Afya Credit Incentives for Improved Maternal and Child Health Outcomes in Kenya
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 7,200
- 试验地点
- 2
- 主要终点
- Ante Natal visits honoured after recruitment
研究概览
简要总结
Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven strategies that can tackle the high burden of maternal and child mortality and morbidity currently witnessed in sub-Saharan Africa. However very few pregnant women utilize these services. This study aims to assess the impact, cost-effectiveness, and scalability of conditional cash transfers (CCTs) to promote increased and uninterrupted contact between pregnant women and the formal healthcare system in Siaya County, Kenya.
The study is a cluster randomized controlled trial with the intervention being a conditional cash transfer to women each time they honour their health appointments for ANC, facility birth and PNC visits until their new-borns reach 1 year of age. Study participants are pregnant women identified during their first ANC visit (n = 7200), and their subsequent new-borns. Mothers and their children are followed up throughout their health visits and at 3 additional time points. Trial clusters are 48 public primary health facilities, (24 in the intervention arm and 24 in the control arm).
The primary outcomes are: a) proportion of all eligible ANC visits made during pregnancy; b) delivery at health facility; c) proportion of all eligible PNC visits honoured; d) proportion of referrals honoured during pregnancy and postnatal period; e) proportion of child immunizations received. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 hours after delivery, exclusive breastfeeding, birth spacing and self-rated wellness of mother and new-born at respective time points.
Primary outcomes will be measured through abstraction of health records at the health facilities attended by the women during the trial period and supplemented by data collection using an electronic based system that comprises of a card and reader system installed at recruited study facilities. Secondary data will be abstracted from the women's medical records at the health facilities and supplemented by telephone surveys administered at three time-points over the course of the study. Additional quantitative and qualitative data will be collected through questionnaires and phone interviews for process and economic evaluations.
This trial will contribute to evidence on effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in Kenya and other similar contexts.
详细描述
- BACKGROUND
A "Continuum of Care" for reproductive, maternal, new-born and child health (RMNCH) includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood (1). Assuring continuity of care has become a key programme strategy for improving the health of mothers and new-borns, and is an important measure of service quality for outcomes such as prevention of mother-to-child transmission of HIV (PMTCT) (2). Yet in many countries there remains major gaps in seeking care along this continuum. Retaining women in this continuum even during pregnancy has not been possible to achieve in sub-Saharan Africa (SSA), with only 44% of women making the recommended 4 minimum ANC visits (focused ANC) (3). Focused ANC is a scheduled service, and when clients do not adhere to the recommended timing and repeat visits as required, the very purpose of the service is challenged. A number of treatments provided during ANC have to be delivered in sequence for them to be effective. Post-natal services are equally essential, as half of all postnatal maternal deaths occur during the first week after the baby is born, and one in four child deaths occur during the first month of life (5). In SSA, postnatal care programmes are among the weakest of all reproductive and child health programmes (6). Follow-up treatments and services such as PMTCT; counselling on family planning, breastfeeding and infant feeding practices; and childhood immunizations cannot be achieved if many women are lost to care immediately after delivery, as is the current trend.
A major opportunity for altering the low care seeking behavior in SSA exists however, since over two thirds of women come into contact with the formal healthcare system at least once during pregnancy (3). A strategy that can retain these women in care, from their first contact during pregnancy through to birth and childhood period could thus alter considerably the negative trends in maternal and child health in Africa.
Personal financial incentives (PFIs) can offer a broad based solution that is needed to tackle the challenge of low care seeking and retention of women in the care continuum. It can tackle both the financial barriers to care seeking, as well as the motivational barriers. A number of studies (30, 31, 32, 33) have demonstrated personal financial incentives (PFIs) can help to increase adherence to lengthy treatment schedules. Empirical evidence supports this rationale; although it is still an emerging field. In developed countries, paying people to change their behaviour has been demonstrated as effective with behavioural problems (10). Notable successes in developing countries are in TB treatment programmes (11) (12). In sub-Saharan Africa, this is still a very new concept. 2. METHODS
2.1 Study setting
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 16 Years 至 —（Child, Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Pregnant woman is attending her first ANC visit, A long-term resident in the catchment area served by the health facility Women in both study groups to have access to a mobile phone that belongs to them or to a member of their household or anyone else who they trust
排除标准
- 未提供
结局指标
主要结局
Ante Natal visits honoured after recruitment
时间窗: up to 18 months
The proportion of required ANC visits honoured after recruitment into the study in the intervention arm compared to the control arm
Refferal visits honoured by study particpants
时间窗: up to 18 months
The proportion of health referrals for ANC, PNC and (children) immunization honoured by study particpants
Immunization visits honoured by children recruited into the study
时间窗: 1 year
The proportion of eligible immunization visits honoured by children after recruitment into the study in the intervention arm compared to the control arm
Delivery at health facility
时间窗: up to 18 months
The proportion of health facility deliveries made by pregnant women recruited in the study in the intervention arm compared to the control arm
Post natal visits honoured after recruitment
时间窗: 1 year
The proportion of required post natal visits honoured after recruitment into the study in the intervention arm compared to the control arm
次要结局
- Live birth and child survival 48-hours after birth(up to 1 year)
- Self rated wellness(up to 1 year)
- Exclusive breastfeeding(Up to 1 year)
- Maternal death 48 hours post partum(up to 1 year)
- Contraceptive use(up to 18 months)
- Infection screening(up to 18 months)
- Timeliness of health visits (summary across ANC, PNC, immunization as appropriate)(up to 18 months)
研究者
Onyango Sangoro
Co Principal Investigator
Stockholm Environment Institute