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| Name | Class |
|---|---|
| Brigham and Women's Hospital | OTHER |
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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.
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.
Objective 2: Assess the mechanisms of implementation of group antenatal care through quantitative participant survey measures, qualitative focus group discussions and key informant interviews.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Cohort | Experimental | We will use a cohort of 60 women from intervention village clusters for the group antenatal care intervention. |
|
| Control Cohort | Active Comparator | We will use a cohort of 60 women from control village clusters as an active comparison. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group Antenatal Care | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Institutional Birth Rate | 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. | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Infant Mortality Rate | We expect the infant mortality rate to be 5% lower among the babies from the intervention cohort women compared to control. | 1 year |
| Postpartum contraceptive prevalence rates |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| David Citrin, PhD, MPH | Possible | Study Director |
| Duncan Maru, MD, PhD | Possible | Principal Investigator |
| Biraj Karmacharya, MBBS, Msc | University of Washington | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bayalpata Hospital | Bayaplata | Achham | Nepal |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31952543 | Derived | Harsha Bangura A, Nirola I, Thapa P, Citrin D, Belbase B, Bogati B, B K N, Khadka S, Kunwar L, Halliday S, Choudhury N, Schwarz R, Adhikari M, Kalaunee SP, Rising S, Maru D, Maru S. Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health. 2020 Jan 17;17(1):5. doi: 10.1186/s12978-019-0840-4. | |
| 31640770 |
| Label | URL |
|---|---|
| Possible | View source |
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| ID | Term |
|---|---|
| D063130 | Maternal Death |
| D047928 | Premature Birth |
| D050497 | Stillbirth |
| ID | Term |
|---|---|
| D063129 | Parental Death |
| D003643 | Death |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Individual Antenatal Care | Other | Pregnant women in control village clusters will have individual antenatal care sessions with their healthcare provider. |
|
We expect the postpartum contraceptive prevalence rate to be 5% higher among the intervention cohort women compared to control.
| 1 year |
| Completion percentage of 4 antenatal care visits | We expect that 5% more women in the intervention cohort will complete all 4 antenatal care visits compared to the control. | 1 year |
| Stillbirth rate | We expect that the stillbirth rate will be 5% lower among the intervention cohort compared to control. | 1 year |
| Perinatal mortality rate | We expect that the perinatal mortality rate will be 5% lower among the intervention cohort compared to control. | 1 year |
| Combined infant mortality and stillbirth rate | We expect that the combined infant mortality and stillbirth rate will be 5% lower among the intervention cohort compared to control | 1 year |
| Derived |
| Thapa P, Bangura AH, Nirola I, Citrin D, Belbase B, Bogati B, Nirmala BK, Khadka S, Kunwar L, Halliday S, Choudhury N, Ozonoff A, Tenpa J, Schwarz R, Adhikari M, Kalaunee SP, Rising S, Maru D, Maru S. The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health. 2019 Oct 22;16(1):150. doi: 10.1186/s12978-019-0820-8. |
| Healthcare Systems Design Group | View source |
| D007752 |
| Obstetric Labor, Premature |
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D005313 | Fetal Death |