Preterm Birth Clinical Trial
— PTBi RwandaOfficial title:
Group Antenatal/Postnatal Care in Rwanda: a Cluster Randomized Control Trial (RCT) to Measure Its Effectiveness on Increasing Gestational Age, Mortality Among Preterm and Low Birth Weight Infants
Verified date | June 2019 |
Source | University of California, San Francisco |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The focus of this work is to improve antenatal care (ANC) and postnatal care (PNC) at the
health center level in five districts in Rwanda (Bugesera, Burera, Nyamasheke, Nyarugenge,
and Rubavu). 36 health centers in these districts are included in this cluster randomized
control trial (RCT) of group ANC and PNC care to measure this alternative model's effects on
gestational age at birth, survival of preterm and low birth weight infants at 42 days of
life, and ANC and PNC coverage. To improve antenatal assessment of gestational age, nurses
will be trained in obstetric ultrasound at 18 health centers. These facilities will also
incorporate pregnancy testing with urine dipstick to be performed by community health workers
in charge of maternal health to facilitate early entry into ANC. This trial will test the
hypothesis that women who participate in this alternative model of group ANC will experience
increased gestational age at birth, as compared to women who receive standard focused ANC.
This study is a collaboration with the University of Rwanda, the Rwandan Ministry of Health
(MOH), the Rwanda Biomedical Center, and UCSF.
The group care model used in this study is Rwanda-specific model developed by a Rwandan
technical working group. The model includes an individual clinical visit for the first
antenatal visit, followed by three group visits spaced about 8 weeks apart throughout
pregnancy and a postnatal group visit at approximately 6 weeks after birth. Women will be
grouped into stable groups of approximately 8-12 women with similar due dates. A community
health worker (CHW) and a health center nurse will work together as co-facilitators to lead
each of the groups. Each group visit includes clinical assessment, education, and treatments
as appropriate for the women who attend. The model is founded on facilitative leadership of
the groups, in which the co-facilitators allow women's experiences and interests to drive the
content and women are encouraged to help one another cope with obstacles to optimal health.
Facilitators will be supported by master trainers who will visit health centers to observe
group sessions and offer supportive feedback.
Data collected in this trial will include measures of the satisfaction of both women and
providers with the group care, content of care differences between standard and group care,
and perinatal outcomes such as gestational age at delivery and 42-day preterm and low birth
weight infant survival.
Status | Completed |
Enrollment | 26381 |
Est. completion date | May 31, 2019 |
Est. primary completion date | May 31, 2019 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 13 Years to 64 Years |
Eligibility |
Individual inclusion Criteria: Women receiving ANC and PNC care - all women who enroll in ANC —including pregnant adolescents - primary data analysis will be restricted to those women in the intervention and control facilities who present for ANC 1 before 24 weeks gestation and have attended more than 1 ANC visit at the health facility. Providers • Currently provide antenatal or postnatal care Individual exclusion Criteria: Women receiving ANC and PNC care - women who present for ANC 1 after 24 weeks gestation - women who do not attend more than 1 ANC at the health facility will be excluded from the primary analysis Providers • Providers that do not provide antenatal or postnatal care Site-level exclusion criteria: • sites that have less than 2 ANC providers. Site-level inclusion criteria: • Study sites that have at least 2 ANC providers were included in the final selection of 36 sites. The following are study sites by district: Nyamasheke District Nyamasheke Kibingo Mugera Mwezi Karengera Kibogora Gisakura Yove Nyarugenge District Cor-unum Biryogo Rugarama Kabusunzu Rubavu District Murara Nyakiriba Busasamana Karambo Gisenyi Kigufi Mudende Bugesera District Ruhuha Gakurazo Gashora Ngeruka Kamabuye Nyamata Ntarama Juru Mayange Nzangwa Nyarugenge Burera District Cyanika Kirambo Ndongozi Gitare Gahunga Mucaca |
Country | Name | City | State |
---|---|---|---|
Rwanda | Rwanda Biomedical Center | Kigali | |
Rwanda | University of Rwanda | Kigali |
Lead Sponsor | Collaborator |
---|---|
University of California, San Francisco | Ministry of Health, Rwanda, Rwanda Biomedical Center, University of Rwanda |
Rwanda,
Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar MJ, Blencowe H, Rizvi A, Chou VB, Walker N; Lancet Newborn Interventions Review Group; Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014 Jul 26;384(9940):347-70. doi: 10.1016/S0140-6736(14)60792-3. Epub 2014 May 19. Review. Erratum in: Lancet. 2014 Jul 26;384(9940):308. Sankar, Jeeva M [corrected to Sankar, M Jeeva]. — View Citation
Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, Homer CS. Group versus conventional antenatal care for women. Cochrane Database Syst Rev. 2015 Feb 4;(2):CD007622. doi: 10.1002/14651858.CD007622.pub3. Review. — View Citation
Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, Rising SS. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol. 2007 Aug;110(2 Pt 1):330-9. Erratum in: Obstet Gynecol. 2007 Oct;110(4):937. — View Citation
Lincetto O, Mothebesoane-Anoh S, Gomez P, Munjanja S. Antenatal care. Chapter 2. Opportunities for Africa's Newborns.
