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The purpose of this study is to identify the causal impact of performance-based monetary incentives in increasing postnatal care (PNC) referrals by traditional birth attendants (TBAs), via a randomized controlled trial (RCT).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control arm | No Intervention | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. | |
| Referral incentive arm | Experimental | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. Traditional birth attendants randomized to this arm will also receive an offer of two-weekly payouts per successful referral of delivery clients to postnatal care within 48 hours of delivery in a facility if verified. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Performance-based monetary incentives | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maternal Postnatal Care Referral | The proportion of delivery clients that are successfully referred by the traditional birth attendant for postnatal care within 48 hours of delivery. For each delivery client that the traditional birth attendant reported, we visited at least three days after delivery to ascertain if they had been asked to visit the postnatal clinic, clarify if they had visited the clinic within 48 hours of delivery, and what care they had received (if yes). The team visited traditional birth attendants every two weeks to identify new clients. Where a new client was not up to three days post-delivery, the interview was postponed until the next visit by the team to the community. This occurred repeatedly, over a five-month frame. | Within 48 hours of delivery |
| Measure | Description | Time Frame |
|---|---|---|
| Neonatal Postnatal Care Referral | Proportion of neonates delivered by the traditional birth attendant that are successfully referred for postnatal care within 48 hours of delivery | Within 48 hours of delivery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Adanna Chukwuma, MBBS, MSc. | Harvard School of Public Health (HSPH) | Principal Investigator |
| Margaret McConnell, PhD | Harvard School of Public Health (HSPH) | Principal Investigator |
| Jessica Cohen, PhD | Harvard School of Public Health (HSPH) | Principal Investigator |
| Chinyere Mbachu, MBBS, MPH | Health Policy Research Group | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 9509629 | Background | Itina SM. Characteristics of traditional birth attendants and their beliefs and practices in the Offot Clan, Nigeria. Bull World Health Organ. 1997;75(6):563-7. | |
| 22895949 | Background | Sibley LM, Sipe TA, Barry D. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD005460. doi: 10.1002/14651858.CD005460.pub3. |
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De-identified data for this study including all the variables used for the analysis are available for download on the Harvard Dataverse.
The data on the Harvard Dataverse are available indefinitely as long as the website continues to host datasets.
The data can be freely downloaded without permission.
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Of the 269 TBAs identified through community leaders and facility heads that met the inclusion criteria and were recruited, 20 declined to participate and 27 could not be located at the given addresses.
Participants were recruited from the community within 128 wards in Ebonyi State in August 2016.
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| ID | Title | Description |
|---|---|---|
| FG000 | Control Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. |
| FG001 | Referral Incentive Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. Traditional birth attendants randomized to this arm will also receive an offer of two-weekly payouts per successful referral of delivery clients to postnatal care within 48 hours of delivery in a facility if verified. Performance-based monetary incentives |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Control Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. |
| BG001 | Referral Incentive Arm |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Maternal Postnatal Care Referral | The proportion of delivery clients that are successfully referred by the traditional birth attendant for postnatal care within 48 hours of delivery. For each delivery client that the traditional birth attendant reported, we visited at least three days after delivery to ascertain if they had been asked to visit the postnatal clinic, clarify if they had visited the clinic within 48 hours of delivery, and what care they had received (if yes). The team visited traditional birth attendants every two weeks to identify new clients. Where a new client was not up to three days post-delivery, the interview was postponed until the next visit by the team to the community. This occurred repeatedly, over a five-month frame. | The analysis did not include information from the 7 TBAs lost to follow-up. | Posted | Number | 95% Confidence Interval | proportion of maternal clients referred | Within 48 hours of delivery |
|
5 months
At recruitment, participants were informed about potential adverse events in a consent form. During follow-up, enumerators were required to ask for these and other events. All reportable events were to be forwarded to the Harvard Longwood Medical Area Institutional Review Board within 5 days of the PI becoming aware of the situation as per the Office of Human Research Administration policy.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Control Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. |
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This study was concluded prior to schedule due to community conflict affecting the length of follow-up time; we relied on self-reports due to the poor information systems within the study context.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Adanna Chukwuma | World Bank | 9173712931 | adc785@mail.harvard.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jul 7, 2016 | May 3, 2019 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Jul 7, 2016 | May 3, 2019 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D063130 | Maternal Death |
| D066087 | Perinatal Death |
| ID | Term |
|---|---|
| D063129 | Parental Death |
| D003643 | Death |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Background | Oyebola, B. C., Muhammad, F., Otunomeruke, A., & Galadima, A. (2014). Effect of Performance-Based Incentives for Traditional Birth Attendants on Access to Maternal and Newborn Health-care Facilities in Gombe State, Nigeria: A Pilot Study. Meeting Abstract. Lancet. |
| Background | WHO. (2004). Making Pregnancy Safer: The Critical Role of the Skilled Attendant - A Joint Statement by WHO, ICM, and FIGO. Geneva: World Health Organization. |
| 31104629 | Derived | Chukwuma A, Mbachu C, McConnell M, Bossert TJ, Cohen J. The impact of monetary incentives on referrals by traditional birth attendants for postnatal care in Nigeria. BMC Pregnancy Childbirth. 2019 May 20;19(1):150. doi: 10.1186/s12884-019-2313-8. |
| Legal Case |
|
| Protocol Violation |
|
Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client.
Traditional birth attendants randomized to this arm will also receive an offer of two-weekly payouts per successful referral of delivery clients to postnatal care within 48 hours of delivery in a facility if verified.
Performance-based monetary incentives
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants | No |
|
| Number of participants lacking formal education | Number | Participants |
|
| Average income per pregnancy | Mean | Standard Deviation | Naira |
|
| Number of participants offering postnatal care | Number | Participants |
|
| Monthly average of delivery clients | Mean | Standard Deviation | clients |
|
| Number of participants that are literate in English | Number | Participants |
|
| Number of participants that are literate in non-English Language | Number | Participants |
|
| Number of participants who are leaders of any association | Number | Participants |
|
| Number of participants who are members of any association | Number | Participants |
|
| Number of participants who are the main income earner in household | Number | Participants |
|
Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. |
| OG001 | Referral Incentive Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. Traditional birth attendants randomized to this arm will also receive an offer of two-weekly payouts per successful referral of delivery clients to postnatal care within 48 hours of delivery in a facility if verified. Performance-based monetary incentives |
|
|
| Secondary | Neonatal Postnatal Care Referral | Proportion of neonates delivered by the traditional birth attendant that are successfully referred for postnatal care within 48 hours of delivery | The analysis did not include data from 7 TBAs lost to follow-up. | Posted | Number | 95% Confidence Interval | proportion of neonates referred | Within 48 hours of delivery |
|
|
|
| 0 |
| 104 |
| 0 |
| 104 |
| 0 |
| 104 |
| EG001 | Referral Incentive Arm | Traditional birth attendants will receive an offer of two-weekly payouts per reported delivery they take that is verified by client. Traditional birth attendants randomized to this arm will also receive an offer of two-weekly payouts per successful referral of delivery clients to postnatal care within 48 hours of delivery in a facility if verified. Performance-based monetary incentives | 1 | 103 | 0 | 103 | 0 | 103 |
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| D011248 |
| Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |