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. 2020 Jun 26;20(1):374.
doi: 10.1186/s12884-020-03056-x.

The Rajarata Pregnancy Cohort (RaPCo): study protocol

Thilini Chanchala Agampodi  1 , Nuwan Darshana Wickramasinghe  2 , Rampathige Indika Ruwan Prasanna  3 , Malawara Kankanamalage Lasandha Irangani  4 , Jayasundara Mudiyanselage Samarakoon Banda  5 , Pradana Mudiyanselage Bandula Jayathilake  6 , Ayesh Hettiarachchi  2 , Gayani Amarasinghe  2 , Imasha Jayasinghe  2 , Iresha Koralagedara  7 , Sajaan Praveena Gunarathne  2 , Sujanthi Wickramage  8 , Janith Warnasekara  2 , Niroshan Lokunarangoda  9 , Vasana Mendis  10 , Ajith Kumara Dissanayaka  11 , Jagath Premadasa  12 , Nandana Hettigama  11 , Dayaratne Koralagedara  12 , Manjula Weerasinghe  2 , Krishanthi Malawanage  13 , Hemali Jayakodi  14 , Anuprabha Wickramasinghe  15 , Suneth Buddhika Agampodi  2
Affiliations

The Rajarata Pregnancy Cohort (RaPCo): study protocol

Thilini Chanchala Agampodi et al. BMC Pregnancy Childbirth. .

Abstract

Background: Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes.

Methods: The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses.

Discussion: This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.

Keywords: Cohort; Mental health; Pregnancy; Social determinants; Sri Lanka.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Conceptual framework of RaPCo study hypothesis
Fig. 2
Fig. 2
Spatial distribution of 22 participant recruitment areas of RaPCo study in the Anuradhapura district, Sri Lanka
Fig. 3
Fig. 3
RaPCo study flow chart
See this image and copyright information in PMC

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