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2. Evidence-based reproductive health care

Author

Colomar, Mercedes, Cafferata, Maria Luisa, and Belizán, José Miguel

Subjects
Health Knowledge, Attitudes, Practice, Letter, Evidence-Based Medicine, Population, HIV Infections, Prenatal Care, Pregnancy Complications, Folic Acid, Reproductive Medicine, Adrenal Cortex Hormones, Pregnancy, Surveys and Questionnaires, Dietary Supplements, Humans, Female, Cameroon, Clinical Competence, Practice Patterns, Physicians', Iron Compounds
Abstract

To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon.In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions.Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI)=11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% CI=2.0- 6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice.The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed.

Published
2006

3. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care

Author

Villar, José, primary, Ba'aqeel, Hassan, additional, Piaggio, Gilda, additional, Lumbiganon, Pisake, additional, Belizán, José Miguel, additional, Farnot, Ubaldo, additional, Al-Mazrou, Yagob, additional, Carroli, Guillermo, additional, Pinol, Alain, additional, Donner, Allan, additional, Langer, Ana, additional, Nigenda, Gustavo, additional, Mugford, Miranda, additional, Fox-Rushby, Julia, additional, Hutton, Guy, additional, Bergsjø, Per, additional, Bakketeig, Leiv, additional, and Berendes, Heinz, additional

Published
2001
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4. Are women and providers satisfied with antenatal care? Views on a standard and a simplified, evidence-based model of care in four developing countries.

Author

Langer, Ana, Villar, José, Romero, Mariana, Nigenda, Gustavo, Piaggio, Gilda, Kuchaisit, Chusri, Rojas, Georgina, Al-Osimi, Muneera, Belizán, José Miguel, Farnot, Ubaldo, Al-Mazrou, Yagob, Carroli, Guillermo, Ba'aqeel, Hassan, Lumbiganon, Pisake, Pinol, Alain, Bergsjö, Per, Bakketeig, Leiv, Garcia, Jo, and Berendes, Heinz

Subjects
SATISFACTION, PRENATAL care, PREGNANT women, LABOR (Obstetrics), DELIVERY (Obstetrics), DEVELOPING countries
Abstract

Background: This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC) model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. Methods: Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. Results: Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. Conclusions: Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice. [ABSTRACT FROM AUTHOR]

Published
2002
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5. Methodological considerations on the design and analysis of an equivalence stratified cluster randomization trial

Author

Piaggio, Gilda, Carroli, Guillermo, Villar, José, Pinol, Alain, Bakketeig, Leiv, Lumbiganon, Pisake, Bergsjø, Per, Al-Mazrou, Yagob, Ba'aqeel, Hassan, Belizán, José Miguel, Farnot, Ubaldo, and Berendes, Heinz

Abstract

The World Health Organization and collaborating institutions in four developing countries have conducted a multi-centre randomized controlled trial, in which clinics were allocated at random to two antenatal care (ANC) models. These were the standard ‘Western’ ANC model and a ‘new’ ANC model consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. The two models were compared using the equivalence approach. This paper discusses the implications of the equivalence approach in the sample size calculation, analysis and interpretation of results of this cluster randomized trial. It reviews the ethical aspects regarding informed consent, concluding that the Zelen design has a place in cluster randomization trials. It describes the estimation of the intracluster correlation coefficient (ICC) in a stratified cluster randomized trial using two methods and reports estimates of the ICC obtained for many maternal, newborn and perinatal outcomes. Finally, it discusses analytical problems that arose: issues encountered using a composite index, heterogeneity of the intervention effect across sites, the choice of the method of analysis and the importance of efficacy analyses. The choice of the clustered Woolf estimator and the generalized estimating equations (GEE) as the methods of analysis applied is discussed. Copyright © 2001 John Wiley & Sons, Ltd.

Published
2001

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