Making birthing safe for Pakistan women: a cluster randomized trial

BMC Pregnancy and Childbirth

Study Protocol

Maqsood Ahmed¹  Shirin Mirza¹  Muhammad Amir Khan¹  John Walley²  Akhtar Rasheed³  Amanullah Khan⁴  Nailah Nisar⁵ 

[1] Association for Social Development, Islamabad, Pakistan;Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK;Provincial Programme for Family planning and Primary health care (Lady Health workers programme) for Punjab, Lahore, Pakistan;Save the Children, Islamabad, Pakistan;The Royal Surrey County Hospital NHS Foundation Trust, Surrey, UK;

关键词: Neonatal Mortality;    Verbal Autopsy;    Maternal Mortality Ratio;    Skilled Birth Attendant;    Emergency Obstetric Care;   

DOI  :  10.1186/1471-2393-12-67

 received in 2012-06-29, accepted in 2012-06-29,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundTwo out of three neonatal deaths occur in just 10 countries and Pakistan stands third among them. Maternal mortality is also high with most deaths occurring during labor, birth, and first few hours after birth. Enhanced access and utilization of skilled delivery and emergency obstetric care is the demonstrated strategy in reducing maternal and neonatal mortality. This trial aims to compare reduction in neonate mortality and utilization of available safe birthing and Emergency Obstetric and Neonatal Care services among pregnant mothers receiving ‘structured birth planning’, and/or ‘transport facilitation’ compared to routine care.MethodsA pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Jhang, Chiniot and Khanewal districts of Punjab, Pakistan, from February 2011 to May 2013. At least 29,295 pregnancies will be registered in the three arms, seven clusters per arm; 1) structured birth planning and travel facilitation, 2) structured birth planning, and 3) control arm. Trial will be conducted through the Lady Health Worker program. Main outcomes are difference in neonatal mortality and service utilization; maternal mortality being the secondary outcome. Cluster level analysis will be done according to intention-to-treat.DiscussionA nationwide network of about 100,000 lady health workers is already involved in antenatal and postnatal care of pregnant women. They also act as “gatekeepers” for the child birthing services. This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required). The review of current arrangements and practices show that the care delivery process needs enhancement to include adequate information provision as well as informed “decision” making and planned “action” by the pregnant women. The proposed three-year research is to develop, through national technical working group process, and then test a set of arrangements for achieving the enhanced utilization of safe birthing services.Trial registrationCurrent Controlled Trials ISRCTN86264432

【 授权许可】

Unknown   
© Khan et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.