Quality in Primary Care Open Access

Evaluation of a cluster-randomized controlled trial to increase skilled birth attendant utilization in mid- and far-western Nepal

7^th Edition of International Conference on Family Medicine & Primary Care

February 22-24, 2018 Paris, France

Bishnu P Choulagai

Tribhuvan University, Nepal

Posters & Accepted Abstracts: Quality in Primary Care

Abstract:

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. Implementation was administered by trained health volunteers, youth groups, mothers groups, and health facility management committee members. Post-intervention, we used mixed-effects regression models to assess and analyze any increase in the utilization of skilled birth care and antenatal care (ANC) services. Interviewees included 1,746 and 2,098 eligible women in the intervention and control groups, respectively. Utilization of skilled birth care and completion of at least one ANC visit increased significantly (OR=1.50; CI: 1.14-1.97 and OR=1.48; CI: 1.03-2.14, respectively) as a result of the intervention. Increased age of mother at current childbirth was associated with decreased use of ANC services and skilled birth care. Higher age at first childbirth significantly increased the use of ANC services and skilled birth care. The one-year community-intervention was effective in increasing the use of skilled birth care and at least one ANC visit, but was not effective in increasing adequate number of ANC visit. Scaling up of the intervention to other areas with low SBA utilization is recommended to achieve increased use of skilled birth care.