Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT00198731 |
Other study ID # |
H.22.04.09.03.D1 |
Secondary ID |
|
Status |
Completed |
Phase |
|
First received |
|
Last updated |
|
Start date |
April 2005 |
Est. completion date |
May 2007 |
Study information
Verified date |
April 2021 |
Source |
Johns Hopkins Bloomberg School of Public Health |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
Maternal death is a substantial burden in developing countries. In Bangladesh, recent studies
have suggested that a large proportion of women giving birth in rural areas experience
pregnancy and delivery related complications. This study, which is set in context where
home-birth is the norm, provides the opportunity to provide descriptive information on the
self-reported prevalence of maternal behaviors and morbidities during pregnancy, delivery and
postpartum periods and to quantify the effects of provision of maternal care interventions
through trained community health workers on a few selected maternal behaviors and
morbidities.
Description:
Maternal mortality is a substantial burden in developing countries. The World Health
Organization (WHO) estimates that between 500,000 to 600,000 women die from complications
related to pregnancy and childbirth each year, with 99% of these deaths occurring in
developing countries (WHO/UNICEF/UNFPA, 2000). It is estimated that pregnancy-related causes
result in about one-quarter to one-third of the deaths of women in their reproductive years
(Koblinsky, 1995). Improving maternal mortality has received recognition at the global level
as evidenced by the inclusion of reducing maternal mortality in the Millennium Development
Goals (United Nations, 2004).
Among problems experienced by women related to child-bearing, maternal mortality is the "tip
of the iceberg". Consideration of the morbidity associated with pregnancy, delivery and the
postpartum period is essential in understanding the burden of diseases due to maternal
causes. The WHO estimates that up to 300 million women suffer from short- or long-term
illnesses related to pregnancy and childbirth (WHO, 1998). In addition, the WHO estimates
that in developing countries, death and disability related to maternal morbidity account for
18.5% of the burden of disease among women of reproductive age (WHO, 1998).
In Bangladesh, recent studies have suggested that a large proportion of women giving birth in
rural areas experience pregnancy- and delivery- related complications (NIPORT et al, 2001),
and more than 80% of the women suffer from a serious postpartum illness (Goodburn et al,
1994; BIRPERHT, 1994). In the baseline survey for the project "Community-Based Interventions
to Reduce Neonatal Mortality in Bangladesh" in Sylhet, a total of 75% of women reported at
least one maternal complication during pregnancy, delivery and the postpartum.
There is little evidence as to the effect of maternal care interventions on maternal
morbidity. Several studies have evaluated the impact of traditional birth attendant (TBA)
training on morbidity and referral rates. In a review of 15 studies on the effects of TBA
training programs, Ray and Salihu found an improvement in maternal morbidities in two of the
three studies reviewed, and an impact on referral rates in six of the seven studies reviewed
(Ray & Salihu, 2004). In a meta-analysis conducted by Sibley et al, there was no effect
detected between TBA training and recognition of maternal complications, referral for
complications or on maternal compliance with referral (Sibley, Sipe, & Koblinsky, 2004).
Maternal morbidity is a substantial burden on the health of women in Bangladesh and
throughout developing countries. Further research is needed to more carefully document the
community-based incidence of maternal morbidity and to evaluate program impact on maternal
morbidity.
The objectives of this study are to provide data on descriptive information on self-reported
maternal morbidities for future planning, and to measure the effect of a package of maternal
care interventions by comparing differences in care seeking for perceived complications and
the unmet obstetric need (based on major obstetric interventions (MOI) for facility-validated
absolute maternal indications (AMI) ) among the three arms, and by comparing anemia rates
among the three arms.