Effects of Implementing the Timed and Targeted Counselling Model on Pregnancy Outcomes and Newborn Survival in Rural Uganda: Protocol for a Quasi-Experimental Study

Abstract

Background: Although mortality rates have declined in Uganda over the last decade, maternal mortality is still high at 336 deaths per 100,000 live births, as is infant mortality at 43 deaths per 1000 live births. One in every 19 babies born in Uganda does not live to celebrate their first birthday. Many of these deaths occur within the first 28 days of life, forming the single largest category of death. Promising effects for preventing death are expected from timed and targeted counselling (ttC), an intervention package of key messages and actions that address integrated health and nutrition needs of the mothers and children, barriers and negotiation agreement, to cause sustainable behavioural change at specific timelines in the first 1000 days. Methods: The study has a quasi-experimental design in order to evaluate the implementation and effectiveness of the ttC intervention. Participants are pregnant women who have been registered by village health team (VHT) members and who live in Hoima (intervention region) or Masindi (control region) districts, who will be monitored throughout their pregnancy up to at least six weeks after delivery. A multi-stage sampling technique will be employed to select participants, the study sites being purposively chosen. Sample size is determined using the pregnancy rate from the population estimates, resulting in a total required sample of 1218 (609 each in the intervention and control group). Study instruments that will be used include the Ugandan VHT household register (in which all mothers to be studied will be registered), the ttC register (an additional tool for the study area), and a study questionnaire, to collect data at outcome level. Univariate, bivariate and multivariate analyses will be performed using SPSS to evaluate intervention effects on outcomes (e.g., relationship between pregnancy outcomes and antenatal attendance). In addition, quantitative findings will be triangulated with qualitative data, and collected through interviews and focus group discussions with participants and implementers. Discussion: The proposed study will examine the effectiveness of implementing ttC to improve maternal and child outcomes in Uganda. If ttC is effective, broader implementation of appropriate antenatal services can be advised as essential newborn care improvements. Trial registration: PACTR, PACTR202002812123868. Registered on 25 February 2020.

It Takes A Village; Involvement of Village Health Teams to Develop Tools and Resources to Communicate about Antiretroviral Use in Pregnancy and Breastfeeding at Community Level in Uganda.

“…Furthermore, existing relationships with the Hoima district coordinator of people living with HIV/AIDS Networks indicated feasibility. Hoima has a strong network of VHTs who have basic familiarity with research principles 21 .…”

Can the Timed and Targeted Counseling Model Improve the Quality of Maternal and Newborn Health Care? A Process Analysis in the Rural Hoima District in Uganda

“…However, most of the households depend on subsistence agriculture and small-scale cash crops such as tobacco and coffee [ 23 ]. ttC was implemented in the Hoima district, because this district has one of the highest maternal mortality rates in Uganda [ 24 ].…”

“…The ttC visits pass on a particular message at set times to trigger the household to encourage the mother to go for a given service at the health center, which is relevant at that moment in pregnancy or the neonatal period. The visits that the VHT makes are in line with the Ministry of Health’s goal-oriented ANC [ 24 ] services package and the institutional delivery framework of the road to the reduction of maternal and newborn death in Uganda [ 31 ]. For this study, the focus is on the four visits made during pregnancy, the three visits made when the child is in the newborn period for essential newborn care practices, and finally, a fourth postpartum visit at six weeks to enhance exclusive breastfeeding and routine immunization.…”

Impact of the Timed and Targeted Counselling Model on Maternal Health Continuum of Care Outcomes in Northern Uganda: Protocol of a Quasi-Experimental Study

“…They further encourage male caregivers to be involved in the whole cycle from pregnancy through birth to nurturing the baby by providing both emotional and logistical support. CHWs make four visits during pregnancy before birth and seven visits postnatally in the rst 2 years after birth, as explained in Table 1, which is adapted from the ttC manual (13), and in an earlier study on the effects of implementing the ttC model on pregnancy outcomes and newborn survival in rural Uganda (23). Table 1 below summarizes and provides a concise and visually organized reference for the key components and objectives of the ttC approach.…”

“…where: = = =1.96 is the critical value (from the Z table) at type 1 error, which is the critical value for the chosen level of signi cance = = 0.842 is the critical value for the chosen power from the standard normal distribution at 80% = 71.5% is the estimated proportion of the population with the outcome of interest in the control group. This gure is derived by averaging the proportions observed in two previously related studies (23,25)examining one of the outcomes of interest, facility-based deliveries without intervention.…”