Maternal Morbidity¨ Clinical Trial
Official title:
A Matched Pair Cluster-randomized Implementation Study to Measure the Effectiveness of an Intervention Package Aiming to Decrease Perinatal Mortality and Increase Institution-based Obstetric Care Among Indigenous Populations in Guatemala
A matched pair cluster-randomized trial of this intervention package will be conducted in
four rural and indigenous districts (Huehuetenango, Quiche, Alta Verapaz and San Marcos) of
the Republic of Guatemala, using the health clinic as the unit of randomization. No external
intervention is planned for control facilities, although enhanced monitoring, surveillance
and data collection will occur throughout the study in all facilities in the four districts.
The package includes 3 interventions: 1) To train health care professionals in emergency
obstetric and perinatal care using an innovative high-fidelity, low-tech, in situ,
multidisciplinary simulation training curriculum (PRONTO); 2) To design and implement a
social marketing strategy that promotes institution-based delivery; and 3) To integrate the
role of obstetric nurse and professional midwife in intervention communities to act as
liaisons between traditional birth attendants (TBA) and public health units. A fourth,
cross-cutting component involves ongoing analysis, monitoring, surveillance and evaluation to
strengthen information systems and monitor perinatal outcomes throughout the two years of the
study.
Overall goal
To evaluate the impact of a package of three interventions aiming to increase
institution-based delivery and improve emergency obstetric and neonatal care on perinatal
mortality, in the four districts with the highest maternal mortality ratios in Guatemala.
Specific objectives
- Measure the impact of this intervention package on perinatal mortality rates.
- Measure the impact of this intervention package on the proportion of institution-based
delivery among study facilities.
- Evaluate the processes and success of implementing this combined package of
interventions by analyzing process indicators related to the intervention element
designed to improve emergency obstetric and neonatal care (PRONTO: emergency obstetric
and perinatal training program).
Primary outcome of interest:
1. Increase in the proportion of institutional deliveries in intervention vs. control
clusters.
2. Decrease perinatal death rate in intervention vrs control clinics
;