In a significant stride towards improving maternal healthcare outcomes, a recent study conducted by researchers has shown that an integrated intervention consisting of peer support, mobile phone messaging, and provision of mama kits at the household level is successful in increasing the proportion of facility-based births. This groundbreaking research comes at a time when Uganda is still grappling with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births and neonatal mortality rate also at 22/1000 live births
In the 2024 BMJ Published study titled “Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomized controlled trial in Northern Uganda by researchers namely; Dr. Victoria Nankabirwa and a team including David Mukunya, Grace Ndeezi, Beatrice Odongkara, Agnes A Arach, Vicentina Achora, Levi Mugenyi, Mohammad Boy Sebit, Julius N Wandabwa, Paul Waako, Thorkild Tylleskär, and James K Tumwine,sought to evaluate the effect of the integrated intervention package on increasing the proportion of health facility births compared to routine government health services.
As part of study trial, 2354 pregnant women were identified between January 2018 and February 2019 and 1887 women were recruited into the trial, with 995 in the intervention arm and 882 in the control arm.
Women in the intervention clusters were each provided with a mama kit consisting of clean plastic sheets, a razor blade, cord ligatures, swabs, two pairs of gloves, cotton and gauze. The kits were given to the women during the third trimester, after 28 weeks of gestation. They also had pregnancy buddies who often visited them and offered peer support
On the other hand, Participants in the control cluster received the standard of care, which involved occasional radio health promotional messages by the Ministry of Health, as well as information obtained during the antenatal, natal and postnatal health facility visits. This cluster had no pregnancy buddies
In the findings, the study found that more women prefer giving birth in health facilities when supported with supplementary like mama kits. Specifically, 76% of participants in the intervention group opted for health facility births compared to 57% in the control group
However, while the intervention successfully increased facility-based births, it did not lead to a reduction in perinatal or neonatal mortality rates. Neonatal mortality rates were similar between the intervention arm (3.1%) and the control arm (2.8%). Giving birth at a health facility was found to be more common among women in the upper socioeconomic strata
It was observed in this study that Mothers in the intervention arm are less single (living alone) compared with mothers giving birth under control arm. This is particularly owed to the fact that the intervention cluster employed pregnancy buddies who engaged mothers unlike the control cluster.
In terms of lessons learned from the study, part of the report reads
‘’This trial has shown that an integrated intervention consisting of peer support, mobile phone messaging and provision of mama kits at household level was successful in increasing the proportion of facility-based births.
‘’Future studies seeking to lower mortality outcomes need to carefully consider adding ‘supply-side’ intervention packages that improve the health facilities’ ability to provide emergency obstetric and newborn care’’ part of the research paper recommends.
Study Implications
Importance of Peer Support
This study highlights the crucial role of peer support in influencing pregnant women’s decisions regarding birthing location. This underscores the significance of establishing strong support networks within communities to promote maternal health.
Significance of Mama Kits
Provision of mama kits can help alleviate barriers to accessing facility-based births, especially in resource-limited settings where these kits may not be readily available in health facilities. Ensuring the availability of essential birthing supplies is crucial for improving maternal and newborn outcomes.
Need for Tailored Interventions
This trial underscores the importance of tailoring interventions to address specific barriers within communities. Understanding local contexts and preferences is essential for designing effective maternal health programs that resonate with target populations.
In conclusion , this study emphasizes the importance of holistic approaches that integrate peer support, mobile technology, and provision of essential supplies to promote facility-based births and improve maternal and newborn health outcomes.
To read more about the study click; https://pubmed.ncbi.nlm.nih.gov/38326267/
By Joseph Odoi