Reaching the unreached through trained and skilled birth attendants in Ethiopia: a cluster randomized controlled trial study protocol

Zerfu, Taddese Alemu; Taddese, Henok; Nigatu, Tariku; Tenkolu, Girma; Vogel, Joshua P.; Khan‐Neelofur, Dina; Biadgilign, Sibhatu; Deribew, Amare

doi:10.1186/s12913-017-2041-6

Cited by 2 publications

(3 citation statements)

References 33 publications

(34 reference statements)

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“…The three districts are: Wonago, Yirgachefe and Kochere [Fig. 1] having a total estimated population of 284,450, 320,012 and 187,654; respectively [ 21 ]. Dilla University Hospital is a referral center for the catchment population serving the largest population group in the area.…”

Section: Methodsmentioning

confidence: 99%

“…This study is a continuation of a larger cluster randomized trial (RCT) that was implemented in Gedeo zone. Details on the process and implementation of this project were given in the trial registration website and reported elsewhere [ 21 ]. Briefly, it involved deployment of skilled and trained nurses called community based reproductive health nurses (CORN) to improve maternal health indicators including antenatal, skilled birth attendance (SBA) and delivery service.…”

Section: Methodsmentioning

confidence: 99%

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Challenges and experience of the Ethiopian rural health extension program: implications for reform and revitalization

Zerfu,

Tareke,

Biadgilign

2023

BMC Health Serv Res

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Background Despite remarkable gains over the past decade, mounting evidence suggests that Ethiopia’s rural health extension program (HEP) is facing serious implementation challenges. We investigated the current and potential future program design and implementation challenges of Ethiopia’s rural HEP based on the lived experiences of health extension workers (HEW) implementing the program at the grassroots level. Methods We employed a longitudinal qualitative exploration linked to a larger cluster-randomized trial (RCT) which was implemented in 282 villages randomly selected from 18 Kebeles of the Gedeo zone, southern Ethiopia. Data were collected using in-depth interviews with key informants, focus group discussion, and passive observation of program implementation. The data were analyzed manually using a thematic framework analysis approach. Themes and sub-themes were generated by condensing, summarizing, and synthesizing data collected in the field in the form of extended notes and field observation checklists. Findings Despite considerable gains in availing basic health services to the rural population, HEP seems to suffer serious design and implementation flaws that demand thoughtful and immediate adjustment. The design constraints span from the number and type of intervention packages to the means of dissemination (vehicle) as well as the target population emphasized. As such, some low-cost high-impact interventions that were strongly desired by the community were overlooked, while others were inappropriately packed. The means of distribution - female health extension workers trained with basic prevention skills, were lacking essential skills. They also had high burnout rates and with little engagement with men, were repeatedly mentioned flaws of the program demanding revitalization. Furthermore, the sheer structure of HEP precluded adult and adolescent men, non-reproductive women, and the elderly. Conclusion Despite significant gains over the last couple of months, Ethiopia’s rural HEP appears to have reached a tipping point that requires a comprehensive revamp of the program package, means of distribution, and target beneficiaries rather than the “usual” tweaks to reap maximum benefits.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Challenges and experience of the Ethiopian rural health extension program: implications for reform and revitalization

Zerfu,

Tareke,

Biadgilign

2023

BMC Health Serv Res

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“…Dilla University Hospital is a referral centre for the catchment population surrounding the health facilities. Details on the methods of the present study is given elsewhere in a published methodology [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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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.

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Reaching the unreached through trained and skilled birth attendants in Ethiopia: a cluster randomized controlled trial study protocol

Cited by 2 publications

References 33 publications

Challenges and experience of the Ethiopian rural health extension program: implications for reform and revitalization

Challenges and experience of the Ethiopian rural health extension program: implications for reform and revitalization

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

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