Home Based Life Saving Skills Training in a Rural Area in Tanzania

NCT01192646 | Unknown

• 1 other identifier: HBLSS TRIAL
• Study Type: interventional
• Target: 28
• Locations: 1 country
• Sites: 1

Brief Summary

Background The maternal mortality ratio in Tanzania has been persistently high for ten years with no signs of the ratio going down.The Tanzania Demographic and Health Survey (TDHS) of 1999 and 2005 estimate the maternal mortality ratio to be 528 and 578 per 100,000 live births respectively (TDHS 1999, TDHS 2004/05).The major direct causes include obstetric haemorrhage, obstructed labour, pregnancy induced hypertension, sepsis and abortion complications. Most deliveries (53%) in Tanzania occur outside the health facilities. Of these 53% of births that occur outside the health facilities 31% are attended by relatives, 19% by traditional births attendants (TBA) while 3% have no assistance at all. Though, the proportional of mothers delivering in health facilities (47%) and receiving skilled attendance at birth (46%) is low but more than 94 percent of women attend antenatal care (ANC) in health facilities at least once. This indicates that there are factors that impede these women delivering in the health facilities. Low awareness of obstetric danger signs may be one of the contributing factors for delay to decide to seek care when a complication occur thus contributing the first phase of delay. Studies in Tanzania show that most women are not aware of danger signs of obstetric complications during pregnancy, delivery and after delivery. A study conducted in Mtwara rural to assess the use and determinants of skilled attendants at delivery showed that proportional of women delivered with skilled care increases with increasing knowledge of pregnancy danger signs, but it also showed that few women have knowledge of pregnancy danger signs An increasing body of evidence supports the importance of community participation in maternal and infant health programs for establishing ownership, identifying problems effectively, achieving equity and helping to institutionalize health programs. To mount an effective maternal health effort aimed at reducing maternal and infant mortality, multiple levels of program and policies need to be in place and functioning. In addition, linkages, from the communities, local dispensaries and health centres to first referral hospitals that are adequately equipped, need to be developed and sustained A home based life saving skills (HBLSS) is a strategy that intends to educate pregnant women and their primary family caregivers and home birth attendants on critical knowledge and skills to keep a pregnant woman healthy, to recognize life-threatening maternal and newborn complications and promote the adoption of health care and health-seeking behaviours at the individual and community levels. The aim of this strategy is to prevent maternal and neonatal morbidity and mortality through creating awareness on women's birth preparedness and access to emergency obstetric care services RESEARCH QUESTIONS

1. 1.Can HBLSS increase women empowerment and male involvement in the decisions relating to access of emergency obstetric and newborn cares?
2. 2.Can the HBLSS increase hospital deliveries, increase awareness of obstetric and neonatal danger signs, birth preparedness and emergency readiness in a rural community?
3. 3.To investigate social-cultural, community and traditional practices that impact on women's birth preparedness and access and utilization of emergency obstetric care services in rural district.
4. 4.To assess the impact of home based life saving skills (HBLSS) on hospital delivery awareness of obstetric and neonatal danger signs, birth preparedness
5. 5.To explore customs, taboos and practices including herbal remedies during pregnancy and labour that influence birth preparedness and utilization of emergency obstetric care services.
6. 6.To assess perception, attitude and health seeking behaviour when a complication occur.
7. 7.To determine the effect of HBLSS educational programme on hospital delivery, birth preparedness, emergency readiness and utilization of emergency obstetric care services among women in Rufiji district.
8. 8.To assess the impact of HBLSS educational programme on male awareness and involvement in assisting women on birth preparedness and access to emergency obstetric care services.
9. 9.To determine the cost-effectiveness of HBLSS educational programme

Conditions

Pregnancy

Keywords

maternal health; birth preparedness; cost effectiveness; male involvement; delivery at hospital; complication readiness; Health seeking behavior in pregnancy, labour and pregnancy complication

Outcome Measures

Primary Outcomes (1)

• Proportion of women delivering in a health facility

  1 year

Secondary Outcomes (5)

• Proportion of community members pregnant mothers involved in birth preparedness and complication readiness

  1 year

• Proportion of men involved in birth preparedness and assisting in women seeking care for complications.

