A Study for Assessing the Feasibility of Introducing a Midwifery-embodied Community Clinic (MCC) Model Within the Health System in Rural Bangladesh
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 70
- 主要终点
- Fesibility of the midwifery-embodied community clinic model
研究概览
简要总结
Background (brief):
- Burden: Maternal and neonatal mortality continue to be a serious public health problem in Bangladesh. Facility-based healthcare services reduce the probability of preventable causes of maternal and neonatal death. Community clinics (CCs) are located closer to the community than other healthcare facilities are. However, only 2.8% of all CCs are ready to provide antenatal care (ANC) and 2.4% of these facilities are ready to provide delivery services. Despite the wide acceptance of midwifery care for ANC and delivery services, they are posted only up to the Upazila Health Complexes and at selected Union Health and Family Welfare Centers.
- Knowledge gap: There is a dearth of evidence on whether the utilisation of ANC, normal vaginal delivery, and postnatal care (PNC) services can be increased if midwives are assigned to CCs to provide these services.
- Relevance: Midwives were trained to provide antenatal and postnatal care, conduct normal deliveries, and manage CC-specific pregnancy-related complications. Midwives are posted up to union-level facilities, and the Government of Bangladesh has a strategic plan to enable selective community clinics for normal delivery services in addition to antenatal and postnatal care.
Hypothesis (if any): N/A
Objectives: This study aims to assess the feasibility, adoption, acceptability, appropriateness, fidelity, coverage, and possible barriers and enablers of introducing Midwifery-embodied Community Clinic (MCC) model in selected community clinics of Bangladesh.
Methods: We will implement a Midwifery-embodied Community Clinic (MCC) model in two CCs of the Baliakandi sub-district of Rajbari district. Trained midwives will provide ANC, select low-risk pregnant women, conduct their normal deliveries, and provide PNC services in CCs, while the CHCP will provide essential newborn care during NVD. High-risk mothers will be referred to the upper level of healthcare facilities for managment. In addition, counselling services will be provided to mothers by the Health Assistants and Family Welfare Assistants during their domiciliary visits. Transport services using the ambulances of the Upazila Health Complex will be integrated into the model to transport patients to the CCs and upper-level healthcare facilities in case of emergencies.
Outcome measures/variables: The outcome measures will be feasibility, adoption, acceptability, appropriateness, fidelity, coverage, and possible barriers and enablers of the MCC model.
详细描述
Study design and setting:
This is a feasibility study in which a Midwifery-embodied Community Clinic (MCC) model will be introduced in two Community Clinics (CCs) located in the Baliakandi sub-district of the Rajbari District of the Dhaka division of Bangladesh. Rajbari district lies between 22º40' and 23º50' North latitudes and between 89º19' and 90º40' East longitudes (19). The total area of the district is 1092.28 sq. km and the Baliakandi sub-district is 229 sq. km (19). It has 22 Community Clinics in 7 unions covering 258 villages (20, 21). The total population of the Baliakandi sub-district is 207,086, of which 103,411 are females (19). The proportion of home deliveries in the Baliakandi sub-district is around 21% (22). The model will be implemented in the Delua and Sonapur Community Clinics of Narua and Nawabpur unions of Baliakandi sub-district which are located approximately 12km away from the Baliakandi Upazila Health Complex (Nearest CEmONC facility).
Steps of the study
- Pre-implementation period 1.1 Stakeholder engagement We will engage potential stakeholders from the beginning of the study. These stakeholders will include personnel from the government, development partners, and technical bodies.
1.2 Baseline data collection Before the implementation of the MCC model, we will conduct household survey and health facility assessment. We will adopt both qualitative and quantitative approaches to collect data.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 10 Years 至 49 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- 未提供
排除标准
- 未提供
结局指标
主要结局
Fesibility of the midwifery-embodied community clinic model
时间窗: Immediately after the intervention
We will measure feasibility using qualitative method of data collection. We will conduct in-depth interviews and key-informant interviews to understand the extent to which the midwifery-led care in the primary level of healthcare facility (community clinic) can be introduced
次要结局
- Appropriateness of midwifery-embodied community clinic model(Immediately after the intervention)
- Barriers and enablers of midwifery-embodied community clinic model(Immediately after the intervention)
- Acceptability of midwifery-embodied community clinic model(Immediately after the intervention)
- Fidelity of midwifery-embodied community clinic model(Immediately after the intervention)
- Proportion of women and newborns with a history of birth in last one year received maternal and newborn healthcare(Immediately after the intervention)