The Effectiveness of Multi-pronged Interventions to Improve Institutional Delivery in South Ethiopia

Overview

This study aims to improve the health and safety of mothers during pregnancy and childbirth by working closely with their husbands. In many communities in Ethiopia, husbands play an important role in decisions about where women give birth. The study involves educating husbands in group sessions to help them understand how to support their wives during pregnancy, prepare for childbirth, recognize danger signs, and encourage giving birth in health centers where skilled care is available. At the same time, some health workers receive training to improve their ability to handle childbirth emergencies and provide respectful, culturally sensitive care. Communities are divided into groups that receive either husband education, health worker training, both, or no additional support. The study will see which approach helps more women deliver safely in health centers and receive care after birth. By involving husbands and improving health worker skills, this study hopes to support mothers better and improve outcomes for families.

Detailed description

This study is conducted in Southern Ethiopia to improve the utilization of maternal health services, helping more women access safe childbirth and postnatal care. Many women face challenges in using health facilities for delivery, which can increase risks for mothers and babies. The study tests two key interventions that support mothers by involving both their families and health workers.

1. Husband Group Education:

Since husbands often influence decisions about childbirth, this intervention provides group education sessions for husbands. These sessions focus on:

Supporting their wives during pregnancy and childbirth.

Preparing for birth and recognizing danger signs.

Encouraging facility-based delivery where skilled care is available.

Promoting shared decision-making and responsibility sharing between husbands and wives around pregnancy and childbirth.

By increasing husbands' knowledge and encouraging joint responsibility, the study aims to improve the use of maternal health services by women. 2. Health Worker Training on Helping mother survive integrated RMC:

This intervention improves health workers' skills at local health facilities in Southern Ethiopia to:

Manage common childbirth emergencies.

Provide timely referrals and emergency care.

Deliver culturally sensitive and woman-centered care.

Enhance overall quality of care, making health facilities more effective and trusted.

The study uses a cluster randomized controlled trial design with four groups to compare the effects of these interventions:

Husband group education only,

Health worker training only,

Both husband education and health worker training,

No intervention (control group).

The primary goal is to identify which intervention best increases the number of women who give birth at health facilities and receive postnatal care. Secondary goals include improving husbands' knowledge and attitudes about birth preparedness, gender roles, and shared responsibilities, as well as enhancing health workers' knowledge and skills.

Overall, this study seeks to find effective ways to increase maternal health service utilization by fostering husband involvement and strengthening health system readiness, contributing to safer childbirth and healthier families in Southern Ethiopia

Interventions

• Behavioral Husband Group Health education.
  The community-based husband group health education will target expectant fathers with pregnant partners. It will focus on reshaping gender-related attitudes and beliefs, promoting caregiving best practices, preventing violence against women, and improving men's involvement in maternal health. The intervention will comprise group sessions with 20 participants each, conducted over three sessions lasting 2.5 hours each, with a 15-day interval between sessions. The sessions will cover key topics, in
• Behavioral Helping Mothers Survive + RMC
  The "Helping Mothers Survive" training is designed by Jhpiego, an affiliate of Johns Hopkins University, in collaboration with global health partners, including the World Health Organization (WHO), Laerdal Global Health, and the International Confederation of Midwives (ICM) for healthcare professionals involved in childbirth care focusing on saving lives at birth in low-resource settings. This on-site training will use realistic simulations to enhance skills in identifying and managing key cause

Primary outcome measures

• institutional delivery [Time frame: 8 months/ 37 weeks]
• Maternal postnatal care [Time frame: 8 months/37 weeks]

Secondary outcome measures (3)

• Husband's involvement in maternal health [Time frame: 8 months/37 weeks]
• knowledge of obstetric danger signs and birth preparedness [Time frame: 8 months/ 37 weeks]
• Gender-equitable attitude [Time frame: 8 months/ 37 weeks]

Eligibility criteria

Inclusion criteria

A husband whose wife is under 27 weeks of gestation

• A husband whose wife had a previous baby within 5 years
• A husband who lives with his wife together
• A husband who has lived with his wife in the selected cluster for at least six months

Exclusion criteria

\-

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Factorial

Masking

Open label

Primary purpose

Health services research

Study locations

Ethiopia · 1 center

• Arba Minch university — Arba Minch

Identifiers

NCT: NCT07133321 · AMU-IUC-P3

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