scholarly journals Effectiveness of checklist-based box system intervention (CBBSI) versus routine care on improving postnatal care utilization in Northwest Ethiopia: a cluster randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Netsanet Belete Andargie ◽  
Gurmesa Tura Debelew
Keyword(s):  
Randomized Controlled Trial ◽  
Postnatal Care ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Outcome Variable ◽  
Difference In Difference ◽  
System Intervention ◽  
Randomized Controlled ◽  
Care Visit ◽  
Cluster Randomized

Abstract Background The period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization. Methods A double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model. Result Of 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4–24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31–8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15–2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71–7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18–0.59) less likely to attend three postnatal care visit. Conclusions The implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother’s decision. Trial registration: ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030.

scholarly journals Effectiveness of Checklist based Box system Interventions (CBBSI) versus routine care on improving utilization of Maternal Health Service in North West, Ethiopia: Study protocol for a Cluster Randomized Controlled Trial

2019 ◽  
Author(s):  
Netsanet Belete ◽  
Mulusew Gerbaba ◽  
Gurmesa Tura
Keyword(s):  
Randomized Controlled Trial ◽  
Maternal Health ◽  
Antenatal Care ◽  
Service Utilization ◽  
Postnatal Care ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Maternal Health Service ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background-Maternal mortality is still high in Ethiopia. Antenatal care, use of skilled delivery and postnatal care are key maternal health care services that can significantly reduce maternal mortality. However, in low and middle-income countries including Ethiopia, utilization of these key services is limited, so that preventive, promotive and curative services are not provided as per the recommendation. The aim of this study is to examine the effectiveness of checklist based box system interventions on improving maternal health service utilization. Methods - A community level cluster-randomized controlled trial will be conducted to compare the effectiveness of checklist based box system interventions over the routine standard of care, as a control arm. The intervention will use health extension program and provided by health extension workers and midwives, using a special type of health education scheduling and service utilization monitoring boxes, placed at health posts and health centers respectively. For this, 1,200 pregnant mothers, below 16 weeks of gestation, will be recruited from 30 clusters. Suspected pregnant mothers will be identified through a community survey and linked to the nearby health center. With effective communication between health centers and health posts, dropout-tracing mechanisms are implemented to make mothers resume service utilization. Data will be collected using ODK-Collect and analyzed using STATA version 13.0. Data will be analyzed by intention to treat analysis. Risk ratio will be computed at cluster level and the summary will be compared using t-test. Outcomes between intervention and control groups will be compared with random effects logistic regression models. Achieving four antenatal care, health facility delivery and postnatal care visits at 6 weeks of delivery were treated as primary out comes for this study. Discussion - The authors of this study expect that, the study will generate evidence on the effectiveness of checklist based box system interventions on improving utilization of maternal health care service, that produce inputs for related policies in the country. Trial Registration – ClinicalTrials.gov NCT03891030, 26 March 2019, Retrospectively Registered Keywords - Box system, maternal health, Antenatal care, skilled delivery, postnatal care, cluster randomized controlled trial, Ethiopia

Evaluation of a collaborative protocolized approach by community pharmacies and general medical practitioners for an Australian minor ailments scheme: study protocol for a cluster-randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Sarah Dineen-Griffin ◽  
Victoria Garcia Cardenas ◽  
Kylie Williams ◽  
Shalom Isaac Benrimoj
Keyword(s):  
Randomized Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Self Care ◽  
Cluster Randomized Controlled Trial ◽  
Control Group ◽  
Community Pharmacies ◽  
Randomized Controlled ◽  
Minor Ailments ◽  
Cluster Randomized

BACKGROUND Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MAS) promote efficiencies within the healthcare system. The cost savings and health outcomes demonstrated in the UK and Canada opens up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. OBJECTIVE This trial is evaluating the clinical, economic and humanistic impact of an Australian minor ailments service (AMAS), compared with usual pharmacy care in a cluster-randomized controlled trial in Western Sydney, Australia. METHODS The cluster-randomized controlled trial design has an intervention and a control group, comparing individuals receiving a structured intervention with those receiving usual care for specific common ailments. Participants will be community pharmacies, general practices and patients located in Western Sydney Primary Health Network region. 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients seeking, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments (reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhoea and low back pain). Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The co-primary outcomes are rates of appropriate use of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, time to resolution of symptoms, health services resource utilization and EQ VAS. Differences in the primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost analysis compared with usual care. RESULTS The study began in July 2018. At the time of submission, 30 community pharmacies have been recruited. Pharmacists from the 15 intervention pharmacies have been trained. 27 general practices have consented. Pharmacy patient recruitment began in August 2018 and is ongoing and monthly targets are being met. Recruitment will be completed March 31st, 2019. CONCLUSIONS This study may demonstrate the utilization and efficacy of a protocolized intervention to manage minor ailments in the community, and will assess the clinical, economic and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and self-medication may contribute greater efficiency of healthcare resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a MAS national service, with protocolized care for common ailments using a robust framework for management and referral. CLINICALTRIAL Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.

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