Maternal and newborn health Pregnancy and Childbirth
Conditions
Interventions
The intervention will be implemented for four years in 12 dispensaries and 12 dispensaries will continue with care as usual.
The intervention includes training of health care providers in basic emerg
Sponsors
National Institute of Allergy and Infectious Diseases (NIAID) (USA)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Household survey: 1. Reside within the official catchment area of one of the study health facilities at time of interview. 2. Age >= 15 years 3. Delivered a child within 12 months of interview Provider surveys: 1. Working in one of the study health facilities at time of interview 2. For the knowledge surveys, providers need to be skilled in deliveries (e.g. medical doctors, clinical officers, and nurses) Focus group discussions: 1. Age >= 15 years 2. Delivered a child in the past year 3. Lived in the study districts, but not in the official catchment areas of the study dispensaries
Exclusion criteria
Exclusion criteria: Does not meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| All measures will be collected at baseline. Provider and facility indicators will be measured yearly. Population characteristics will be measured again after two years of implementation and at endline. Measures of facility functioning will be repeated monthly. Measures will compare the intervention facilities to the control facilities. There are three primary outcome measures: utilization, quality, and extent of implementation and unintended consequences of implementation. These will be measured in many ways: Utilization 1. Proportion of women in the study facilities' official catchment area with a facility delivery (coverage) 2. Number of women utilizing the study facilities for delivery (volume) Quality 1. Women's satisfaction with services, measured using a four-point Likert scale ranging from 1, 'very satisfied' to 4 'very unsatisfied' 2. Service quality as perceived by women, measured using a five-point Likert scale ranging from 1, 'excellent' to 5, 'poor' 3. Processes of care: services received by the women (including proportion of women receiving a uterotonic and proportion of women receiving IV antibiotics) 4. Services delivered by the facility measured both through the registers and interviews with providers (including performance of obstetric signal functions in past three months, proportion of partographs completely and properly filled out, proportion of deliveries where active management of third stage of labor was performed) 5. Morbidity (including distribution of mothers' EQ-5D and MUAC within one year post-delivery) Implementation Dose of the intervention 1. Dose delivered (including: number of providers trained, number of equipment delivered, number of supportive supervision visits, number of peer outreach workers trained, number of peer outreach visits conducted) 2. Provider knowledge (measured through provider knowledge tests and provider vignettes) 3. Women's experience of outreach (e.g. proportion of women receiving peer outreach visits, pro | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcome measures will be collected at baseline. Provider and facility indicators will be measured yearly. Population characteristics will be measured again after two years of implementation and at endline. Measures of facility functioning will be repeated monthly. These measures will look at issues surrounding the main aims, women's delivery experiences, and implementation of the intervention. They will include: 1. Extent and indications of bypassing (e.g. proportion of women bypassing for delivery, characteristics of bypassers, experiences of bypassers) 2. Preferences for delivery care (measured through discrete choice experiments and focus group discussions) 3. Cost of the intervention and cost effectiveness 4. Mortality (measured through the case fatality rate in facilities as well as the number of maternal and newborn deaths in the catchment areas) 5. Level of functioning of the facilities (measured through facility assessments of indicators measuring infrastructure, human resources, availability of drugs, equipment, and supplies, e.g. proportion of facilities with no stockouts of essential maternal drugs in the past 90 days, proportion of essential labor and delivery equipment available at the facility) | — |
Countries
Tanzania
Outcome results
None listed