Clinical trial NCT03774602: Evaluation of the Maternal and Child Survival Program (MCSP) in Mozambique Using Mixed Methods
Official title: Evaluation of the Maternal and Child Survival Program (MCSP) in Mozambique Using Mixed Methods
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Knowledge, Attitudes, Practice
Gender Issues
Lead sponsor: Jhpiego
Sponsor class: OTHER
Collaborators: name: Ministry of Health, Mozambique
name: United States Agency for International Development (USAID)
name: Save the Children
First posted: 2018-12-13
Enrollment: 2767
Sex: ALL
Minimum age (years): 15
Maximum age (years): 49
Standard ages: CHILD
ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: PREVENTION

Brief summary: This study evaluates changes in knowledge, attitudes, practices and coverage of key reproductive, maternal, newborn, and child health (RMNCH) areas, including malaria, family planning (FP), nutrition, water, sanitation and hygiene (WASH), and gender equity among the population in Nampula and Sofala provinces targeted by the Maternal and Child Survival Program (MCSP) in Mozambique.

Detailed description: The specific objectives of the study are to:

1. Assess changes in knowledge, attitudes, practices and coverage (KAPC) of high-impact interventions related to MNCH (antenatal care, delivery, post-partum/natal care, and sick child care), immunization, family planning and reproductive health, nutrition, WASH and malaria among mothers and fathers of children age 0-23 months in MCSP supported areas;
2. Evaluate the effectiveness of male engagement interventions that encourage couples communication at increasing antenatal care (ANC) attendance, joint birth preparedness and complication readiness (BPCR) plans, institutional birth, and use of modern FP;
3. Determine the feasibility and acceptability of male engagement interventions on RMNCH services for clients and providers;
4. Explore how decisions between couples are made and what may influence their decisions about seeking RMNCH services; and
5. Explore the experiences of women who were referred to a health facility for themselves or their child for obstetric, newborn or child health complications, and examine the factors contributing to whether and how those referrals were completed in Nampula Province.

This study is a final program evaluation that will use a mixed methods approach, including both quantitative and qualitative data collection.

Quantitative data will be collected through a cross-sectional KAPC household survey of mothers and fathers of children age 0-23 months, replicating the same KAPC questionnaire that was conducted at baseline in 2016 in the same geographic areas. Questions were harmonized with the DHS and MICS where appropriate. Findings from the endline KAPC survey will be compared to findings from the baseline survey to assess changes over time in the primary outcomes of interest.

Qualitative data will be collected through focus group discussions (FGDs) and in-depth interviews (IDIs) with clients (mothers and fathers of children age 0-23 months) and health providers in MCSP-supported areas. The qualitative component will be conducted to help us gain a more in-depth understanding of the influence of male engagement interventions on couples' decision-making and care-seeking related to RMNCH as well as the barriers and facilitators that affected the experience of identified women who were referred to health facilities for obstetric or newborn complications. We will explore both client and provider experiences with gender-equitable male engagement practices, as well as individual client referral narratives related to obstetric or newborn complications.

Eligibility criteria: Inclusion Criteria (KAPC survey):

* Women 15 years and older who have had a live birth in the 2 years preceding the survey and the child is living at the time of the interview
* Male partners (age 18 and older) of women 15 years and older who have had a live birth in the 2 years preceding the survey and the child is living at the time of the interview

Exclusion Criteria (KAPC survey): Women 15-17 years without parent permission to participate in study

Inclusion Criteria (Referral narrative interviews): Women who: a) delivered in the last 12 months who experienced obstetric complications; b) whose newborn experienced complications in the last year; c) whose child 0-59 months experienced an illness in the last year

Inclusion Criteria (Provider interviews):

* Facility managers working in selected primary health care centers
* Health care workers who provide RMNCH services in MCSP-supported facility in one of these six areas: ANC, maternity, postnatal care, FP, sick child, or well-child

Exclusion Criteria (Provider interviews): Has been working in the facility for \< 6 months

Inclusion Criteria (Male engagement FGDs):

* Women 18-49 years of age who delivered in the last 12 months
* Male partner (age 18 and older) of a woman 18-49 years of age who delivered in the last 12 months
* Participated in a community dialogue

Primary outcomes:
measure: Institutional delivery rate
timeFrame: 2 years
measure: Percentage of pregnant women who had four or more ANC visits
timeFrame: 2 years
measure: Percentage of children under 2 years of age who received Penta 1 vaccination but did not receive Penta 3 (Drop out rate)
timeFrame: 2 years
measure: Percentage of mothers who made birth preparations before giving birth
timeFrame: 2 years
Secondary outcomes:
measure: Percentage of women who have discussed FP use with her partner
timeFrame: 2 years
measure: Percent of infants under 6 months of age who are exclusively breastfed
timeFrame: 2 years
Other outcomes:
Locations:
city: Angoche
country: Mozambique
facility: Angoche District, Community Setting
state: Nampula
city: Meconta
country: Mozambique
facility: Meconta District, Community Setting
state: Nampula
city: Mecuburi
country: Mozambique
facility: Mecuburi District, Community Setting
state: Nampula
city: Moma
country: Mozambique
facility: Moma District, Community Setting
state: Nampula
city: Monapo
country: Mozambique
facility: Monapo District, Community Setting
state: Nampula
city: Mossuril
country: Mozambique
facility: Mossuril District, Community Setting
state: Nampula
city: Nacala
country: Mozambique
facility: Centro de Saude Ontupaia
state: Nampula
city: Nacala
country: Mozambique
facility: Centro de Saude Quissinmanjulo
state: Nampula
city: Nacala
country: Mozambique
facility: Nacala Porto District, Community Setting
state: Nampula
city: Namapa-erati
country: Mozambique
facility: Erati District, Community Setting
state: Nampula
city: Ribaue
country: Mozambique
facility: Centro de Saude Iapala Sede
state: Nampula
city: Ribaue
country: Mozambique
facility: Hospital Rural de Ribaue
state: Nampula
city: Ribaue
country: Mozambique
facility: Ribaue District, Community Setting
state: Nampula
city: Beira
country: Mozambique
facility: Beira City, Community Setting
state: Sofala
city: Buzi
country: Mozambique
facility: Buzi District, Community Setting
state: Sofala
city: Buzi
country: Mozambique
facility: Centro de Saude Ampara
state: Sofala
city: Buzi
country: Mozambique
facility: Centro de Saude Bandua
state: Sofala
city: Dondo
country: Mozambique
facility: Dondo District, Community Setting
state: Sofala
city: Nhamatanda
country: Mozambique
facility: Centro de Saude Metuchira
state: Sofala
city: Nhamatanda
country: Mozambique
facility: Hospital Rural de Nhamatanda
state: Sofala
city: Nhamatanda
country: Mozambique
facility: Nhamatanda District, Community Setting
state: Sofala
Study officials:
affiliation: Jhpiego
name: Connie Lee, MPH, MIA
role: PRINCIPAL_INVESTIGATOR
References: