Department of Public Health and Health Sciences, Department of Economics, Northeastern University, Boston, Massachusetts, USA.
Navrongo Health Research Centre, Navrongo, Ghana.
J Glob Health. 2024 Oct 25;14:04217. doi: 10.7189/jogh.14.04217.
Maternal mortality remains a challenge in Ghana, where 263 women per 100 000 live births die during pregnancy or childbirth. Barriers to reaching the recommended antenatal care (ANC) include poor access to quality health care, cultural factors, and lack of support for pregnant women.
We piloted two cross-randomized interventions: durbars, or local community meetings that incorporated education about ANC and supporting pregnant women, and an enhanced ANC model that added phone calls and a home visit to standard care. The study took place in 30 villages in the Upper East Region of Ghana between August 2021 and November 2022.
We tracked 277 women during pregnancy, with 120 women randomly assigned to the enhanced ANC intervention and 142 women living in villages randomized to the durbar intervention. Women who were randomized to the enhanced ANC intervention were 13.2 percentage points (pp) (95% confidence interval (CI) = 0.1, 24.3) more likely to have average or above average knowledge of pregnancy danger signs, 22.1 pp (95% CI = 9.1, 36.5) more likely to have a birth plan, 28.2 pp (95% CI = 13.0, 42.4) more likely to prepare the plan with their partners, and 16.4 pp (95% CI = 0.9, 29.3) more likely to pay for delivery with funds set aside in birth plan. They were also 35 pp (95% CI = 16.1, 48.1) more likely to make blood donor arrangements than control women who made birth plans. We found no impact of the durbar intervention on study outcomes.
Evidence from this pilot suggests that interventions that increase interactions between health providers and pregnant women outside of the health facility may substantially improve women's experience during pregnancy and maternal health outcomes. Providing structured ways for men to get engaged in ANC increased their involvement. Although we found no evidence the community meetings improved study outcomes, larger studies with repeated meetings and community-wide surveys are needed to make causal conclusions.
American Economic Association RCT Registry: 10360; ISCRNT: ISRCTN95961119.
在加纳，每 10 万名活产中仍有 263 名妇女死于妊娠或分娩，产妇死亡率仍然是一个挑战。无法获得高质量的医疗保健、文化因素以及缺乏对孕妇的支持等因素都阻碍了推荐的产前护理（ANC）的实施。
我们试点了两种交叉随机干预措施：durbar，即当地社区会议，会上进行了关于 ANC 和支持孕妇的教育，以及强化 ANC 模式，即在标准护理的基础上增加电话咨询和家访。该研究于 2021 年 8 月至 2022 年 11 月在加纳上东部地区的 30 个村庄进行。
我们在怀孕期间跟踪了 277 名妇女，其中 120 名妇女被随机分配到强化 ANC 干预组，142 名妇女居住在随机分配到 durbar 干预组的村庄。随机分配到强化 ANC 干预组的妇女对妊娠危险信号的平均或以上的知识的知晓率提高了 13.2 个百分点（95%置信区间（CI）=0.1，24.3），有生育计划的可能性提高了 22.1 个百分点（95% CI=9.1，36.5），与伴侣一起制定生育计划的可能性提高了 28.2 个百分点（95% CI=13.0，42.4），为分娩预留资金支付分娩费用的可能性提高了 16.4 个百分点（95% CI=0.9，29.3）。与制定生育计划的对照组妇女相比，她们提前安排献血的可能性也高出 35 个百分点（95% CI=16.1，48.1）。我们没有发现 durbar 干预对研究结果有任何影响。
这项试点研究的证据表明，增加卫生保健提供者与孕妇在卫生机构之外的互动的干预措施可能会显著改善孕妇在妊娠期间的体验和母婴健康结果。为男性提供参与 ANC 的结构化方式增加了他们的参与度。虽然我们没有证据表明社区会议改善了研究结果，但需要进行更大规模的研究，包括重复的会议和社区范围的调查，以得出因果结论。
美国经济协会 RCT 登记处：10360；ISCRTN：ISRCTN95961119。
