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A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal

Journal article
Authors Bishnu Choulagai
S. Onta
N. Subedi
D. N. Bhatta
B. Shrestha
Max Petzold
Alexandra Krettek
Published in Health Policy and Planning
Volume 32
Issue 8
Pages 1092-1101
ISSN 0268-1080
Publication year 2017
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages 1092-1101
Language en
Links https://doi.org/10.1093/heapol/czx0...
Keywords Cluster randomized controlled trial, maternal health, newborn health, skilled birth attendant, controlled-trial, health, determinants, bangladesh, services, Health Care Sciences & Services
Subject categories Health Care Service and Management, Health Policy and Services and Health Economy, Nursing

Abstract

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.

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