Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda
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Date
2024-01-29
Journal Title
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Publisher
BMJ OPEN
Abstract
Objective To assess the effect of an integrated
intervention package compared with routine
government health services on the frequency of health
facility births.
Setting Three subcounties of Lira district in Northern
Uganda.
Design A cluster randomised controlled trial where a
total of 30 clusters were randomised in a ratio of 1:1 to
intervention or standard of care.
Participants Pregnant women at ≥28 weeks of gestation.
Interventions Participants in the intervention arm
received an integrated intervention package of peer
support, mobile phone messaging and birthing kits
during pregnancy while those in the control arm
received routine government health services (‘standard
of care’).
Primary and secondary outcome measures The
primary outcome was the proportion of women giving birth
at a health facility in the intervention arm compared with
the control arm. Secondary outcomes were perinatal and
neonatal deaths.
Results In 2018–2019, 995 pregnant women
were included in 15 intervention clusters and 882
in 15 control clusters. The primary outcome was
ascertained for all except one participant who died
before childbirth. In the intervention arm, 754/994
participants (76%) gave birth at a health facility
compared with 500/882 (57%) in the control arm.
Participants in the intervention arm were 35% more
likely to give birth at a health facility compared with
participants in the control arm, (risk ratio 1.35 (95%
CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI
0.13 to 0.27)). Adjusting for baseline differences
generated similar results. There was no difference in
secondary outcomes (perinatal or neonatal mortality
or number of postnatal visits) between arms.
Conclusion The intervention was successful in increasing
the proportion of facility- based births but did not reduce
perinatal or neonatal mortality.
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Citation
Nankabirwa V, Mukunya D, Ndeezi G, et al. Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda. BMJ Open 2024;14:e070798. doi:10.1136/ bmjopen-2022-070798