Ahissou Noudéhouénou Credo Adelphe, Uehara Manami, Nonaka Daisuke, Vongphoumy Inthanomchanh, Pongvongsa Tiengkham, Ounlienvongsack Khamtoun, Phongluxa Khampheng, Kounnavong Sengchanh, Kobayashi Jun
Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, JPN.
Department of Maternal and Child Care, Savannakhet Provincial Health Office, Savannakhet, LAO.
Cureus. 2025 Apr 22;17(4):e82786. doi: 10.7759/cureus.82786. eCollection 2025 Apr.
Despite substantial improvements in antenatal care and skilled birth attendance coverage, postpartum service uptake lags in the Lao People's Democratic Republic (Lao PDR). The 2019 Lao Primary Health Care Policy emphasizes the importance of village health volunteers/workers (VHVs/VHWs) working as groups or pairs to promote primary care services, including obstetric care. However, little is known about whether or how the pairing of male and female VHVs/VHWs may encourage better uptake of postpartum care in communities with solid gender norms.
Therefore, the study aims to assess the effectiveness of male-female VHVs/VHWs working in pairs on women's uptake of facility-based follow-up PNC visits in rural Sepone, Lao PDR.
A quasi-experimental cluster study will be conducted between July 2024 and October 2026 in 37 selected sites from two districts in the southern Lao PDR. In 19 selected intervention villages in the Sepone district, trained female-male VHVs/VHWs pairs will promote postpartum services, whereas in 18 similar control villages in the Vilabuly district, VHVs/VHWs will implement standard activities for obstetric care promotion. The study obtained ethical approvals from the University of the Ryukyus and the Lao Tropical and Public Health Institute.
Difference-in-difference analyses will be conducted to estimate service coverage pre-post intervention changes in study sites. Then, using mixed-effect binary logistic regressions, we will assess the association between pairing VHVW/s and facility-based follow-up PNC use, which will be adjusted for other covariates and time effects. Finally, we will analyze the context of pairing VHVs/VHWs implementation using coded transcripts of interviews and focus group discussions.
At the end of the study period, we anticipate at least a 10% increase in follow-up PNC visits at intervention sites compared to control sites. The improvement is expected to result from improved mothers' trust and satisfaction with VHVs/VHWs, and enhanced husband support.
The findings of this study will guide the Lao government's strategy to involve both male and female VHVs/VHWs in primary healthcare according to the 2019 Primary Health Care Policy.
尽管老挝人民民主共和国（老挝）的产前护理和熟练接生服务覆盖率有了显著提高，但产后服务的利用率仍然滞后。2019年老挝初级卫生保健政策强调了乡村卫生志愿者/工作者（VHV/VHW）以小组或两人一组的形式开展工作以促进包括产科护理在内的初级保健服务的重要性。然而，对于在性别规范严格的社区中，男女VHV/VHW配对是否或如何能鼓励更好地利用产后护理，人们知之甚少。
因此，本研究旨在评估男女VHV/VHW配对对老挝色蓬农村地区妇女接受基于机构的产后保健访视的有效性。
2024年7月至2026年10月期间，将在老挝南部两个地区的37个选定地点开展一项准实验性整群研究。在色蓬区19个选定的干预村庄中，经过培训的男女VHV/VHW配对将推广产后服务，而在维拉布利区18个类似的对照村庄中，VHV/VHW将开展促进产科护理的标准活动。该研究获得了琉球大学和老挝热带与公共卫生研究所的伦理批准。
将进行差异分析以估计研究地点干预前后服务覆盖率的变化。然后，使用混合效应二元逻辑回归，我们将评估VHVW配对与基于机构的产后保健利用之间的关联，并对其他协变量和时间效应进行调整。最后，我们将使用访谈和焦点小组讨论的编码记录来分析VHV/VHW配对实施的背景情况。
在研究期结束时，我们预计干预地点的产后保健随访访视次数相比对照地点至少增加10%。预计这种改善将源于母亲对VHV/VHW的信任和满意度提高，以及丈夫支持的增强。
本研究的结果将指导老挝政府根据2019年初级卫生保健政策，让男女VHV/VHW参与初级卫生保健的战略。
