Group Antenatal Care: The Power of Peers for Increasing Skilled Birth Attendance in Achham, Nepal
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 2,184
- 试验地点
- 1
- 主要终点
- Institutional Birth Rate
研究概览
简要总结
In rural Nepal, the major drivers of underutilization of skilled birth attendance are poverty, poor social support and inadequate birth planning. Drawing from similar programs that have been shown to improve maternal and neonatal outcomes, we have designed a group antenatal care program that uses a participatory learning and action process to engage women in identifying and solving problems accessing maternity care services and create a supportive social network. We plan to test a group antenatal care program that will change antenatal care in three major ways: 1) conduct care in a group setting with women matched by gestational age, 2) incorporate participatory learning and action, and 3) provide expert and facilitated peer counseling.
详细描述
The group antenatal care intervention aims to improve rates of institutional birth and ANC care completion via improving acceptability of group care, maternal and neonatal health knowledge, self-efficacy, social support, and birth planning.
Objective 1: Assess the effect of group antenatal care on institutional birth rates through a prospective study using community household census data. Secondary outcomes will be completion of basic ANC package; neonatal mortality rate; percentage of preterm births; percentage of stillbirths; and percentage of small-for-gestational age (SGA) births.
- Hypothesis 1: Group ANC will increase institutional birth rates by 5% over one year.
- Hypothesis 2: Group ANC will increase completion of 4 ANC visits by 5% over one year.
- Hypothesis 3: Group ANC will reduce infant mortality rate by 5% over one year.
- Hypothesis 4: Group ANC will reduce the postpartum contraceptive prevalence rate by 5% over one year.
- Hypothesis 5: Group ANC will reduce the stillbirth rate by 5% over one year.
- Hypothesis 6: Group ANC will reduce the perinatal mortality rate 5% over one year.
- Hypothesis 7: Group ANC will reduce the combined infant mortality and stillbirth rate by 5% over one year.
Objective 2: Assess the mechanisms of implementation of group antenatal care through quantitative participant survey measures, qualitative focus group discussions and key informant interviews.
- Hypothesis 1: Group antenatal care will be acceptable to participants and providers, and preferred to individual care.
- Hypothesis 2: Group antenatal care will increase pregnant patients' access to and utilization of delivery services through improved knowledge, self-efficacy, social support and birth planning.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 15 Years 至 49 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Age 15-49 years old
- •Resident of 14 village clusters in study site
- •Intervention cohort: less than 24 weeks' gestation prior to first group antenatal care session.
排除标准
- •Intervention cohort: more than 24 weeks' gestation prior to first group antenatal care session.
研究组 & 干预措施
Intervention Cohort
We will use a cohort of 60 women from intervention village clusters for the group antenatal care intervention.
干预措施: Group Antenatal Care (Other)
Control Cohort
We will use a cohort of 60 women from control village clusters as an active comparison.
干预措施: Individual Antenatal Care (Other)
结局指标
主要结局
Institutional Birth Rate
时间窗: 1 year
We expect the number of pregnant women from intervention village clusters who give birth at a healthcare facility to increase by 5% compared to control.
次要结局
- Stillbirth rate(1 year)
- Perinatal mortality rate(1 year)
- Combined infant mortality and stillbirth rate(1 year)
- Infant Mortality Rate(1 year)
- Postpartum contraceptive prevalence rates(1 year)
- Completion percentage of 4 antenatal care visits(1 year)