Integrated group antenatal and pediatric care in Haiti: A comprehensive care accompaniment model

Introduction The J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes. Methodology We conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais. Quantitative data was collected retrospectively to compare dyads receiving J9 care to usual care. A secondary analysis of qualitative data described patient perspectives of J9 care. Results Antenatal care attendance was significantly higher among women in J9 (n=524) compared to usual care (n=523), with 490(93%) and 189(36%) having >4 visits, respectively; p <0.001, as was post-partum visit attendance [268(51%) compared to  82(16%), p<0.001] and use of post-partum family planning methods [99(19%) compared to 47(9%), p=0.003]. Incidence of severe pre-eclampsia was significantly lower in the J9 group [44(9%)] compared to the usual care group [74(14%)], p <0.001. Maternal and neonatal mortality and low birth weight did not differ across groups, but with earlier interventions, cesarean delivery [103(20%) and 82(16%), p<0.001] and preterm birth [169 (34%)] and 128 (27%), p=0.041] were higher in the J9 group compared to usual care, respectively. In the qualitative analysis, ease of access to high-quality care, meaningful social support, and maternal empowerment through education were identified as key contributors to these outcomes. Conclusion Compared to usual care, the J9 Plus maternal-child accompaniment model of care is associated with increased engagement in antenatal and postpartum care, increased utilization of post-partum family planning, and lower rates of severe pre-eclampsia, which remains a leading cause of maternal mortality in Haiti. The J9 accompaniment approach to care is an empowering model that has the potential to be replicated in similar settings to improve quality of care and outcomes globally. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study involved human participants and was approved by the Zanmi Lasante Institutional Review Board (reference #: ZLIRB03022021). The IRB granted a waiver of informed consent for this retrospective analysis of de-identified clinical data. Retrospective quantitative data was accessed, de-identified, and stored for analysis on a secure platform. A select group of participants gave informed consent for their focus group transcripts to be used for qualitative analysis. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data will not be held in a public repository. All relevant data are within the manuscript and its Supporting Information files.