Abstract
Aim
This study assesses the impact of a community-based intervention package delivered through community lady health workers (LHWs) to improve early postpartum and newborn care practices.
Methods
A cluster randomized controlled trial was carried out in Sukkur, Sindh Province, Pakistan. We conducted a baseline survey and delivered an enhanced postpartum care package through the existing LHW cadre to the intervention clusters.
Results
Thirty clusters were randomly assigned to the intervention and control groups. A total of 3999 women in the intervention group and 3234 women in the control group were enrolled. During the study period, there were 1296 births in the intervention arm and 1326 in the control arm. Compared with the control group, the intervention group showed a significant improvement in the number of women receiving antenatal care (p = 0.001), fewer home deliveries (p = 0.022), increased number of deliveries by skilled birth attendants (p = 0.005), and more participation in care-seeking practices during the postpartum period (p = 0.023). Similarly, hygienic cord-cutting (p = 0.014) and a cord clamp (p = 0.049) were prevalent in the intervention group. Moreover, the intervention group had more visits by LHWs during pregnancy and in the postpartum period.
Conclusion
The use of maternal and neonatal intervention packages through trained community LHWs within the existing health system has the potential to improve maternal, perinatal and neonatal care practices, particularly in low-resource settings where home deliveries still occur.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Code availability
SPSS v.14 was used for data anlysis.
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Acknowledgements
We would like to thank the Aga Khan University, Pakistan, for supporting this study. We are also immensely grateful to all participants for their cooperation during the study.
Funding
This study was funded by PAIMAN (Pakistan Initiative for Mothers and Newborns) and John Snow Inc, via a grant from the US Agency for International Development (USAID; Award Number: 36098-01, cooperative agreement number 391-A-00-05-01037-00).
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ZAB conceptualized the study, provided technical supervision. SA and SBS designed the study, developed the sampling strategy, assisted with interpreting the results, and reviewed the manuscript. MB, AK and SA drafted the manuscript. MS and AR were involved in data management and analysis. SK, MU and IA critically reviewed the manuscript. All authors reviewed and approved the final manuscript for submission.
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The study was approved by the Ethical Review Committee of the Aga Khan University, Pakistan (770-Ped/ERC-06). This trial was registered at ClinicalTrial.gov. ID: NCT01389219, dated 01 October 2007.
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Ariff, S., Soofi, S.B., Bhura, M. et al. Impact of a community-based intervention package delivered through community health workers on post-partum care practices: a cluster randomized controlled trial. J Public Health (Berl.) (2023). https://doi.org/10.1007/s10389-023-01955-9
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DOI: https://doi.org/10.1007/s10389-023-01955-9