IMPACT OF HOME BASED LIFE SAVING SKILLS TRAINING IN A RURAL AREA IN TANZANIA IN FACILITY DELIVERY, PREPARATION OF BIRTH PLANS AND COST-EFFECTIVENESS. AN INTERVENTION CLUSTER RANDOMIZED TRIAL.
试验速览
- 阶段
- 不适用
- 入组人数
- 28
- 试验地点
- 2
- 主要终点
- Proportion of women delivering in a health facility
研究概览
简要总结
Background
The maternal mortality ratio in Tanzania has been persistently high for ten years with no signs of the ratio going down.The Tanzania Demographic and Health Survey (TDHS) of 1999 and 2005 estimate the maternal mortality ratio to be 528 and 578 per 100,000 live births respectively (TDHS 1999, TDHS 2004/05).The major direct causes include obstetric haemorrhage, obstructed labour, pregnancy induced hypertension, sepsis and abortion complications.
Most deliveries (53%) in Tanzania occur outside the health facilities. Of these 53% of births that occur outside the health facilities 31% are attended by relatives, 19% by traditional births attendants (TBA) while 3% have no assistance at all. Though, the proportional of mothers delivering in health facilities (47%) and receiving skilled attendance at birth (46%) is low but more than 94 percent of women attend antenatal care (ANC) in health facilities at least once. This indicates that there are factors that impede these women delivering in the health facilities.
Low awareness of obstetric danger signs may be one of the contributing factors for delay to decide to seek care when a complication occur thus contributing the first phase of delay. Studies in Tanzania show that most women are not aware of danger signs of obstetric complications during pregnancy, delivery and after delivery. A study conducted in Mtwara rural to assess the use and determinants of skilled attendants at delivery showed that proportional of women delivered with skilled care increases with increasing knowledge of pregnancy danger signs, but it also showed that few women have knowledge of pregnancy danger signs
An increasing body of evidence supports the importance of community participation in maternal and infant health programs for establishing ownership, identifying problems effectively, achieving equity and helping to institutionalize health programs. To mount an effective maternal health effort aimed at reducing maternal and infant mortality, multiple levels of program and policies need to be in place and functioning. In addition, linkages, from the communities, local dispensaries and health centres to first referral hospitals that are adequately equipped, need to be developed and sustained
A home based life saving skills (HBLSS) is a strategy that intends to educate pregnant women and their primary family caregivers and home birth attendants on critical knowledge and skills to keep a pregnant woman healthy, to recognize life-threatening maternal and newborn complications and promote the adoption of health care and health-seeking behaviours at the individual and community levels. The aim of this strategy is to prevent maternal and neonatal morbidity and mortality through creating awareness on women's birth preparedness and access to emergency obstetric care services
RESEARCH QUESTIONS
- Can HBLSS increase women empowerment and male involvement in the decisions relating to access of emergency obstetric and newborn cares?
- Can the HBLSS increase hospital deliveries, increase awareness of obstetric and neonatal danger signs, birth preparedness and emergency readiness in a rural community?
Objectives
Broad Objectives:
- To investigate social-cultural, community and traditional practices that impact on women's birth preparedness and access and utilization of emergency obstetric care services in rural district.
- To assess the impact of home based life saving skills (HBLSS) on hospital delivery awareness of obstetric and neonatal danger signs, birth preparedness
Specific Objectives
- To explore customs, taboos and practices including herbal remedies during pregnancy and labour that influence birth preparedness and utilization of emergency obstetric care services.
- To assess perception, attitude and health seeking behaviour when a complication occur.
- To determine the effect of HBLSS educational programme on hospital delivery, birth preparedness, emergency readiness and utilization of emergency obstetric care services among women in Rufiji district.
- To assess the impact of HBLSS educational programme on male awareness and involvement in assisting women on birth preparedness and access to emergency obstetric care services.
- To determine the cost-effectiveness of HBLSS educational programme
Methodology
A Cluster Randomized Trial
28 clusters will be randomly selected, 14 clusters will receive HBLSS training and the other 14 clusters will not receive HBLSS training.
详细描述
STATEMENT OF THE PROBLEM AND RATIONALE
Despite several interventions to address the unacceptably high rates of maternal and neonatal mortality, the problem still persists. Maternal Mortality ratio in Tanzania has been persistently high without signs of declining. Currently it stands between 578 and 950 per 100,000 live births (TDHS 2005, WHO 2007). The neonatal mortality rate as well in the country is 32 per 1,000 live births (TDHS 2005).
Almost 94% of pregnant women attend antenatal care in health facilities at least once, but only 47% deliver in these facilities and skilled attendance at birth is 46% (TDHS 2005, Mpembeni et al 2007). Births that occur outside the health facilities are assisted by relatives, TBA and some women do not have assistance at all (Kayombo 1995, Kayombo 2008, Comonsky 1983 ). Studies in Tanzania have shown that home birth with unskilled attendants is often the norm (TDHS 1999, TDHS 2005, Mpembeni 2007). This indicates that there are factors that impede these women delivering in the health facilities. Among the factors may include socio-cultural, economic activities, family, community factors. If these factors are compounded by low awareness of danger signs of obstetric complication then these women and neonates are more at risk of death when a complication occurs.
Previous studies in Rufiji district showed that community has low acceptance of facility delivery and referral to hospitals when advised (Pembe 2008b). Furthermore, like in other parts of Tanzania women have low knowledge of danger signs of complications during pregnancy, delivery and after delivery despite attending antenatal care (Mpembeni 2007, Pembe 2008a). In another study on the use of essential obstetric care facilities, a quarter (60/232) of women with complications were referred to the hospital level but less than half (48%) arrived at their referral points. Out of 60 referred cases 31 (52%) did not arrive in any of the two hospitals of the district. Nineteen were traced for their outcome and it was found that three died on the way to the hospital (Urassa 2005). Consequently, there is a great need for an innovative and empowering community-based intervention whose characteristics address this problem.
METHODOLOGY
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 盲法
- None
入排标准
- 年龄范围
- 15 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Pregnant women in the community
- •Relatives of the pregnant women including aunts, husbands and in-laws
排除标准
- 未提供
研究组 & 干预措施
Home based life saving skills training
Home based life saving skills will done in one the study group and in the control group no training will be done
干预措施: HBLSS (Behavioral)
NO HBLSS
No intervention will be given to the control clusters
干预措施: HBLSS (Behavioral)
结局指标
主要结局
Proportion of women delivering in a health facility
时间窗: 1 year
次要结局
- Proportion of community members pregnant mothers involved in birth preparedness and complication readiness(1 year)
- Proportion of men involved in birth preparedness and assisting in women seeking care for complications.(1 year)
- Proportion of pregnant women with birth plans(1 year)
- Proportion of pregnant women using herbal remedies during pregnancy and labour(1 year)
- The cost-effectiveness of HBLSS training(1 year)