Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol

Abstract

BackgroundAntenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher.WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used in the country.MethodsThis is a demonstration project to be developed through a facility-based cluster randomized controlled trial with a stepped wedge design. The intervention was tailored, based on formative research findings, to be readily applicable to local prenatal care services and acceptable to local pregnant women and health providers. The intervention includes four components: the provision of kits with all necessary medicines and laboratory supplies for ANC (medical and non-medical equipment), a storage system, a tracking system, and training sessions for health care providers. Ten clinics were selected and will start receiving the intervention in a random order. Outcomes will be computed at each time point when a new clinic starts the intervention. The primary outcomes are the delivery of selected health care practices to women attending the first ANC visit, and secondary outcomes are the delivery of selected health care practices to women attending second and higher ANC visits as well as the attitude of midwives in relation to adopting the practices. This demonstration project is pragmatic in orientation and will be conducted under routine conditions.DiscussionThere is an urgent need for effective and sustainable scaling-up approaches of health interventions in low-resource countries. This can only be accomplished by the engagement of the country’s health stakeholders at all levels. This project aims to achieve improvement in the quality of antenatal care in Mozambique through the implementation of a multifaceted intervention on three levels: policy, organizational and health care delivery levels. The implementation of the trial will probably require a change in accountability and behaviour of health care providers and we expect this change in ‘habits’ will contribute to obtaining reliable health indicators, not only related to research issues, but also to health care outcomes derived from the new health care model. At policy level, the results of this study may suggest a need for revision of the supply chain management system. Given that supply chain ma...

Time And Number of Antenatal Visits in Low Socio-Economic Population: Outcomes And Related Factors

“…Antenatal care provides good planning and preparation for the birth and can thereby prevent morbidity and mortality which may occur during delivery [3,7]. Because of all these potential benefits, it is highly recommended, especially in populations with a low socio-economic level [7]. Of the pregnant patients included in this study, 59.9% made more than 4 visits during the pregnancy, which is close to previously reported data [3,6].…”

“…While early diagnosis and treatment of diseases related to pregnancy directly reduce mortality, early diagnosis and treatment of systemic diseases can indirectly reduce mortality. Antenatal care provides good planning and preparation for the birth and can thereby prevent morbidity and mortality which may occur during delivery [3,7]. Because of all these potential benefits, it is highly recommended, especially in populations with a low socio-economic level [7].…”

“…In studies conducted in low-income countries, a positive but weak relationship has been seen between the number of antenatal visits and maternal and perinatal outcomes. Thus, antenatal visits have been recommended to reduce maternal and perinatal morbidity and mortality [7]. According to well-documented data, pregnant patients with poor socio-economic conditions, a poor level of education, and those living in rural areas have a lower likelihood of presenting for antenatal services [8].…”

Findings of the Mozambique Water Supply, Sanitation, and Hygiene Poverty Diagnostic

“…The 2011 DHS recorded 55 percent attendance in rural Sofala, while Maputo City reported 95 percent attendance. Facility-based birth also remains a challenge, with coverage estimates at only 60 percent in a 2011 (Chavane et al 2014). Other health issues for Mozambique include the lack of adequate measures to reduce anemia among women of reproductive age and the limited availability of vitamin A and iodine-deficiency interventions.…”

Community midwifery model’s effect on availability, utilization and outcomes of maternal and newborn health services in hard-to-reach communities of Busia Kenya: a Quasi-experimental study

“…World Health Organization specially emphasizes the role of community midwives (CMs) and other community -based interventions in promoting safe motherhood particularly in rural settings with low access to health services (22,23). However, lack of skills -both clinical and entrepreneurial, and access to funds necessary to develop their practice infrastructure and logistics are major bottlenecks in their operations (11,20,21,24,25).…”