Departments of Global Health and Epidemiology, University of Washington, Seattle, WAUSA.
Department of Epidemiology & Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
J Glob Health. 2021 Oct 30;11:04063. doi: 10.7189/jogh.11.04063. eCollection 2021.
Ethiopia and other countries continue to experience high rates of maternal mortality and neonatal deaths. Interventions are needed to increase utilization of antenatal care (ANC) and facility delivery services to improve outcomes.
A cluster-randomized trial was conducted in the Amhara Region of Ethiopia, with 6 communities randomly assigned to receive the intervention and 12 communities monitored as controls. Intervention teams provided outreach to pregnant women and their families. Registry data were used to measure utilization of services provided at health centers in intervention and control communities.The intervention consisted of trained pairs of community health workers and Ethiopian Orthodox priests who worked together to promote health messages around safe delivery. The pairs visited pregnant women and their families in their homes to provide counseling, discuss concerns, and answer questions about ANC and facility deliveries. Intervention impact was measured using facility-level data on monthly number of ANC visits and facility deliveries at the health centers that served the intervention and control communities. Intervention effect was measured using difference-in-difference analyses estimated by generalized estimating equation models.
During the 12-month intervention period, intervention facilities (n = 6) recorded 14% more ANC1 visits (relative risk RR = 1.14; 95% confidence interval (CI) = 1.09-1.19; < 0.001) and 26% more ANC4 visits (RR = 1.26; 95%CI = 1.18, 1.34; < 0.001) compared to control health centers (n = 12). The intervention health centers experienced a 10% increase in facility deliveries over what would have been expected had the intervention not occurred (RR = 1.10; 95% CI = 1.05-1.16; < 0.001).
Promotion of safe delivery through home visits by community health workers paired with Ethiopian Orthodox priests increased utilization of ANC and facility delivery services. This approach could leverage the influential role of faith leaders and increase the impact of community health workers in Ethiopia.
NCT04039932.
埃塞俄比亚和其他国家继续面临高孕产妇死亡率和新生儿死亡的问题。需要采取干预措施来增加产前护理（ANC）和住院分娩服务的利用，以改善结果。
在埃塞俄比亚阿姆哈拉地区进行了一项集群随机试验，将 6 个社区随机分配接受干预，将 12 个社区作为对照进行监测。干预小组向孕妇及其家庭提供外展服务。使用登记数据来衡量干预和对照社区的卫生中心提供的服务的利用情况。干预措施包括经过培训的社区卫生工作者和埃塞俄比亚东正教牧师配对，共同宣传安全分娩的健康信息。这些对搭档会到孕妇及其家庭的家中提供咨询，讨论问题，并回答有关 ANC 和住院分娩的问题。使用干预和对照社区服务的卫生中心的每月 ANC 就诊次数和住院分娩次数的设施级数据来衡量干预的影响。使用广义估计方程模型估计的差值分析来衡量干预效果。
在 12 个月的干预期间，干预设施（n=6）记录了 14%的 ANC1 就诊次数增加（相对风险 RR=1.14；95%置信区间（CI）=1.09-1.19；<0.001）和 26%的 ANC4 就诊次数增加（RR=1.26；95%CI=1.18，1.34；<0.001），与对照卫生中心（n=12）相比。干预卫生中心的住院分娩率增加了 10%，如果没有干预，这将是不可能的（RR=1.10；95%CI=1.05-1.16；<0.001）。
通过社区卫生工作者与埃塞俄比亚东正教牧师配对进行家访来促进安全分娩，增加了 ANC 和住院分娩服务的利用。这种方法可以利用信仰领袖的影响力，增加社区卫生工作者在埃塞俄比亚的影响力。
NCT04039932。
