Birth Injuries, Delivery Complication, Delivery; Injury, Maternal, Delivery Problem for Fetus, Maternal Death Affecting Fetus or Newborn, Obstetric Complication
Conditions
Keywords
maternal health, community health, health services, Tanzania, evaluation, cluster randomized trial
Brief summary
This study investigates whether training Community Health Workers (CHW) to use a smartphone-based prenatal counseling application as a job aid instead of the existing paper based standard is associated with increased women's use of maternal health services in Singida region, Tanzania.
Detailed description
In low-income countries, frontline community health workers (CHWs) have potential to improve women's access to maternal health services through prenatal counseling and referral. However, CHW performance can often be enhanced with sufficient training, incentives, supportive supervision and job aids. Smartphone-based applications designed to assist CHWs with referrals, health education and client counseling may improve the quality of care delivered during household visits. There is a need for rigorous scientific studies on the impact of such interventions. This study investigates whether CHWs' use of a smartphone-based application increases women's use of maternal health services in Singida region, Tanzania. It is hypothesized that smartphone-assisted counselling by CHWs can increase use of health facility-based delivery services compared to a control group of CHWs using standard paper-based protocols. This study is conducted within the context of larger project - SUSTAIN-MNCH Project (Supporting Systems to Improve Nutrition, Maternal, Newborn and Child Health), implemented by World Vision through multiple partners.
Interventions
BEHAVIORALSUSTAIN Smartphone training of CHW (SP+)
Intervention (Smart phone assisted): During prenatal household visits, the smart phone based application guides CHW through electronic decision tree protocols, directing them to specific health/nutrition counseling topics and messages based on each woman's gestational age, and her answers to a specific series of diagnostic questions. Based on the client's gestational age, the tool directs CHW to lessons in an accompanying photo book, and reminds them to counsel on the importance of accessing timed and targeted maternal health services at health facilities. The application also assists CHW to identify danger signs during pregnancy, flags clients who require immediate referral to health facilities, and reminds CHW to follow-up with clients who were previously referred to clinics.
BEHAVIORALSUSTAIN Paperbased training of CHW (SOC)
SUSTAIN Paperbased training of CHW (SOC): During prenatal household visits, the CHW asks a specific series of diagnostic questions based on the client's gestational age, offers counsel on the importance of accessing appropriate maternal health services at health facilities and uses lessons in an accompanying photo book to deliver messages on a variety of maternal and newborn health and nutrition topics. CHW are trained to identify danger signs during pregnancy, flag clients who require immediate referral to health facilities, and follow-up with clients who were previously referred to clinics.
Sponsors
World Vision
Muhimbili University of Health and Allied Sciences
University of Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Participants assigned to one of two groups in parallel for the duration of the study
Eligibility
Sex/Gender
FEMALE
Age
16 Years to 49 Years
Healthy volunteers
Yes
Inclusion criteria
* client of one of the CHWs enrolled in the mHealth study * visited at least once by a CHW following intervention (baseline training for CHWs) and during their most recent pregnancy * most recent delivery was a live birth and the child is still living
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Delivery in a facility | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Participant delivered at or on the way to a health facility, measured by retrospective report at time of interview, after delivery |
| Antenatal care attendance | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether participant attended 4 ANC visits or more during their most recent pregnancy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| HIV screening HIV Screening | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant was screened for HIV during pregnancy |
| De-worming treatment during pregnancy | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant reported during interview taking any listed de-worming medication during pregnancy |
| Bednet use | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant slept under an insecticide treated bed net during pregnancy |
| Malaria prophylaxis during pregnancy | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant reported during interview receiving two doses of IPTp during pregnancy |
| Tetanus Toxoid Vaccination | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant received two TT vaccinations during pregnancy |
| Referrals | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant was referred to a clinic during pregnancy by a CHW |
| Gestational age at first contact/ANC | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Number of months into pregnancy the participant had first ANC visit |
| Presence of partner at ANC | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant's husband/spouse accompanied her to at least one ANC visit |
| Birth plan | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant developed a birth plan during pregnancy |
| Early initiation of breastfeeding | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant initiated breastfeeding within 1 hour after birth |
| Exclusive breastfeeding at 7 days | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant breastfed exclusively for the first week after birth |
| BCG vaccination | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether the participant's child received BCG vaccination within the first week of life |
| Maternal knowledge of danger signs during pregnancy | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Number of pregnancy danger signs listed by participant |
| Referral uptake | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether a referred participant went to the facility during pregnancy |
| Iron supplementation during pregnancy | Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months) | Whether participant received 100 IFA tablets during pregnancy |
Outcome results
None listed