Integrating Services for Noncommunicable Diseases in Continuum of Care for Mothers and Children
Condition: Continuum of Care; Noncommunicable Diseases
MeSH terms: Noncommunicable Diseases
Study type: Interventional

Summary: 
      The objectives of this cluster randomized control trial are to examine the effect of combined
      intervention of the utilization of continuum of care (CoC) card and health education on the
      completion of CoC services among mothers and to examine the effect of health education on
      NCDs and nutrition on mothers' knowledge on NCDs and nutrition in Myanmar. Pregnant women
      between 12-20 weeks of pregnancy will be recruited and assigned into intervention arm (n=600)
      and control arm (n=600). The intervention package will comprise of two components, (1)
      utilization of CoC card and (2) health education on CoC in maternal, newborn and child health
      (MNCH), NCD and nutrition. The CoC card will include CoC services from first antenatal
      care(ANC) to last postnatal care(PNC) including four ANC, skilled birth attendance (SBA) and
      four PNC and essential services. Pregnant women will get stickers if they receive above
      services. Health education will be given three times during pregnancy and one time during
      postpartum period. Health education will include importance of continuous uptake of MNCH
      services, NCDs and nutrition. The outcomes are proportion of completion of CoC services and
      knowledge on NCDs and nutrition.
    

Detailed description: 
      Antenatal care (ANC) is an important entry point for subsequent use of delivery and postnatal
      care (PNC) services. When women receive high-quality ANC, they will have skilled birth
      attendant (SBA) at delivery and continue to receive postnatal care. Continuous uptake of
      above services is necessary to improve health and well being of maternal, newborn and child
      health (MNCH). Moreover, the continuum of Care (CoC) offers the critical entry point for
      women and children for preventive care and health promotion on noncommunicable diseases
      (NCDs). ANC and PNC visits for women and a series of immunization for children are crucial
      opportunities to provide integrated services of NCDs. The integration of NCDs prevention and
      control programs in MNCH services would empower women to control NCDs in their families.
      However, no study has examined the effect of antenatal health education on CoC on completion
      of CoC among mothers in Myanmar. In addition, no study has examined the effect of antenatal
      health education on NCDs and nutrition on knowledge on NCDs and nutrition, and on maternal
      complications among mothers in Myanmar.

      A cluster randomized controlled trial will be done among pregnant women living in study area.
      The unit of randomization in this study will be "rural health center (RHC)". In each RHC,
      there are at least four Sub-centers (SCs). RHC including SCs will be considered as one
      cluster. The investigators will advocate midwives (MW) on the CoC in MNCH and introduce the
      CoC card. The investigators will also recruit and train Public Health Supervisors 2 (PHS2) in
      each cluster to provide health education to pregnant women on CoC in MNCH, NCDs and
      nutrition.

      We will conduct the study in three townships (Pantanaw, Inapu, Wakema,) in Ayeyarwaddy
      region, Myanmar from May 2017 to March 2018. There are a total of 22 health facilities. Out
      of 22 health facilities in 3 townships, eleven will be allocated into intervention arm and
      another 11 into control arm. An analyst, who will not be a primary member of the study team,
      will conduct randomization of clusters using computer-generated random sequences. Estimated
      sample size of 1200 pregnant women will be recruited, roughly 400 pregnant women in each
      township. The investigators estimate that about 28 women will seek ANC within one month in
      each cluster. In total of 22 clusters, the investigators estimate 600 women will seek ANC
      within one month; therefore, the enrollment period will take two months to get the targeted
      sample size of 1,200 pregnant women.
    

Intervention name(s): Integrating services for noncommunicable diseases in continuum of care for mothers and children; Ordinary health education for pregnant women
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention package will comprise of two components, (1) utilization of CoC card and (2) health education on CoC in maternal, newborn and child health (MNCH), NCD and nutrition. The CoC card will be distributed to mothers by midwives at the time of receiving ANC. The CoC card includes CoC services from first antenatal care(ANC) to last postnatal care(PNC) including four ANC, skilled birth attendance (SBA) and four PNC and essential services. Pregnant women will get stickers if they receive above services. Health education will be given by Public Health Supervisors 2 at the health facilities. Health education will be given three times during pregnancy and one time during postpartum period with pamphlets and posters.; The ordinary health education intervention will cover schedule for ANC, delivery and PNC; danger signs; birth preparedness and nutrition. Health education will be given three times during pregnancy and one time during postpartum period with pamphlets and posters.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: continuum of care; maternal; newborn; child health; noncommunicable diseases