Effect of a mother-baby delivery pack on institutional deliveries: A community intervention trial to address maternal mortality in rural Zambia.

Abstract

ObjectivesTo test the effect of providing additional health education during antenatal care (ANC) and a mother-baby delivery pack on institutional deliveries in Monze, Zambia.Setting16 primary health facilities conducting deliveries in the district.ParticipantA total of 5000 pregnant women at any gestation and age attending antenatal care (ANC) services in selected health facilities were eligible for enrolment into the study. Out of these, 4,500 (90%) were enrolled into and completed the study. A total of 3,882 (77.6%) were included in the analysis; 12.4% were not included in the analysis due to incomplete data.InterventionA three-year study (2012 to 2014) analysing baseline delivery data for 2012 and 2013 followed by a community intervention trial was conducted from January to December 2014. Health facilities on the western side were assigned to the intervention arm; those on the eastern side were in the control. In addition to the health education provided during routine ANC visits, participants in the intervention arm received health education and a mother-baby delivery pack when they arrived at the health facility for delivery. Participants in the control arm continued with routine ANC services.Outcome measuresThe primary measure was the number of institutional deliveries in both arms over the one-year period. Secondary measures were utilisation of ANC, post-natal care (PNC) and under-five clinic services. Descriptive statistics (frequencies, proportions, means and standard deviation) were computed to summarise participant characteristics. Chi-square and Independent T-tests were used to make comparisons between the two arms. One way analysis of variance (ANOVA) was used to test the effect of the intervention after one year (p-valueResultsAnalysis showed a 15.9% increase in the number of institutional deliveries and a significant difference in the mean number of deliveries between intervention and control arms after one year (F(1,46) = 18.85, pConclusionThese findings provide evidence for the effectiveness of the mother-baby delivery pack and additional health education sessions on increasing institutional deliveries, PNC and under-five children's clinic utilisation in rural Zambia.Trial registrationISRCTN Registry (ISRCTN15439813 DOI 10.1186/ISRCTN15439813); Pan African Clinical Trial Registry (PACTR202212611709509).