Implementing an Integrated RMNCH Intervention by Community Health Workers in Achham and Dolakha: National Pilot
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Reproductive, Maternal, Newborn, and Child Health
- Sponsor
- Possible
- Enrollment
- 12000
- Locations
- 2
- Primary Endpoint
- Institutional Birth Rate
- Last Updated
- 6 years ago
Overview
Brief Summary
The investigators will conduct a cluster-controlled, stepped wedge implementation science trial of a bundled reproductive, maternal, neonatal, and child healthcare (RMNCH) delivery intervention within an approximate population of 300,000 people in rural Nepal. This intervention integrates five evidence-based approaches for reproductive, maternal, newborn, and child health focused on the "golden 1000 days" from conception through age two: 1) Community Health Worker model of home-based care to monitor and increase utilization of services, maternal and neonatal health knowledge, self-efficacy, social support, and emergency planning among mothers; 2) Continuous surveillance of all pregnancies and children via an integrated electronic medical record; 3) Delivering community-based integrated management of newborn and childhood illness (CB-IMNCI) via CHWs; 4) Group antenatal and postnatal care to improve care delivery and reduce mortality during the "golden 1000 days" from conception to age two; and 5) Balanced counseling to increase post-partum contraception.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Reproductive aged women 15-49;
- •Reproductive aged women 15-49; recently delivered in past two years;
- •Reproductive aged women 15-49; active pregnancy during study period and identified by a CHW serving their village
- •Children aged 0-2; children of recently-delivered mothers (population #2 or #3 above);
- •Healthcare staff; CHWs serving village clusters, CHW Leaders serving one of the village clusters, Nyaya Health Nepal and Government of Nepal employees involved in study design, program implementation, data collection, or data analysis processes; and
- •Must reside in either Achham or Dolakha District, Nepal.
Exclusion Criteria
- •Patients meeting inclusion criteria and consenting to study enrollment, as stated above, will be included in the study unless 1) patients migrate from the study are before completion of any of the bundled interventions; 2) patients request exclusion from the study at any point during the bundled intervention.
Outcomes
Primary Outcomes
Institutional Birth Rate
Time Frame: 3 years
The percentage of births in a healthcare facility with a healthcare professional present.
Under-Two Mortality Rate
Time Frame: 3 years
The under-2 mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of two if subject to current age-specific mortality rates.
Post-Partum Contraceptive Prevalence Rate
Time Frame: 3 years
The post-partum contraceptive prevalence rate is number of married reproductive aged women (15-49) in the study population who delivered in the past two years who are using a modern contraceptive method out of the total number of married reproductive aged women (15-49) in the study population who delivered in the past two years.
Secondary Outcomes
- Home Visit Coverage(3 months)
- Group Care Content Fidelity(3 months)
- Group Participation(3 months)
- Session Completion(3 months)
- Pediatric Stunting Prevalence(1 month)
- First-Trimester Pregnancies Identified(3 months)
- Contraceptive Method Mix(3 months)
- Antenatal Care Completion(3 months)
- Pediatric Diarrhea Incidence(1 month)
- Total Intervention Cost(3 years)
- Cost-Effectiveness of Bundled Intervention(3 years)
- Pediatric Pneumonia Incidence(1 month)
- Exclusive Breastfeeding Prevalence(1 month)
- Percent of postpartum women with unmet need for contraception(3 years)