Ministry of Health, Addis Ababa, Ethiopia.
Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
Reprod Health. 2021 Nov 20;18(1):234. doi: 10.1186/s12978-021-01283-9.
The period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization.
A double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model.
Of 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4-24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31-8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15-2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71-7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18-0.59) less likely to attend three postnatal care visit.
The implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother's decision.
ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030 .
产后阶段对母亲和新生儿都存在重大风险。然而，与妊娠和分娩期间提供的护理相比，这一阶段的关注度较低。因此，本研究旨在评估基于清单的方框系统干预在提高三次产后护理就诊利用率方面的效果。
采用双盲、平行分组、两臂聚类随机对照试验设计，评估基于清单的方框系统干预在提高第三次产后护理就诊方面的效果。招募了 15 个干预组和 15 个对照组中的孕妇，妊娠时间均在 16 周以下。使用简单随机化进行分组。使用开放数据工具包收集基线和终线调查的数据，并使用 STATA 版本 15.0 进行分析。采用差异中的差异估计评估干预组和对照组在不同时间的三次产后护理就诊情况。然后使用混合效应多级逻辑回归模型分析结局变量的预测因素。
在基线和终线研究中，分别有 1200 名母亲被考虑，本研究分别纳入了 1162 名和 1062 名母亲的基线和终线调查数据。差异中的差异估计（14.8%，95%CI 5.4-24.2%，p=0.002）和最终模型（AOR 4.45，95%CI 2.31-8.54）表明，基于清单的方框系统干预可有效提高第三次产后护理就诊率。此外，发现住院分娩（AOR 1.62，95%CI 1.15-2.28）和产后期间危险信号知识（AOR 5.20，95%CI 3.71-7.29）是该结局变量的显著预测因素。相反，受老一辈人影响的母亲（AOR 0.32，95%CI 0.18-0.59）不太可能接受三次产后护理就诊。
实施基于清单的方框系统干预可有效提高推荐的三次产后护理就诊利用率。通过最小化实际层面的挑战，以及扩大健康信息的传播范围，以覆盖未接受服务的母亲和可能影响母亲决策的重要他人，可以进一步提高试验对提高第三次产后护理就诊率的效果。
ClinicalTrials.gov，NCT03891030，于 2019 年 3 月 26 日回顾性注册，https://clinicaltrials.gov/ct2/show/NCT03891030。
