Abstract
BackgroundAnaemia is a common health problem among pregnant women and a contributing factor with a major influence on maternal mortality in Indonesia. The Four Pillars Approach is a new approach to anaemia in pregnancy, combining four strategies to improve antenatal and delivery care. The primary objective of this study is to measure the effectiveness of the Four Pillars Approach. The barriers, the facilitators, and the patients’ as well as the midwives’ satisfaction with the Four Pillars Approach will also be measured.Methods/DesignThis study will use a cluster randomised controlled trial. This intervention study will be conducted in the Public Health Centres with basic emergency obstetric care in Yogyakarta Special Province and in Central Java Province. We will involve all the Public Health Centres (24) with emergency obstetric care in Yogyakarta Special Province. Another 24 Public Health Centres with emergency obstetric care in Central Java Province which have similarities in their demographic, population characteristics, and facilities will also be involved. Each Public Health Centre will be asked to choose two or three nurse-midwives to participate in this study. For the intervention group, the Public Health Centres in Yogyakarta Special Province, training on the Four Pillars Approach will be held prior to the model’s implementation. Consecutively, we will recruit 360 pregnant women with anaemia to take part in part in the study to measure the effectiveness of the intervention. The outcome measurements are the differences in haemoglobin levels between the intervention and control groups in the third trimester of pregnancy, the frequency of antenatal care attendance, and the presence of a nurse-midwife during labour. Qualitative data will be used to investigate the barriers and facilitating factors, as to nurse-midwives’ satisfaction with the implementation of the Four Pillars Approach.DiscussionIf the Four Pillars Approach is effective in improving the outcome for pregnant women with anaemia, this approach could be implemented nationwide and be taken into consideration to improve the outcome for other conditions in pregnancy, after further research.Trial registrationCurrent Controlled Trials ISRCTN35822126.
Highlights
Anaemia is a common health problem among pregnant women and a contributing factor with a major influence on maternal mortality in Indonesia
If the Four Pillars Approach is effective in improving the outcome for pregnant women with anaemia, this approach could be implemented nationwide and be taken into consideration to improve the outcome for other conditions in pregnancy, after further research
Learning from the experiences of other low income countries in handling similar conditions, and considering the nurse-midwives’ views, we developed an innovative approach, called the Four Pillars Approach to antenatal care
Summary
Anaemia is a common health problem among pregnant women and a contributing factor with a major influence on maternal mortality in Indonesia. The Four Pillars Approach is a new approach to anaemia in pregnancy, combining four strategies to improve antenatal and delivery care. Anaemia is a significant health problem among pregnant women in Indonesia with a major impact on maternal mortality [1]. Nutrional anaemia in pregnancy is found to be the most prevalent in Indonesia [3]. The 2007 Indonesia Demographic and Health Survey reported the prevalence of anaemia in pregnancy of 28% [6]. Concerning maternal health indicators in Indonesia, only 59.8% of births are attended by skilled birth attendants [8] and less than 70% of pregnant women attend no more than four antenatal care visits [9]. The antenatal care use is influenced by the knowledge of patients and other family members [10]
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