A Cluster Randomized Controlled Community Based Trial Utilizing a Continuum of care Among Pregnant Women: Outcomes in the Women

Abstract

Objective: To assess a home based continuum of pregnancy and neonatal care package, delivered by community based agents (CBAs), to improve maternal and neonatal outcomes. Method: The package was developed and tested in a randomized controlled trial conducted from 2009 to 2013. The unit of randomization was the Neighborhood Health Committee (NHC), within one hour from the client, and serving 150 -200 households with 900 to 1200 persons. The 48 CBAs in10 RHCs, made up 40 clusters. 3846 pregnant women were enrolled and tracked for one year. The intervention group received care from trained, equipped and supported CBAs while the control group received the Standard national health care. Results: The 3486 pregnant women were tracked, 2767 in the intervention group and 1079 in the control group. By the 12th month, 2000 women had delivered, with 1282 (33%) completing 28 days postnatal care, 934 in the intervention and 348 in the control group. A total of 673 (66%) women in the intervention group and 236 (58%) women in the control group were identified with danger signs, among whom 49.3% had institutional deliveries, availing newborn care in addition. The 2013 New Born Framework of the Ministry of Health utilised findings for policy. Conclusion: evidence shows that when trained, equipped and supported, community based caregivers are effective during pregnancy and early newborn care. Geographically disadvantaged populations can benefit from adopting the continuum of care as standard practice to improve maternal and newborn outcomes, within the community.Keywords: Cluster Randomised Trial, continuum of care in pregnant women, Zambia