Abstract
BackgroundDespite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia. One of the key drivers of maternal mortality in Ethiopia is the very low coverage of Skilled Birth attendance (SBA) in rural Ethiopia. This cluster randomized trial piloted an innovative approach of deploying trained community reproductive nurses (CORN) to hard to reach/unreachable rural Ethiopia to improve the coverage of SBA.MethodsWe used a three-arm cluster randomized trial to test the effect of deploying CORN in rural communities in South Ethiopia to improve SBA and other maternal health indicators. A total of 282 villages/clusters (94 from each arm) were randomly selected in the three districts of the zone for the study. The intervention was implemented in four consecutive phases that aimed at of provision of essential maternal, neonatal and child health (MNCH) services mainly focusing on SBA. The CORN were trained and deployed in health centres (arm 1) and in the community/health posts (arm2). A third arm (arm 3) consisting control villages without the intervention. A baseline and end line assessment was conducted to compare the difference in the proportion of SBA and other MNCH service uptake across the three arms Data was entered into computer, edited, cleaned, and analyzed using Epi-data statistical software. The presentation followed the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines for cluster-randomized trials.DiscussionThis trial is designed to test the impact of an innovative and newly designed means of distribution for the national health extension program strategy with additional service package with no change to the target population. The focus is on effect of CORN in revitalizing the Health Extension Program (HEP) through improving SBA service uptake and other maternal health service uptake indicators. The study findings may guide national policy to strengthen and shape the already existing HEP that has certain limitations to improve maternal health indicators. The competency based training methodology could provide feedback for health science colleges to improve the national nursing or midwifery training curriculum.Trial registrationclinicaltrails.gov NCT02501252 dated on July 14, 2015.
Highlights
Despite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia
In rural parts of Ethiopia, which accounts for 85% of the national population, delivery attended by qualified health professionals (SBA) is only 16% and 84% of deliveries occur at home [15, 16]
The coverage of Skilled Birth attendance (SBA) remains low in the last ten years despite the presence of Health extension workers (HEW) in the community. This calls for an innovative approach to improve SBA nationally. This cluster randomized trial aims to assess the impact of such an innovative approach of deploying community reproductive nurses (CORN) to rural Ethiopia on the coverage of SBA
Summary
Despite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia. One of the key drivers of maternal mortality in Ethiopia is the very low coverage of Skilled Birth attendance (SBA) in rural Ethiopia. This cluster randomized trial piloted an innovative approach of deploying trained community reproductive nurses (CORN) to hard to reach/unreachable rural Ethiopia to improve the coverage of SBA. Ethiopia has shown remarkable progress in the reduction of maternal and child mortality rates during the past 25 years [5,6,7]. Maternal mortality rates is still high in Ethiopia [8, 9]. In rural parts of Ethiopia, which accounts for 85% of the national population, delivery attended by qualified health professionals (SBA) is only 16% and 84% of deliveries occur at home [15, 16]
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