Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia

Background: Evidences show that intervention packages at home-community setting are found to reduce neonatal mortality significantly. But millions of neonates are still dying by preventable causes with the implementation of these effective interventions. This might be due to evidence-practice gap. Therefore, this study aimed at assessing the intervention fidelity and factors influencing focused antenatal care package. Methods: Cross-sectional study design was employed in this study. In the selected kebeles’, a total of 898 mothers who gave birth within six months before data collection, ten health posts with their health extension workers were employed. Interview-administered, self-administered and facility audit checklist were used for collecting data from all mothers, health extension workers and health posts respectively. Mothers were asked whether or not the required level of care were provided to them. Health extension workers & health posts were assessed for the competency and organizational drivers. Multilevel linear regression model were used to identify the possible moderating factors at individual and organizational level for intervention fidelity. Result: The overall weighted average focused antenatal care package intervention fidelity was 49.78% (95% CI: 47.73 – 51.83). The weighted average focused antenatal care package intervention fidelity by health extension workers was 62.02% (95% CI: 59.71 – 64.32) and skilled providers were 56.57% (95% CI: 53.94 – 59.19). The overall antenatal care coverage were 83.7% (95% CI: 81.28 – 86.12) with 34.97% (95% CI: of 31.56 – 38.39) of mothers received at least four antenatal visit and 6.12% (95% CI: 4.40-7.83) of them received all the recommended components of focused antenatal care. Previous maternal problem, paternal education and implementation of supportive/facilitation strategy were significant facilitators for focused antenatal care package intervention fidelity. Conclusion: In this study, focused antenatal care package intervention fidelity was low. This implies that the stagnation of neonatal mortality reduction might be partly due to the low focused antenatal care packages intervention fidelity. Paternal education and implementation of supportive/facilitation strategies were statistically significant facilitators of focused antenatal care intervention package fidelity. Therefore, improvement of implementation of facilitation strategy is recommended.