Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project

Abstract

Background: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur.

Method/design: This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization.

Discussion: Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.

Trial registration: ClinicalTrials.gov NCT01751945.

Figure 1

Schema of activities and interventions to be done as part of the trial. UC’s = Union councils, KAP = Knowledge, Attitude and Practices, EmONC = Emergency Obstetrical and Newborn Care, CMW = Community Midwife, TBA = Traditional Birth Attendant, LHW = Lady Health Worker, BHU = Basic Health Unit, RHC = Rural Health Center, THQ = Tehsil Headquarter Hospital.

Figure 2

Map of Pakistan showing study area in District Rahimyar Khan, Province Punjab. International Boundary, Province Boundary, District Boundary, Tehsil Boundary, UC Boundary.