Sepsis Clinical Trial
Official title:
Improved Accessibility of EmONC Services for Maternal and Newborn Health: a Community Based Project.
The purpose of this study is to determine whether an integrated EmONC package (community mobilization, training of community-based health care providers and a maternal and neonatal health pack) reduce perinatal and neonatal mortality.
Deaths during birth are particularly critical to address as these occur because of
complications during childbirth and leads to emergency situation with a slim window of time
to intervene. Every year an estimated 3.6 million newborns and 360,000 mothers die globally.
Of these, maternal health complication contribute to 1.5 million of neonatal deaths in the
first week of life and 1.4 million stillborn neonates, suggesting a major gap of
intervention subsists around childbirth and in the early postnatal period, a time when
mothers and babies are most at risk. While many factors contribute to maternal and neonatal
deaths, one of the most effective means of solving this problem requires effective
preventive measures or treatment provided rapidly to women and newborns, often at home or in
primary health care settings.
It is often addressed that these overwhelming mortalities and morbidities are closely linked
with a number of interrelated delays that prevent a pregnant women from accessing the health
care she needs. Each delay is closely related to services, logistics, facilities and
conditions, which are important elements for their health. These delays are: 1) delay in
seeking appropriate medical help for an obstetric emergency or neonatal complication for
reasons of cost, lack of recognition of an emergency, poor education, lack of access to
information and gender inequality; 2) delay in reaching an appropriate facility for reasons
of distance, infrastructure and transport; 3) delay in receiving adequate care when a
facility is reached because there are shortages in staff, their competency, or due to
unavailability of required medical facilities and equipment. As a result, many preventable
maternal deaths occur, most often in resource poor settings, where births are home-based and
in the event of complications the woman is unable to access the required care in time.
While many proven, cost-effective ways to save the lives of mothers, and newborns exist,
they are not always available to those who need them most. There is bulk of literature that
has identified number of interventions that can improve maternal and newborn health. The
lancet maternal and neonatal survival series emphasized the model of "Basic essential
obstetric care" as one of the most feasible and effective strategies to reduce maternal
mortalities.
For the reasons above, it is essential to create demand of uptake of services and strengthen
primary health care infrastructure at the community level, and improve the liaison of Lady
Health Workers/Traditional Birth Attendants/Community Midwives with local and district
health system for early and timely referral of complicated cases and sick newborns. While
several previous studies from Pakistan have documented the beneficial impact of
community-based interventions in improving maternal and new-born health, further evidence is
required to assess the effectiveness of community-based interventions that can increase the
uptake of EmONC services and reduce the delays that are responsible for poor maternal and
new-born health. Context-specific evidence is also needed on the appropriate mix of
interventions, their delivery strategies, task shifting and sharing options, functional link
and assessment in the primary health care, and complementary health systems and community
support and demand mechanisms.
Therefore, the main target audience and beneficiary of this project is the women which
usually do not have a say in the decision making and cannot have choices for her to opt for
a better treatment. The women usually depend upon the decisions being made by the husbands
and elders as the society is male dominant. We have attempted to take care of this factor to
maximize the uptake of intervention and services by developing the community support groups.
The specific objectives of this study are:
1. To conduct an in-depth analysis of maternal and neonatal health seeking patterns and
behaviors of the target population and care provision at health facilities for
understanding the context and requirements for improved EmONC service delivery.
2. To provide a maternal and neonatal health pack(clean delivery kit, emollient,
chlorhexidine, sms health messages) for safe motherhood and newborn well-being.
3. To mobilize community for creation of demand for improved MNH services and practices
through community mobilization.
4. To train and implement integrated EmONC package for community-level health care
providers (Lady Health Workers, Traditional Birth Attendants, Community Midwives to
provide antenatal, natal and postnatal care services, and recognize and refer
complicated pregnancy and childbirth cases and sick newborns to health facilities.
5. To strengthen and improve the quality of care at health facilities in providing EmONC
services through capacity building of health care providers.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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