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

• Published in: Health policy and planning 2017-10, Vol.32 (8), p.1092-1101
• Main Authors: Choulagai, Bishnu P, Onta, Sharad, Subedi, Narayan, Bhatta, Dharma N, Shrestha, Binjwala, Petzold, Max, Krettek, Alexandra
• Format: Article
• Language: English
• Subjects: Adult; Assistants; bangladesh; Birth; Childbirth & labor; Cluster Analysis; Cluster randomized controlled trial; Committees; Community organizations; controlled-trial; Delivery, Obstetric - statistics & numerical data; determinants; epidemiology; Evaluation; evidence-based policy; Facilities management; Female; health; Health administration; Health care facilities; Health Care Sciences & Services; Health Care Service and Management, Health Policy and Services and Health Economy; Health Services Accessibility; health services research; Human resources; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Individ och samhälle VIDSOC; Individual and Society VIDSOC; Infants; Intervention; Maternal and infant welfare; maternal health; Maternal Health Services - utilization; Midwifery; Midwifery - organization & administration; Mothers; Nepal; newborn health; Nursing; Omvårdnad; Original; ORIGINAL ARTICLES; Patient Acceptance of Health Care; Polls & surveys; Pregnancy; Prenatal care; Prenatal Care - utilization; public health; Registration; Regression analysis; Regression models; Rural areas; Rural communities; Rural Health Services; Services; skilled birth attendant; Utilization; Volunteers; Women
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czx045

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. Le recours aux services des accoucheuses qualifiées (SBA) est peu développé dans les zones reculées et rurales du Népal. Nous avons conçu et mis en œuvre une évaluation afin d’estimer l’efficacité d’une intervention à cinq composantes qui a permis de surmonter les obstacles préalablement identifiés qui handicapent les services SBA dans les régions du centre et de l’extrême-ouest du Népal. Nous avons procédé à une répartition aléatoire et équitable de 36 comités de développement villageois qui utilisent très peu les services SBA au sein des groupes d’intervention et de contrôle sur une période d’un an. Les participantes admissibles à l’enquête étaient des femmes ayant accouché au cours des 12 mois précédant l’enquête. La mise en œuvre a été effectuée par des bénévoles formés, des groupes de jeunes, des groupes de mères et des membres du comité de gestion des établissements de sant