The Rajarata Pregnancy Cohort (RaPCo): study protocol

Abstract

Background Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes. Methods The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses. Discussion This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.

Self-applied ELCSA is valid for rapid tracking of household food insecurity among pregnant women during the COVID-19 pandemic

“…The cognitively validated ELCSA-P-SL was self-administered by a consecutive sample of 269 pregnant women attending the Rajarata Pregnancy Cohort (RaPCo) special clinics in Anuradhapura district, Sri Lanka, in February 2020 (15). Data were collected from 21 out of 22 public health administrative areas (Medical Officer of Health areas) in the district.…”

“…The objective of this study was to test the validity of a self-applied culturally adapted 8-item version of ELCSA in a large population-based cohort study of pregnant women in Sri Lanka (15) in the context of the COVID-19 pandemic.…”

How Costly is the First Prenatal Clinic Visit? Analysis of Out-of-Pocket Expenditure in Rural Sri Lanka - A Country With Free Maternal Health Care

“…The district is divided into 275 public health midwife (PHM) areas, with each PHM area having a population of 1500-4000. The number of pregnant women registered in the area in 2015 was approximately 17,000, and the number of live births was 15,376 (37).…”

“…The study protocol of the RaPCo has published further details on the study setting, including MOH areas (37).…”

A self‐applied valid scale for rapid tracking of household food insecurity among pregnant women in Sri Lanka

“…The objective of this study was to test the validity of a selfapplied culturally adapted eight-item version of ELCSA in a large population-based cohort study of pregnant women in Sri Lanka (Agampodi et al, 2020) in the context of the COVID-19 pandemic.…”