Association for Social Development, Islamabad, Pakistan.
BMC Pregnancy Childbirth. 2012 Jul 15;12:67. doi: 10.1186/1471-2393-12-67.
Two out of three neonatal deaths occur in just 10 countries and Pakistan stands third among them. Maternal mortality is also high with most deaths occurring during labor, birth, and first few hours after birth. Enhanced access and utilization of skilled delivery and emergency obstetric care is the demonstrated strategy in reducing maternal and neonatal mortality. This trial aims to compare reduction in neonate mortality and utilization of available safe birthing and Emergency Obstetric and Neonatal Care services among pregnant mothers receiving 'structured birth planning', and/or 'transport facilitation' compared to routine care.
A pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Jhang, Chiniot and Khanewal districts of Punjab, Pakistan, from February 2011 to May 2013. At least 29,295 pregnancies will be registered in the three arms, seven clusters per arm; 1) structured birth planning and travel facilitation, 2) structured birth planning, and 3) control arm. Trial will be conducted through the Lady Health Worker program. Main outcomes are difference in neonatal mortality and service utilization; maternal mortality being the secondary outcome. Cluster level analysis will be done according to intention-to-treat.
A nationwide network of about 100,000 lady health workers is already involved in antenatal and postnatal care of pregnant women. They also act as "gatekeepers" for the child birthing services. This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required). The review of current arrangements and practices show that the care delivery process needs enhancement to include adequate information provision as well as informed "decision" making and planned "action" by the pregnant women. The proposed three-year research is to develop, through national technical working group process, and then test a set of arrangements for achieving the enhanced utilization of safe birthing services.
Current Controlled Trials ISRCTN86264432.
每三个新生儿死亡中就有两个发生在仅仅 10 个国家，而巴基斯坦在这 10 个国家中排名第三。产妇死亡率也很高，其中大多数死亡发生在分娩、生产以及生产后最初几个小时内。增加熟练分娩和紧急产科及新生儿护理的可及性和利用率是降低产妇和新生儿死亡率的已证明策略。本试验旨在比较在接受“结构化分娩计划”和/或“交通便利”的孕妇中，新生儿死亡率的降低和现有安全分娩及紧急产科和新生儿护理服务的利用情况与常规护理相比。
这是一项在巴基斯坦旁遮普省的詹赫、奇尼奥特和汗瓦拉地区开展的实用集群随机试验，同时进行定性和经济学研究。从 2011 年 2 月到 2013 年 5 月，三个组将至少登记 29295 例妊娠，每组 7 个集群；1）结构化分娩计划和旅行便利化，2）结构化分娩计划，和 3）对照组。试验将通过妇女保健工作者计划进行。主要结局是新生儿死亡率和服务利用率的差异；产妇死亡率是次要结局。将根据意向治疗进行集群水平分析。
一个拥有约 10 万名妇女保健工作者的全国性网络已经参与到孕妇的产前和产后护理中。他们还充当分娩服务的“把关人”。这种把关角色主要包括对熟练分娩的咨询和转介以及紧急产科护理的旅行安排（如果需要）。对现有安排和实践的审查表明，护理提供过程需要加强，包括充分的信息提供以及孕妇的知情“决策”和计划“行动”。拟议的为期三年的研究旨在通过国家技术工作组的过程制定并随后测试一套安排，以实现安全分娩服务利用率的提高。
当前对照试验 ISRCTN86264432。
