Justification:
This project aims to improve maternal health indicators in a national context where the maternal mortality rate is among the highest in the world. Our hypothesis is that an intervention combining (i) training traditional birth attendants on the identification and follow-up of high-risk pregnancies, (ii) their integration into the health system, and (iii) the use of a digital decision support application installed on smartphones and tailored to their profile, could strengthen the identification and follow-up of high-risk pregnancies, increase the attendance at health facilities, and thus the rate of deliveries assisted in health care facilities.
Main Objective:
To assess whether an intervention targeted at midwives, combining multiple components (training, use of a digital application, collaboration with the health system), increases the proportion of births by pregnant women at risk of obstetric complications in the health facilities included in this study after 10 months of intervention.
Secondary Objectives:
1. Describe the characteristics of prenatal care, pregnancy outcomes, postnatal care, the incidence of maternal and neonatal mortality, in the community and in health facilities, and the evolution of health facility attendance by pregnant women.
2. Evaluate the acceptability and feasibility of this intervention in order to understand the potential drivers and barriers to implementing the intervention.
Methods:
The project involves conducting: - a quasi-experimental pilot study with a before/after intervention approach that takes into account aggregated data on deliveries in the health facilities included in the study (primary objective); - a prospective observational cohort study with an exploratory purpose, including pregnant women of any age of pregnancy who reside in the health areas included in the study, having given their informed consent (secondary objective 1); - a sub-study with a mixed methodology, combining qualitative and quantitative data from the various stakeholders (secondary objective 2).
Expected Outcomes:
If the research yields positive results, we expect the evidence produced to assist the Central African Ministry of Health in renewing its community health policy by integrating community midwives. This could also influence other humanitarian actors to include this community component in their maternal health programs in the country and progressively improve communication between traditional birth attendants and health facilities. If our experience with the digital application used by midwives to identify high-risk pregnancies is positive, we assume that it could be expanded by the Ministry of Health to other districts, by the health ministries of other countries, or by ALIMA or other humanitarian actors in various humanitarian contexts. In this sense, if the results of this pilot study justify it, we commit to providing free access to the final version of the application to these stakeholders.
Learn more about the "Wakobo Ti Kodro" project
