Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT03299491 |
Other study ID # |
108028-002 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
October 15, 2016 |
Est. completion date |
October 2020 |
Study information
Verified date |
November 2020 |
Source |
University of Ottawa |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Ethiopia has one of the highest rates of maternal mortality among all countries in Africa and
indeed worldwide, with a maternal mortality ratio of 676 per 100,000 live births in 2011
(UNFPA, 2012). The majority of maternal deaths are preventable through early detection and
management of complications, and access to adequate obstetric care (Say et al, 2014).
However, in 2011 only 34% of women received antenatal care, 10% of births were delivered at a
health facility and 7% of women received postnatal care during the first two days after
delivery (Ethiopian DHS, 2011). Large distances and poor access to transport are two major
obstacles that women face when trying to access services. In order to facilitate timely
access to obstetric care, the Ethiopian Government introduced Maternity Waiting Areas (MWAs)
at health centres to enable women to stay close to health facilities as they await delivery.
Utilization of MWAs has generally been low due to the poor state of the homes and lack of
adequate community support. This study aims to evaluate the effectiveness of two
interventions to promote safe motherhood in increasing coverage of maternal health care
services: (i) upgraded MWAs (ii) community and religious leader sensitization using
information, education and communication (IEC) materials. The IEC materials are expected to
increase leader awareness and support of antenatal care, facility deliveries, postnatal care
and MWA use. Together with increased use of functional MWAs, improved support from leaders is
expected to increase the proportion of facility-based births in interventions area. The
interventions are also expected to positively impact antenatal care and postnatal care use in
the study districts.
Description:
A three-arm cluster trial design will be used to measure the impact of the intervention
packages in three districts (Gomma, Seka Chekorsa, Kersa) in Jimma Zone, Ethiopia.
Twenty-four clusters with 160 individuals each are required to detect a 17% change in the
primary outcome (proportion of facility-based births) with 80% power,assuming a cluster
autocorrelation of 0.8 and an intra-cluster correlation coefficient of 0.1. Primary health
care units (PHCU) which consist of a health centre and several community-based health posts
will serve as trial clusters. All PHCUs with maternity waiting areas (MWAs) constructed will
be eligible for selection. Eligible women will be randomly selected from PHCU catchment areas
stratified by MWA functionality and health centre basic emergency obstetric care (BEmOC)
capacity. This is to ensure balanced distribution of poorly functioning MWAs and facilities
with diminished BEmOC capacity between trial arms.
Cross-sectional household surveys will be conducted with eligible women to collect
information on socio-demographics, knowledge, attitudes and practices regarding maternal
health services, reproductive history and maternal health service utilization. Surveys will
be administered by trained interviewers on tablet computers programmed using Open Data Kit at
baseline prior to intervention roll out and at endline. Multilevel regression models will be
used to quantify the effect of the intervention packages on outcomes of interest. Random
effect terms for PHCUs will be included to account for the clustered nature of the data.