Group Antenatal Care: The Power of Peers for Increasing Skilled Birth Attendance in Achham, Nepal
Study Details
Study Description
Brief Summary
In rural Nepal, the major drivers of underutilization of skilled birth attendance are poverty, poor social support and inadequate birth planning. Drawing from similar programs that have been shown to improve maternal and neonatal outcomes, we have designed a group antenatal care program that uses a participatory learning and action process to engage women in identifying and solving problems accessing maternity care services and create a supportive social network. We plan to test a group antenatal care program that will change antenatal care in three major ways: 1) conduct care in a group setting with women matched by gestational age, 2) incorporate participatory learning and action, and 3) provide expert and facilitated peer counseling.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The group antenatal care intervention aims to improve rates of institutional birth and ANC care completion via improving acceptability of group care, maternal and neonatal health knowledge, self-efficacy, social support, and birth planning.
Objective 1: Assess the effect of group antenatal care on institutional birth rates through a prospective study using community household census data. Secondary outcomes will be completion of basic ANC package; neonatal mortality rate; percentage of preterm births; percentage of stillbirths; and percentage of small-for-gestational age (SGA) births.
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Hypothesis 1: Group ANC will increase institutional birth rates by 5% over one year.
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Hypothesis 2: Group ANC will increase completion of 4 ANC visits by 5% over one year.
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Hypothesis 3: Group ANC will reduce infant mortality rate by 5% over one year.
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Hypothesis 4: Group ANC will reduce the postpartum contraceptive prevalence rate by 5% over one year.
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Hypothesis 5: Group ANC will reduce the stillbirth rate by 5% over one year.
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Hypothesis 6: Group ANC will reduce the perinatal mortality rate 5% over one year.
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Hypothesis 7: Group ANC will reduce the combined infant mortality and stillbirth rate by 5% over one year.
Objective 2: Assess the mechanisms of implementation of group antenatal care through quantitative participant survey measures, qualitative focus group discussions and key informant interviews.
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Hypothesis 1: Group antenatal care will be acceptable to participants and providers, and preferred to individual care.
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Hypothesis 2: Group antenatal care will increase pregnant patients' access to and utilization of delivery services through improved knowledge, self-efficacy, social support and birth planning.
Objective 3: Report on key aspects of the implementation process: costs, human resources, logistics, and fidelity of the group antenatal program to model content and participatory processes.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention Cohort We will use a cohort of 60 women from intervention village clusters for the group antenatal care intervention. |
Other: Group Antenatal Care
The group antenatal care intervention will match pregnant women by gestational age in the intervention village clusters and assign them to peer group sessions facilitated by local healthcare clinic staff.
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| Active Comparator: Control Cohort We will use a cohort of 60 women from control village clusters as an active comparison. |
Other: Individual Antenatal Care
Pregnant women in control village clusters will have individual antenatal care sessions with their healthcare provider.
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Outcome Measures
Primary Outcome Measures
- Institutional Birth Rate [1 year]
We expect the number of pregnant women from intervention village clusters who give birth at a healthcare facility to increase by 5% compared to control.
Secondary Outcome Measures
- Infant Mortality Rate [1 year]
We expect the infant mortality rate to be 5% lower among the babies from the intervention cohort women compared to control.
- Postpartum contraceptive prevalence rates [1 year]
We expect the postpartum contraceptive prevalence rate to be 5% higher among the intervention cohort women compared to control.
- Completion percentage of 4 antenatal care visits [1 year]
We expect that 5% more women in the intervention cohort will complete all 4 antenatal care visits compared to the control.
- Stillbirth rate [1 year]
We expect that the stillbirth rate will be 5% lower among the intervention cohort compared to control.
- Perinatal mortality rate [1 year]
We expect that the perinatal mortality rate will be 5% lower among the intervention cohort compared to control.
- Combined infant mortality and stillbirth rate [1 year]
We expect that the combined infant mortality and stillbirth rate will be 5% lower among the intervention cohort compared to control
Eligibility Criteria
Criteria
Inclusion Criteria:
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Female
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Age 15-49 years old
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Resident of 14 village clusters in study site
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Intervention cohort: less than 24 weeks' gestation prior to first group antenatal care session.
Exclusion Criteria:
- Intervention cohort: more than 24 weeks' gestation prior to first group antenatal care session.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Bayalpata Hospital | Bayaplata | Achham | Nepal |
Sponsors and Collaborators
- Possible
- Brigham and Women's Hospital
Investigators
- Study Director: David Citrin, PhD, MPH, Possible
- Principal Investigator: Duncan Maru, MD, PhD, Possible
- Study Chair: Biraj Karmacharya, MBBS, Msc, University of Washington
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- GroupANCnyaya