Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Reprod Health. 2023 Nov 18;20(1):169. doi: 10.1186/s12978-023-01713-w.
Maternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia.
We conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables.
The study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar's Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4).
The study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings.
The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.
在埃塞俄比亚农村，孕产妇医疗保健的利用，尤其是机构分娩，比例严重偏低。本研究旨在评估在加莫地区农村地区实施基于社区的综合干预措施包对提高产科危险信号、生育准备和机构分娩服务利用的效果。
我们于 2019 年至 2021 年在阿尔巴明奇健康和人口监测系统点进行了一项整群随机对照试验（NCT05385380）。我们将 10 个 kebeles 集群随机分配到干预组和对照组。我们采用了一揽子干预措施，包括为孕妇提供有关安全孕产的信息，通过视频和/或音频以及生育准备卡，培训社区志愿者和卫生推广人员，并改善产妇等候室服务。对照组仅接受常规服务。我们使用广义混合效应逻辑回归模型评估干预对结局变量的效果。
该研究在 10 个集群中招募了 727 名孕妇，617 名（84.9%）成功随访。干预组的机构分娩比例从基线时的 36.4%（174/478）增加到 52.5%（224/427）（McNemar 检验调整优势比 [AOR] = 1.5；95%置信区间 [CI]：1.1 至 2；p < 0.001）。然而，在对照组中，机构分娩比例下降了 10.3%（从 164/249 下降到 105/190）。接受干预的孕妇在医疗机构分娩的可能性明显高于未接受干预的孕妇（AOR 2.8；95%CI：1.2，6.4）。
本研究表明，包括基于视频的故事讲述和升级产妇等候室在内的综合社区干预措施包增加了农村妇女对机构分娩护理的利用。我们建议将视听故事讲述纳入常规孕产妇保健服务，以解决农村地区获得护理的不平等问题，从怀孕开始并持续到产后。
该研究方案在 clinicaltrials.gov 上注册，注册号为 NCT05385380。