  1 year

• Proportion of pregnant women with birth plans

  1 year

• Proportion of pregnant women using herbal remedies during pregnancy and labour

  1 year

• The cost-effectiveness of HBLSS training

  1 year

Study Arms (2)

Home based life saving skills training

ACTIVE COMPARATOR

Home based life saving skills will done in one the study group and in the control group no training will be done

Behavioral: HBLSS

NO HBLSS

NO INTERVENTION

No intervention will be given to the control clusters

Behavioral: HBLSS

Interventions

HBLSS BEHAVIORAL

Home Based life saving skills training will be done in the intervention cluster while in the control group no training

Home based life saving skills training; NO HBLSS

Eligibility Criteria

• Age: 15 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Pregnant women in the community
• Relatives of the pregnant women including aunts, husbands and in-laws

Sponsors & Collaborators

• Muhimbili University of Health and Allied Sciences: lead
• Uppsala University: collaborator
• Swedish International Development Cooperation Agency (SIDA): collaborator

Study Sites (1)

Rufiji District

Rufiji, Coast Region, 00000, Tanzania

Location

Related Publications (9)

• Sibley L, Buffington ST, Beck D, Armbruster D. Home based life saving skills: promoting safe motherhood through innovative community-based interventions. J Midwifery Womens Health. 2001 Jul-Aug;46(4):258-66. doi: 10.1016/s1526-9523(01)00139-8.

  PMID: 11603641 BACKGROUND

• Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H. Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007 Dec 6;7:29. doi: 10.1186/1471-2393-7-29.

  PMID: 18053268 BACKGROUND

• Ahluwalia I, Kouletio M, Curtis K, Schmid T. Observations from the CDC: community empowerment: CDC collaboration with the CARE Community-Based Reproductive Health Project in two districts in Tanzania. J Womens Health Gend Based Med. 1999 Oct;8(8):1015-9. doi: 10.1089/jwh.1.1999.8.1015. No abstract available.

  PMID: 10565658 BACKGROUND

• Ahluwalia IB, Schmid T, Kouletio M, Kanenda O. An evaluation of a community-based approach to safe motherhood in northwestern Tanzania. Int J Gynaecol Obstet. 2003 Aug;82(2):231-40. doi: 10.1016/s0020-7292(03)00081-x.

  PMID: 12873791 BACKGROUND

• Berer M. Maternal mortality and morbidity: is pregnancy getting safer for women? Reprod Health Matters. 2007 Nov;15(30):6-16. doi: 10.1016/S0968-8080(07)30338-8. No abstract available.

  PMID: 17938066 BACKGROUND

• Donner A and Klar N. Design and Analysis of Cluster Ramdomization Trial In Health Research. Arnold-Hooder Headline Group. 2000. ISBN 0 340 69153 0

  BACKGROUND

• Goodburn E, Campbell O. Reducing maternal mortality in the developing world: sector-wide approaches may be the key. BMJ. 2001 Apr 14;322(7291):917-20. doi: 10.1136/bmj.322.7291.917. No abstract available.

  PMID: 11302911 BACKGROUND

• Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105-12. doi: 10.1016/j.nedt.2003.10.001.

  PMID: 14769454 BACKGROUND

• National Bureau of Statistics (NBS) and ORC Macro. Tanzania Demographic and Health Survey 2004-5. Dar es salaam, Tanzania: National Bureau of statistics and ORC Macro. 2005

  BACKGROUND

MeSH Terms

Conditions

Pregnancy Complications

Condition Hierarchy (Ancestors)

Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases

Study Officials

• Furaha August, MD,M.Med

  Muhimbili University of Health and Allied Sciences

  PRINCIPAL INVESTIGATOR

• Andrea Pembe, MD, M.Med, PhD

  Muhimbili University of Health and Allied Sciences

  PRINCIPAL INVESTIGATOR

• Siriel Massawe, MD, M.Med, M.Ed, PhD

  Muhimbili University of Health and Allied Sciences

  STUDY CHAIR

• Elisabeth Darj, PhD

  Upssala University

  STUDY CHAIR

Central Study Contacts

Furaha August, MD, M.Med

CONTACT

255754304250; drfuraha@gmail.com

Andrea Pembe, MD,M.Med, PhD

CONTACT

255754262483; drfuraha@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: August 31, 2010
• First Posted: September 1, 2010
• Study Start: August 1, 2011
• Primary Completion: August 1, 2012
• Study Completion: December 1, 2012
• Last Updated: September 1, 2010

Record last verified: 2010-08

Locations

TA (1)