Background
Safe motherhood promotion project (SMPP) in Bangladesh
Rationale of the current study
Methods
Description of interventions
Interventions | Comparison Arm | Intervention Arm | |
---|---|---|---|
Facility | District Hospital | Health Facility Assessment and planning Resource support for infrastructure and equipment Capacity building ANC and PNC campaign Strengthening monitoring and supportive supervision Perinatal death audits in facilities EOC team meeting | |
Upazila Health Complex | |||
Union Sub-Centre and Family Welfare Centre | |||
Linkage | Union and Upazila development coordination committee meeting | As per the GoB system | Facilitation |
CSG, CG and health provider meeting | As per the GoB system | Facilitation | |
Strengthening referral linkages through active facilitation | As per the GoB system | Facilitation | |
Observe relevant days | No | Yes | |
Community | Community diagnosis and resource mapping | As per the GoB system | Active Facilitation through UH&FPO |
Local level advocacy and planning meeting | As per the GoB system | Training and orientation | |
Establish CSG | As per the GoB system | Active Facilitation through Union Parishad | |
Capacity building of CG and CSG members | No | Yes | |
Maternal and perinatal death audit in the community | No | Yes | |
Creating enabling environment for women and children | As per the GoB policy | Active Facilitation | |
Community death audits | No | Yes |
Study design
Study setting
Area (sq km) | Upazila | Municipality | Union | Mouza | Village | Population | |
---|---|---|---|---|---|---|---|
Urban | Rural | ||||||
1704.06 | 8 | 6 | 87 | 1062 | 1237 | 314,102 | 1,957,127 |
Selection of unions and randomisation:
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Number of Community Skilled Birth Attendants (CSBA)
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Ongoing or planned maternal and child health services / programmes by BG or NGO. This information will be obtained from relevant government programme managers, upazila managers and NGO managers
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Number of functional community clinics
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Terrain (proportion of wetlands, hill, forest), accessibility (average time to reach union health facility from the farthest point within union, and approximate travel time to reach UHC from union health facility). This information will be obtained from facility service providers attending UHC monthly meetings.
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Number of active NGOs and type of NGO activities
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Demographic and socio-economic information from Bangladesh Bureau of Statistics, on number of villages, households, population, population density, literacy rate, school attendance, proportion of persons with no work, percentage of households drinking safe water and using sanitary toilets, proportion of households with electricity, and proportion of households receiving remittance income. This will then be followed by the final step where contextual and available facilities will be taken into account to derive the final set of pairs for the trial.
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Type of union level facilities and functionality will be collected as part of the upazila selection process.
Study population
Sample size
Data collection methods
Aims | Expected outcomes | Indicators | Tools |
---|---|---|---|
To measure the effectiveness of intervention on neonatal mortality. | Improved survival of neonates and improved MNH in the community. | Neonatal mortality rate. | Household survey, death audits, and Management Information System (MIS). |
To assess the effect of the intervention on knowledge and practices related to MNH at community. | Improved MNH knowledge and practices of participants (mothers / caregivers / families at home). | Proportion of Recently Delivered Women (RDW) having knowledge of danger signs; delivered by skilled birth attendants; delivered at facility; received at least 4 ANC and PNC within 2 days. Proportion of newborn received Essential Newborn Care. | Household survey, and qualitative assessment. |
To evaluate the effect of intervention on health and care seeking behaviour. | Increased knowledge of participants which translates into appropriate care-seeking behaviour. | Proportion of RDW who sought care from trained providers for complications. Proportion of neonates that were taken to trained providers with at least one danger sign. | Household survey, MIS, and qualitative assessment. |
To measure and compare utilization of facilities for neonatal illness episodes and complications. | Increased, sustained utilization of facilities for neonatal and maternal cases. | Number of neonatal and maternal cases managed at health facilities. Number of maternal near miss cases managed at health facilities. | MIS. |
To measure and compare the quality of care for neonates and mothers. | The quality of care at different level of facilities will be increased. | Facility readiness to provide quality care in terms of infrastructures, staffs, trainings, and logistics. | Assessment of health facility and, quality of care, and qualitative assessment; |
To measure incremental costs and estimate the cost-effectiveness. | Costs for improved neonatal health outcomes, and related health services. | Costs per Disability Adjusted Life in Years (DALY) averted, costs per life-year gained, costs per case of delivery by skilled attendance, costs per case of essential neonatal care, programme cost, incremental health service costs for providing quality services, and out of pocket expenditure. | Client interview at hospitals, facility records, semi-structured interviews, and review of programme spending |