Overcoming barriers to scaling skilled birth attendants? utilization in improving maternal, newborn and child health in Nepal

• Register: ISRCTN
• Last refreshed on: 5 June 2017
• Main ID: ISRCTN78892490
• Date of registration: 24/10/2013
• Prospective Registration: No
• Primary sponsor: World Health Organization (Switzerland)
• Public title: Overcoming barriers to scaling skilled birth attendants? utilization in improving maternal, newborn and child health in Nepal
• Scientific title: Implementation research to overcome barriers to scaling skilled birth attendants? utilization in improving maternal, newborn and child health in Nepal: a cluster randomized controlled trial
• Date of first enrolment: 01/04/2011
• Target sample size: 5000
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN78892490
• Study type: Interventional
• Study design: Cluster randomized controlled trial (Quality of life)
• Phase: Not Applicable

Countries of recruitment

Nepal

Contacts

• Name: Sharad Onta

Key inclusion & exclusion criteria

Inclusion criteria: 1. Bajhang, Dailekh and Kanchanpur has 120 Village Development Committees (VDCs). Baseline survey involved only women having children under 1 year of age in 50 VDCs. 20 VDCs were excluded because of their proximity to district hospital. Only 50% of the remaining 100 VDCs were selected for the baseline survey.
2. The intervention phase of the project involved only VDCs which have SBA utilization less than 60%. All mothers groups, youth groups, SBA, Female Community Health Volunteer (FCHV) of 36 VDCs were involved. One VDC with 57% utilization rate has been excluded to distribute clusters equally and evenly.
3. Evaluation phase will be similar to baseline phase. It will involve mothers having children under 1 year of age.
Exclusion criteria: Does not meet inclusion criteria

Age minimum:
Age maximum:
Gender: Female

Health Condition(s) or Problem(s) studied

Maternal and Newborn Health
Pregnancy and Childbirth

Intervention(s)

Village Development Committees (VDCs) from three districts (Bajhang, Dailekh and Kanchanpur) were allocated to intervention and control clusters by randomization.

The intervention package to be implemented has five components to directly address these barriers. Each component has several activities, described below.

Component 1: Increased family support for the pregnant women to reach a facility for childbirth.
Female Community Health Volunteers (FCHVs) were oriented by project staff to discuss with the pregnant women and family members the importance of birth with a skilled attendant and review with the family the birth and emergency preparedness card which the woman has completed in her antenatal care visits. Mothers groups were given an orientation by FCHV with the support of project staff to invite the family of identified pregnant women (identify through FCHV and mothers group members in each ward) to regular meetings to discuss the importance of birth with a skilled attendant and family member?s support to the pregnant women to reach this care.
The mothers groups provide information to the family members about the fund and transportation arrangement mechanism.

Component 2: Develop a system to provide funds to support women and families to seek childbirth care with a SBA
The research team organized discussions with the Health Facility Management Committees (HFMCs) of respective Health Post, Sub Health Post on the operation of a fund by the mothers groups. Discussion on the roles and scope of HFMC to support mothers groups in operating the emergency fund and possible modalities for the operation of the fund, particularly how to protect against losses and replenishment of the fund was done.The project staff supported the HFMC in their discussions with mothers groups for the expansion of the current fund, to agree upon a modality of operation and to establish regular coordination and feedback between the Committee and mothers group. All mothers group agreed

Primary Outcome(s)

1. Utilization of SBA services by pregnant women for childbirth (% of women who give birth with a SBA [facility and home])

Secondary Outcome(s)

1. Ante-natal check-up four times by pregnant women (% of pregnant women who had one and who had four ante-natal checkups during pregnancy)
2. Post-natal check-up of mothers and babies (% of mothers who received at least one post-natal check of mother and newborn baby)
3. Availability of transport to the women to visit a health institution for childbirth (% of women who used services and % of women who informed they did not receive SBA services because of transport problems)
4. Functional operation of emergency fund (% of women who perceived lack of finances as a problem in utilizing SBA services; % of women who received a loan from emergency fund and % of women who paid back the loan)
5. Security of SBA (% of SBAs who perceived security as a problem in work)
6. Support from family to the women for childbirth at health institution (% of women who perceived they had support from their family to use SBA services; % of women who informed lack of support from their family as a reason for not using SBA services)
7. Women-friendly health facility environment (% of women who inform that health workers were supportive at the facility; % of women who informed that they did not use SBA services because of unsupportive behaviour of health workers)

Secondary ID(s)

N/A

Source(s) of Monetary Support

The Implementation Research Platform, World Health Organization (WHO) (Switzerland)