariable logistic regression, while multiple linear regression isolated the independent contribution of GMP attendance to height-for-age z-score (HAZ) and weight-for-age z-score (WAZ). A formal mediation analysis with bootstrapped inference (5,000 resamples) examined the Knowledge–Attitude–GMP Attendance pathway, and Spearman’s correlation was used to probe dose-response patterns. **Results:** Regular GMP attendance reached 41.8% (n = 258/617), a level 36 percentage points below ever-attendance (77.8%). Stunting prevalence stood at 28.7% (95% CI: 25.1–32.3%) and global acute malnutrition (GAM) at 18.3% (95% CI: 15.3–21.4%), surpassing the WHO emergency threshold. Children attending regularly showed markedly less stunting (19.0% vs. 35.7%; OR = 0.42, 95% CI: 0.29–0.62) and a mean HAZ that was 0.49 SD higher (Cohen’s d = 0.41, p < 0.001). Within the multivariable linear model, regular attendance held as an independent predictor of HAZ (β = 0.365, SE = 0.102, p < 0.001) and WAZ (β = 0.343, SE = 0.095, p < 0.001) once 11 covariates were taken into account. IYCF counselling (aOR = 4.20), positive attitude (aOR = 3.72), mother support group membership (aOR = 1.87), and perceived benefit (aOR = 1.79) each independently predicted regular attendance, whereas maternal knowledge lost significance entirely (aOR = 1.23, p = 0.807). Mediation analysis indicated that attitude carried an estimated 25.3% of the knowledge–attendance association (indirect effect a×b = 0.048; bootstrap 95% CI: 0.023–0.079). Dose-response patterns showed stunting falling steadily from 32.5% at zero sessions to 13.3% at six (ρ = 0.170, p < 0.001). The qualitative data supplied convergent mechanistic support for each quantitative result. **Conclusion:** GMP participation shows an independent and significant association with stronger child linear growth and ponderal status in one of Sierra Leone’s most underserved settings. The modifiable levers that matter are not individual knowledge but attitudinal, relational, and structural ones: quality service encounters that cultivate a positive attitude, IYCF counselling that fosters purposeful engagement, social capital generated through mother support groups, and physical accessibility. Taken together, the results argue that programmes should consider shifting away from attendance registration toward quality-centred integrated service delivery, reinforced by community mobilisation and satellite GMP infrastructure serving distant populations.