The USAID funded Maternal and Child Survival Program (MCSP) plans to investigate the behavioral barriers and motivators to practicing appropriate hygiene during the highest risk period for both newborn sepsis and puerperal sepsis in mothers, the period from the onset of labor through the first two days of life. This activity will be conducted in three phases:
Phase 1. A global (and Nigeria-specific) literature review of existing research on hygienic practices including cord care from onset of labor to the first two days of life will be performed.
Phase 2. Qualitative and observational studies in Nigeria, involving human subjects, will be conducted to elucidate barriers and motivators to practicing appropriate hygiene behaviors during the period from the onset of labor through the first two days of life (to include follow-up visits at
Phase 3. Design, implement, and evaluate a set of interventions recommended based on the results from the literature review, qualitative and observational assessments to increase hygienic practices during labor and in the first two days of life in selected areas of Ebonyi and Kogi States, Nigeria.
The activity will primarily focus on factors affecting hygienic practices related to neonatal sepsis; however, since the same hygienic practices are likely to influence the development of maternal sepsis, as a secondary objective, the study will assess the effect of the interventions on hygiene behaviors aimed at reducing puerperal sepsis. The activity will also seek opportunities to improve providers’ capacity to identify at risk-newborns for referral and appropriate counseling and integrate those improvements into ongoing MNCH activities. While the activity will recognize the importance of learning more about better hygiene for home births, it will focus on facility births and the subsequent transition to the home environment.
The Consultant will serve as the Principal Investigator for Phases 1-2 over the course of an 11-month period. Upon completion of Phase 2, MCSP will assess to what extent services may be required in Phase 3. The assigned tasks and deliverables for this scope of work are divided into two phases:
Duration: 41 days
- Conduct literature review – 14 days
- Global Key Informant interviews – 3 days
- Nigeria Key informant interviews and scoping visit in Nigeria – 12 days
- Draft and finalize report and presentation of findings – 4 days
- Phase 2 protocol, instrument and consent form development and IRB submission – 8 days
Phase 1 Scope of Work: The Consultant will lead the design and implementation of a global (and Nigeria-specific) literature review of existing research on hygienic practices and WASH from onset of labor to the first two days of life. The literature review should summarize existing evidence, approaches, and effectiveness of the “six clean” behaviors and their contributions to neonatal and maternal sepsis prevention:
Six Clean Behaviors:
- Clean hands
- Clean delivery surface
- Clean perineum
- Clean cord cutting
- Clean cord tying
- Clean Cord Care
The literature review should include an examination of the following:
- Evidence of barriers, barrier solutions, and motivators to practicing the “six cleans” for all Day of Birth and family stakeholders (Facility Birth Attendants (e.g. nurses), Maternity staff, Discharge Nurses, New Mothers, Caregivers, and Community Health Workers).
- Current global and Nigeria-specific national standards, strategies, and policies related to DOB WASH practices.
Although review of peer-reviewed literature is the priority, grey literature should not be completely ignored, particularly where little peer-reviewed research is available. The Consultant will ensure that where less reliable evidence is presented, the extent of data reliability is clearly communicated.
The Consultant will also identify and interview key informants with global and national (Nigeria) experts in maternal health, newborn health and WASH to identify global and national challenges, successes, opportunities and policy implications.
During the scoping visit the Consultant will travel to Nigeria for a period of 12 days in order to conduct key informant interviews with Nigerian key informants, establish relationships, assist the MCSP staff in recruitment of local consultant(s) for Phase II data collection, and gather contextual information required to inform the Phase II study protocol.
In addition to conducting the literature review, the Consultant is expected to lead the design and IRB submission of Phase 2 study protocol and data collection instruments. The Consultant is expected to submit a minimum of two drafts of the protocol and data collection tools for MCSP technical and field team review prior to submitting for IRB approval.
Expected Phase 1 deliverables and due dates
- IRB approved Phase 2 study protocols, data collection tools and consent forms for the planned observational and qualitative studies. (December 31, 2016 to USAID for formal review)
- Completed literature review and summary of key informant interviews: 5-page report to include background (1 pages), methods (0.5 pages), findings (3 pages), and a discussion (3 pages). The report should highlight WASH contributions to maternal and neonatal sepsis prevention as well as gaps in existing literature. (February 28, 2017)
- Completed Phase 1 findings presentation to MCSP Nigeria and MCSP Core staff members (February 28, 2017)
Duration: 38 days
- Enumerator training – 2 days
- Data collection instrument pretesting and refinement – 3 days
- Management of data collection activities – 10 days
- Data analysis, report writing and presentation of findings – 17 days
- Draft peer reviewed article and submit for publication – 6 days
Phase 2 Scope of Work: Using the study protocol and instruments developed in Phase 1, the Consultant will serve as Principal Investigator (PI) for a qualitative and observational study in Nigeria. The aim of the study is to use semi-structured observations and qualitative research to identify barriers, solutions, and motivators related to target WASH behaviors related to maternal and newborn sepsis prevention (appropriate cord care, handwashing, and general hygiene). The Consultant will manage a local research consultant(s) during this phase.
The observational study component will focus on the time period from the onset of labor through the first 48 hours after birth. Pregnant mothers will be screened and enrolled in the program during presentation at the facility for birth. Once admitted to the health facility, participants will be observed (using semi-structured observations) during 3 time periods – 1) during the first 4 hours after admission, 2) during labor and the 4 hours following birth, and 3) during discharge through the first six hours following discharge, (re-entry into home environment). The activity will seek to observe a sample of births in health facilities with an average of 4 days per observation period. In consultation with MCSP, the Principal Investigator will determine the number of participating facilities (estimated at 3 facilities in Kogi and 3 facilities in Ebonyi States), and the number of observations to be conducted in each facility. This information will be included in the Phase 2 study protocol.
Following the observations, the Consultant will oversee a series of in-depth interviews with a subset of new mothers among whom semi-structured observations have been conducted. A series of focus group discussions and in depth interviews will be conducted with participating health facility staff, community health workers and caregivers (not including mothers) to better understand established behaviors, barriers to hygiene behavior improvement, motivators to hygiene behavior improvement and opportunities for hygiene promotion.
Findings from the observational and qualitative research will be presented to the MCSP Nigeria team, national stakeholders and local stakeholders at the end of Phase 2.
Expected Phase 2 deliverables and due dates
- Final report summarizing key findings and recommendations from the observational and qualitative study (August 31, 2017)
- Submission of a research paper to a peer-reviewed journal (August 31, 2017)
- Completed presentation to MCSP Nigeria staff, national stakeholders and MCSP Core staff members (August 31, 2017)
- Advanced degree in public health, international relations or other related field
- Experience in designing, implementing and analyzing research protocols and activities, including both quantitative and qualitative research methods
- Strong communication, analytical and writing skills
- Ability to travel within Nigeria
- Fluency in written and spoken English
- Prior experience in Nigeria preferred
- Candidates do not need direct affiliation with an IRB institution in order to apply
Job Type: Contract
- Public Health: 7 years
- Other related field: 7 years
- International Relations: 7 years