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Randomized Controlled Trial
. 2014 Mar 19:14:109.
doi: 10.1186/1471-2393-14-109.

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol

Gajananda P Bhandari  1 , Narayan Subedi, Janak Thapa, Bishnu Choulagai, Mahesh K Maskey, Sharad R Onta
Affiliations
Randomized Controlled Trial

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol

Gajananda P Bhandari et al. BMC Pregnancy Childbirth. .

Abstract

Background: Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal.

Method/design: This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs.

Discussion: The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness, finance, transport, security etc. If proven effective, the Ministry of Health has committed to scale up the intervention package throughout the country.

Trial registration number: ISRCTN78892490.

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Figures

Figure 1
Figure 1
Selection of study clusters.
See this image and copyright information in PMC

References

    1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJL. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375(9726):1609–1623. doi: 10.1016/S0140-6736(10)60518-1. PubMed PMID: 20382417. Epub 2010/04/13. eng. - DOI - PubMed
    1. Bryce J, Daelmans B, Dwivedi A, Fauveau V, Lawn JE, Mason E, Bryce J, Daelmans B, Dwivedi A, Fauveau V, Lawn JE, Mason E, Newby H, Shankar A, Starrs A, Wardlaw T. Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet. 2008;371(9620):1247–1258. PubMed PMID: 18406859. Epub 2008/04/15. eng. - PubMed
    1. World Health Organization, UNICEF, UNFPA and The World Bank. Trends in maternal mortality: 1990 to 2010 WHO, UNICEF, UNFPA and The World Bank estimates. Geneva: World Health Organization; 2012.
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–1299. doi: 10.1016/S0140-6736(06)69381-1. PubMed PMID: 17027735. Epub 2006/10/10. eng. - DOI - PubMed
    1. Vaidya A, Jha N. Halfway up the highway: can Nepal meet its Health Millennium Development Goals? JNMA. 2009;48(173):85–91. PubMed PMID: 19529067. Epub 2009/06/17. eng. - PubMed

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