Abstract
BackgroundLow coverage of Skilled Birth Attendance (SBA) is one of the major drivers of maternal mortality in many low- and middle-income countries (LMICs) including Ethiopia. We conducted a cluster-randomized controlled community trial to assess the effect of deploying trained community based nurses to rural communities on the uptake levels of SBA in Ethiopia.MethodsA three-arm, parallel groups, cluster-randomized community trial was conducted to assess the effect of deploying trained community based reproductive health nurses (CORN) on the uptake of SBA services. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where these new service providers were deployed, a health post (HP) or health center (HC). Baseline and end line surveys were conducted to document and measure the effects of the intervention. Program impacts on SBA coverage were calculated using difference‐in‐difference (DID) analysis.ResultsAfter nine months of intervention, the coverage of SBA services increased significantly by 81.1% (from 24.61 to 44.59) in the HP based intervention arm, and by 122.9% (from 16.41 to 36.59) in the HC arm, respectively (p <0.01). Conversely, a small and non-significant (2%) decline in SBA coverage were observed in the control arm (P >0.05). The DID estimate indicated a net increase in SBA coverage of 21.32 and 20.52 percentage points (PP) across the HP and HC based intervention arms, respectively (p < 0.001).ConclusionsDeployment of trained reproductive health nurses to rural communities in Ethiopia significantly improved utilization of SBA services. Therefore; in similar low income settings where coverage of SBA services is very low, deployment of trained community based nurses to grassroots level could potentiate rapid service uptake. Additional cost-effectiveness and validation studies at various setups are required, before scale-up of the innovation, however.Trial registrationclinicaltrails.gov NCT02501252.
Highlights
Even if the global progress has been suboptimal, maternal and child mortality rates have showed a steady declined over the last four decades [1,2,3,4]
After nine months of intervention, the coverage of Skilled Birth Attendance (SBA) services increased significantly by 81.1% in the health post (HP) based intervention arm, and by 122.9% in the health center (HC) arm, respectively (p
Community based nurses and skilled birth attendance indicated a net increase in SBA coverage of 21.32 and 20.52 percentage points (PP) across the HP and HC based intervention arms, respectively (p < 0.001)
Summary
Even if the global progress has been suboptimal, maternal and child mortality rates have showed a steady declined over the last four decades [1,2,3,4]. For every woman who dies, 30 to 50 women will further suffer injury, infection, or disease and obstetric complications, many of which are leading causes of death and disability amongst reproductive age women in low and middle income countries(LMICs) [5,6,7]. Improving the quality of obstetric intra-partum care could save an estimated 113, 000 maternal deaths, 531 000 stillbirths, and 325 million neonatal deaths annually by 2020 [8]. Increasing the coverage and quality of preconception, antenatal, intra-partum, and postnatal interventions by 2025 could avert an estimated 71% of neonatal deaths, 33% of stillbirths, and 54% of maternal deaths per year [8,9]. Low coverage of Skilled Birth Attendance (SBA) is one of the major drivers of maternal mortality in many low- and middle-income countries (LMICs) including Ethiopia. We conducted a cluster-randomized controlled community trial to assess the effect of deploying trained community based nurses to rural communities on the uptake levels of SBA in Ethiopia.
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