The feasibility, acceptability and effectiveness of couple antenatal education in Blantyre, Malawi v1
Authors: Chikalipo Maria , Mbweza Chirwa Ellen , Sinjani Muula Adamson 
Published: March 2019

This is a sequential mixed study which will use qualitative and quantitative research approaches to explore feasibility, acceptability and effectiveness of couple antenatal education in Blantyre, Malawi.The study will be done in two phases. Malawi‘s maternal mortality ratio remains high deeming it a public health concern despite efforts to reduce the mortality ratio. Contributing factors to maternal mortality are complex and one of the factors is the hierarchical patterns of authority which exist at household and community levels. Male partner involvement in maternity care has been reported as one of the fruitful strategy to promote safe motherhood. Yet male partner’s involvement remains low in maternal health including antenatal education. Lack of knowledge and the female oriented design of antenatal education are some of the factors responsible for low male involvement. The situation creates a need for redesigning antenatal education package in such a way that it includes male partners hence the need for this study. The overall objective of the study is to determine an effective curriculum for couple antenatal education.Specifically looking to: Describe male partner’s involvement in antenatal education. Explore factors that can influence male partner’s involvement in antenatal education sessions with their spouses. Identify relevant content for couple antenatal education. Assess relevant mode of delivery of content for couple antenatal education. Evaluate the efficacy of couple antenatal education. For phase one, sites will be Mpemba, South Lunzu Health centres, Mpemba Market, Blantyre District Health Office, Queen Elizabeth Central Hospital ( QECH), Kamuzu College of Nursing, Blantyre Campus, Mwaiwathu Private Hospital, Private Vehicle Hire Organization (PVHO) and Rangers Security Company. Piloting site will be Ndirande Health center. Phase two will be conducted at Mpemba and South Lunzu Health centers. All these sites are in Blantyre, Malawi. A combination of qualitative and quantitative approaches will be employed sequentially. Phase one will be cross sectional exploratory descriptive qualitative design to determine antenatal education needs for male partners. Information gathered will inform development of a tailor made couple antenatal education curriculum. Phase two will employ quantitative approach and the design will be Randomized Controlled Trial to evaluate effectiveness and feasibility of couple antenatal education.To determine acceptability of the intervention, qualitative approach through exit interviews will be conducted still in phase two. The study expects to identify more birth preparedness and knowledge on danger signs among women receiving antenatal education with their male partners than those women receiving health education without their male partners. Qualitative data will be managed with NVivo 10.0 and analysed using thematic content analysis. For quantitative data, descriptive statistics will be used to synthesize the sociodemographic data in the two groups. Furthermore intention to treat analysis will be employed for the intervention. Distribution of baseline characteristics between the study arms will be examined using proportions, means, standard deviation and medians. Mantel-Haenszel method will be used to calculate the risk ratio for birth preparedness between the study arms.