Is deployment of trained nurses to rural villages a remedy for the low skilled birth attendance in Ethiopia? A cluster randomized-controlled community trial

Abstract

BackgroundLow coverage of Skilled Birth Attendance (SBA) is one of the major drivers of maternal mortality in many low- and middle-income countries (LMICs) including Ethiopia. We conducted a cluster-randomized controlled community trial to assess the effect of deploying trained community based nurses to rural communities on the uptake levels of SBA in Ethiopia.MethodsA three-arm, parallel groups, cluster-randomized community trial was conducted to assess the effect of deploying trained community based reproductive health nurses (CORN) on the uptake of SBA services. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where these new service providers were deployed, a health post (HP) or health center (HC). Baseline and end line surveys were conducted to document and measure the effects of the intervention. Program impacts on SBA coverage were calculated using difference‐in‐difference (DID) analysis.ResultsAfter nine months of intervention, the coverage of SBA services increased significantly by 81.1% (from 24.61 to 44.59) in the HP based intervention arm, and by 122.9% (from 16.41 to 36.59) in the HC arm, respectively (p <0.01). Conversely, a small and non-significant (2%) decline in SBA coverage were observed in the control arm (P >0.05). The DID estimate indicated a net increase in SBA coverage of 21.32 and 20.52 percentage points (PP) across the HP and HC based intervention arms, respectively (p < 0.001).ConclusionsDeployment of trained reproductive health nurses to rural communities in Ethiopia significantly improved utilization of SBA services. Therefore; in similar low income settings where coverage of SBA services is very low, deployment of trained community based nurses to grassroots level could potentiate rapid service uptake. Additional cost-effectiveness and validation studies at various setups are required, before scale-up of the innovation, however.Trial registrationclinicaltrails.gov NCT02501252.

Effect of Recruitment and deployment practices on Performance of Healthcare Workers in Kenya.

“…(χ2= 11.705, df=16, p=0.764, v=0.268) deployment and the performance of nursing officers in Nyeri County, Kenya. This is inconsistent with the findings of Murphy et al (2014), VanDevanter et al (2014 and Rivers and Gordon (2017) and Zerfu et al (2018). They established relationships between the deployment of nurses and their performance.…”

Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

“…In Ethiopia, m-health interventions and educational messages were used in one of the interventional study aimed at improving maternal health utilization through a continuum of care approach [ 19 ]. The other two interventions aimed to increase institutional delivery utilization, the first by improving maternity waiting home utilization [ 18 ] and the second by deploying trained community-based nurses to rural communities [ 20 ]. The former was implemented m-health interventions in order to increase maternal health service utilization (ANC, institutional delivery and PNC).…”

“…Another community trial to improve institutional delivery is the deployment of trained community-based nurses to rural communities in Ethiopia to assess SBA uptake levels. This study found that sending trained reproductive health nurses to rural Ethiopian communities increased SBA service utilization significantly [ 20 ].…”

Effect of Deploying Trained Community Based Reproductive Health Nurses (CORN) on Long‐Acting Reversible Contraception (LARC) Use in Rural Ethiopia: A Cluster Randomized Community Trial

“…We assumed that unobserved characteristics affecting program participation do not vary over time with treatment status (also known as the parallel trend assumption). The reporting of the study has also followed the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines for cluster randomized trials . These guidelines provide recommendations for reporting parallel group randomized trials in which individual participants are randomly assigned to health care interventions.…”