Maternal Health Task Force, Harvard School of Public Health, et al. Group Care. Innovative Methods 2014.
National Institute of Statistics of Rwanda. (2015). Demographic and Health Survey 2014-2015: Key Findings.
Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, Houweling TA, Fottrell E, Kuddus A, Lewycka S, MacArthur C, Manandhar D, Morrison J, Mwansambo C, Nair N, Nambiar B, Osrin D, Pagel C, Phiri T, Pulkki-Brännström AM, Rosato M, Skordis-Worrall J, Saville N, More NS, Shrestha B, Tripathy P, Wilson A, Costello A. Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013 May 18;381(9879):1736-46. doi: 10.1016/S0140-6736(13)60685-6. Review. Erratum in: Lancet. 2014 May 24;383(9931):1806. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Cost-effectiveness | Costs of ANC delivery and program costs will be collected prospectively, and costs associated with each adverse outcome that may be potentially averted will be calculated. Effectiveness measures will be: number of deliveries conducted by skilled health workers; total number of ANC visits, first ANC visit before 16 weeks and 4 standard ANC visits completed; and number of preterm births prevented. | Costs will be measured prospectively from baseline through the end of the intervention once sample size is achieve--approximately 18 months from baseline. | |
Other | Qualitative assessment of group care feasibility and acceptability to women and providers | Qualitative work (in-depth interviews and focus group discussions) with women and providers to inform any fine tuning to the model will be conducted at 9 and 18 months after implementation. | up to 18 months | |
Primary | Gestational Age | Average gestational age at delivery among women who enroll in ANC before 24 weeks of gestation and had at least 2 ANC visits at that facility. | within the first 3 days after delivery | |
Secondary | Preterm birth rate | Proportion of preterm deliveries among mothers enrolled in ANC | At delivery | |
Secondary | Preterm 28-day and 42-day mortality rate | 28-day and 42-day mortality rate among preterm infants whose mother enrolled in ANC | 28 days and 42 days post delivery | |
Secondary | Women who adhered to four ANC visits | Proportion of women who adhered to four ANC visits among all mothers who have received at least one ANC visit at facility. | From the day of first ANC visit at the health center until the day of delivery | |
Secondary | Adherence to 6 week postnatal visit | Proportion of women who adhered to the 6-week PNC visit at the health center among those who attended at least 2 ANC at the facility. | 42 days post delivery | |
Secondary | 1st ANC visit during the first trimester | Proportion of women with 1st ANC visit during the first trimester among those who have at least one ANC visit. | up to 14 weeks gestation | |
Secondary | High-risk Women | Proportion of women identified during ANC as being high-risk | From the day of first ANC visit at the health center until the day of delivery | |
Secondary | C-section deliveries | Proportion of pregnancies resulting in C-section deliveries among those enrolled in ANC at facility. | At Delivery | |
Secondary | Newborns with neonatal morbidities, specifically, jaundice, rapid breathing, fever, pneumonia, hypothermia, and/or cord infection | Proportion of newborns with neonatal morbidities, specifically, jaundice, rapid breathing, fever, pneumonia, hypothermia, and/or cord infection, among all those whose mother received ANC at facility, and among all those who received PNC at facility. | 28 days post delivery |
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