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

Abstract

Background About 287,000 women died during and following pregnancy and childbirth in 2020 worldwide. Almost 95% of all these maternal deaths occurred in low and lower middle-income countries, and most could have been prevented. The timed and targeted counselling behavioural change approach, implemented by community health workers targeting mothers and their male caregivers (e.g., their husband, brother or father), is expected to positively impact overall maternal health. This study aims to assess the impact of timed and targeted counselling on the continuum of care outcomes in Northern Uganda. Methods This study will employ a cross-sectional quasiexperimental design, with retrospective data collection comparing an intervention group to a control group. The main outcome measures are antenatal care, place of delivery and postnatal care. The study employs a two-stage sampling procedure purposively selecting the Oyam District, including two strata of subcounties: Aber (Treatment) and Otwal (Control). The required sample size consisted of 456 mothers per treatment group (i.e., 912 in total). The study participant selection criterion will be mothers who have given birth between the 2nd the 12th month of the study area. Propensity score matching will be used to control for confounders and improve causal inference. Sensitivity analysis will be carried out to test the robustness of the results to unmeasured confounders in the propensity score match. After regression, postmodel estimation tests such as the Akaike information criterion, the link test and the Wald test will be carried out. Discussion This study is the first to evaluate the impact of timed and targeted counselling on maternal health in Northern Uganda. These findings will be used to modify the implementation of the timed and targeted counselling approach, thereby enhancing its impact, efficiency, and effectiveness. Protocol Registration This study protocol was registered under the Makerere University School of Social Sciences Research Ethics Committee (MAKS REC) under MAKSSREC 10.2023.710 (registration date 30th of November 2023) and the Uganda National Council for Science and Technology (UNCST HS3826ES).