Abstract
BackgroundAs an evidence-based intervention to prevent maternal and neonatal morbidity and mortality, cesarean birth at rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem and represents an important disparity in the use of this life-saving treatment compared to more developed regions. The objective of this study is to explore an innovative clinical solution (a mobile cesarean birth center) to low cesarean birth rates resulting from the Three Delays to emergency obstetric care in isolated and underserved regions of Ethiopia, and the world.MethodsWe will use mixed but primarily qualitative methods to explore and prepare the mobile cesarean birth center for subsequent implementation in communities in Bench Sheko and West Omo Zones. This will involve interviews and focus groups with key stakeholders and retreat settings for user-centered design activities. We will present stakeholders with a prototype surgical truck that will help them conceive of the cesarean birth center concept and discuss implementation issues related to staffing, supplies, referral patterns, pre- and post-operative care, and relationship to locations for vaginal birth.DiscussionCompletion of our study aims will allow us to describe participants’ perceptions about barriers and facilitators to cesarean birth and their attitudes regarding the appropriateness, acceptability, and feasibility of a mobile cesarean birth center as a solution. It will also result in a specific, measurable, attainable, relevant, and timely (SMART) implementation blueprint(s), with implementation strategies defined, as well as recruitment plans identified. This will include the development of a logic model and process map, a timeline for implementation with strategies selected that will guide implementation, and additional adaptation/adjustment of the mobile center to ensure fit for the communities of interest.Trial registrationThere is no healthcare intervention on human participants occurring as part of this research, so the study has not been registered.
Highlights
As an evidence-based intervention to prevent maternal and neonatal morbidity and mortality, cesarean birth at rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem and represents an important disparity in the use of this life-saving treatment compared to more developed regions
Low cesarean birth rates plague many regions of sub-Saharan Africa, so the context of rural Southwest Ethiopia is generalizable to other settings [6]
1: EXPLORE the outer and inner contexts of the communities in rural Ethiopia where we will study the pre-implementation of the mobile cesarean birth center [33]
Summary
Logic model Process map SMART timeline Implementation strategies Plan recruitment code the transcripts with the PI and qualitative expert heavily involved in codebook development (e.g., coding the first few iterations), with feedback and participation of the facilitators. We will utilize a quantitative assessment tool to have participants rate the appropriateness, acceptability, and feasibility of the intervention during iteration 5 (Table 1) [46]. The tool uses four questions to ask about each concept with a grading system to quantify the results [46]. It will be translated, back-translated, and piloted to ensure applicability to the study populations. Participant timeline All our study activities are planned for October 2021 and will not require any ongoing follow-up of study participants
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