Effectiveness of upgraded maternity waiting homes and local leader training in improving institutional births among women in the Jimma zone, Ethiopia: study protocol for a cluster-randomized controlled trial

Abstract

BackgroundEthiopia is one of the ten countries in the world that together account for almost 60% of all maternal deaths. Recent reductions in maternal mortality have been seen, yet just 26% of women who gave birth in Ethiopia in 2016 reported doing so at a health facility. Maternity waiting homes (MWHs) have been introduced to overcome geographical and financial barriers to institutional births but there is no conclusive evidence as to their effectiveness. We aim to evaluate the effects of upgraded MWHs and local leader training in increasing institutional births in the Jimma zone of Ethiopia.MethodsA parallel, three-arm, stratified, cluster-randomized controlled trial design is being employed to evaluate intervention effects on institutional births, which is the primary outcome. Trial arms are: (1) upgraded MWH + religious/community leader training; (2) leader training alone; and (3) standard care. Twenty-four primary health care unit catchment areas (clusters) have been randomized and 3840 women of reproductive age who had a pregnancy outcome (livebirth, stillbirth or abortion) are being randomly recruited for each survey round. Outcome assessments will be made using repeat cross-sectional surveys at baseline and 24 months postintervention. An intention to treat approach will be used and the primary outcome analysed using generalized linear mixed models with a random effect for cluster and time. A cost-effectiveness analysis will also be conducted from a societal perspective.DiscussionThis is one of the first trials to evaluate the effectiveness of upgraded MWHs and will provide much needed evidence to policy makers about aspects of functionality and the community engagement required as they scale-up this programme in Ethiopia.Trial registrationClinicalTrial.gov, NCT03299491. Retrospectively registered on 3 October 2017.

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia

“…The trial protocol has been published previously [ 29 ] and the trial was retrospectively registered on 3rd October 2017 with Clinical Trials (trial identifier: NCT0329949 ).…”

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

“…This research is part of the Safe Motherhood Project, a mixed-methods intervention trial testing the rollout and scale up of interventions to reduce preventable maternal and newborn morbidity and mortality [41][42][43]. The Safe Motherhood Project has rolled out two interventions (an information, education and communication intervention, and maternity waiting area (MWA) upgrades) and conducted multiple rounds of data collection (prior to the design of the interventions, at baseline and at end line) [44]. MWAs, also known as maternal waiting homes, are residential homes near to the health facility where women can stay in the weeks before their delivery date, thereby overcoming geographic or transportation delays in getting to the health facility and increasing their rate of skilled birth delivery [41].…”

The impact of antenatal care on child mortality in Ethiopia: a difference-in-differences analysis

“…The Ethiopian government has introduced a set of result-oriented measures with the goal of reducing maternal mortality and improving the outcome of child health [12]. Such interventions include Community-based health extension workers and maternity waiting homes where women are temporarily accommodated who are nearing their delivery date and will have di culty getting to a health facility on time [13].…”