Ethiopian Ministry of Health, Addis Ababa, Ethiopia.
Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
BMC Health Serv Res. 2022 Apr 9;22(1):466. doi: 10.1186/s12913-022-07894-7.
In Ethiopia, the proportion of mothers who attend the fourth antenatal care visit is lower than the proportion who attend the first visit. Although the reasons for these dropouts were investigated, few studies introduced interventions to promote the fourth antenatal care visit. Hence, the aim of this study was to assess the effectiveness of checklist-based box system intervention on improving fourth antenatal care visit.
This study employed a double-blind, parallel-group, two-arm cluster randomized controlled trial to compare the effectiveness of checklist-based box system intervention with the usual standard of care as a control arm. Study clusters are assigned to intervention and control arm in 1:1 allocation ratio using simple randomization technique. Pregnant mothers below 16 weeks of gestation were enrolled. Open data kit was used to collect data from the baseline and end-line surveys, and STATA version 15.0 was used to analyse the data. A difference-in-difference estimator was used to compare fourth antenatal care visit between the intervention and control groups across time. Mixed effect multi-level logistic regression was used to examine the relationship between the dependent and independent variables.
Data were collected from 2224 mothers who belong to 15 intervention and 15 control clusters. The difference in difference estimation resulted in a significant difference (26.1, 95%CI: 18-34%, p < 0.0001) between the intervention and control groups. Similarly, as compared to controls, the fourth antenatal care visit was found significantly higher in the intervention clusters (432 (85.2%) Vs. 297 (53.7%), p < 0.0001)/(AOR:5.69, 95% CI:4.14-7.82). Mothers who were knowledgeable about the services given during antenatal care visits (AOR: 2.31, 95% CI:1.65-3.24) and mothers who had a high level of social support (AOR:1.47, 95% CI: 1.06-2.04) were more likely to attend the fourth antenatal care visit.
Implementation of checklist-based box system intervention resulted in a statistically significant effect in attendance of fourth antenatal care visit. Community-level variables were found to be more important in explaining variability in the fourth antenatal care visit. It is recommended that the intervention be implemented on a larger scale.
ClinicalTrials.gov , Retrospectively registered on 26/03/2019, with trial registration number-NCT03891030.
在埃塞俄比亚，接受第四次产前护理的母亲比例低于接受第一次产前护理的母亲比例。尽管已经调查了这些辍学的原因，但很少有研究提出干预措施来促进第四次产前护理。因此，本研究旨在评估基于检查表的盒式系统干预对提高第四次产前护理的效果。
本研究采用双盲、平行组、两臂集群随机对照试验，将基于检查表的盒式系统干预与通常的标准护理作为对照臂进行比较。使用简单随机技术，以 1:1 的分配比例将妊娠母亲分配到干预组和对照组。招募妊娠不足 16 周的孕妇。使用开放数据工具套件从基线和终点调查中收集数据，并使用 STATA 版本 15.0 进行数据分析。差异-差异估计用于比较干预组和对照组在时间上的第四次产前护理。混合效应多水平逻辑回归用于检查因变量和自变量之间的关系。
数据来自 2224 名属于 15 个干预组和 15 个对照组的母亲。差异估计导致干预组和对照组之间存在显著差异（26.1%，95%CI：18-34%，p<0.0001）。同样，与对照组相比，干预组的第四次产前护理显著增加（432（85.2%）vs. 297（53.7%），p<0.0001）/（AOR：5.69，95%CI：4.14-7.82）。那些了解产前护理期间提供的服务的母亲（AOR：2.31，95%CI：1.65-3.24）和那些获得高水平社会支持的母亲（AOR：1.47，95%CI：1.06-2.04）更有可能参加第四次产前护理。
实施基于检查表的盒式系统干预在提高第四次产前护理的效果上具有统计学意义。社区层面的变量在解释第四次产前护理的可变性方面被发现更为重要。建议在更大的范围内实施该干预措施。
ClinicalTrials.gov，于 2019 年 3 月 26 日进行回顾性注册，试验注册编号为-NCT03891030。
