A multi-site, non-randomized study of the feasibility and acceptability of a family-led postnatal care model in the Ada District, Ethiopia

Postnatal care is a critical intervention to reduce newborn and maternal mortality in high-mortality settings. However, it is underutilized in many countries. Family-led postnatal care (FPNC) is an innovative postnatal care service delivery model that leverages self-care principles to address key barriers identified in the Ethiopian context, including women’s preference to stay home in the first week after delivery and receive support from trusted family members. Utilizing an improved discharge process, coupled with user-friendly monitoring devices made available as a home care kit kept with preferred community custodians, this self-care model for postnatal care will be evaluated as a potential solution to very low coverage of postnatal care in the first week of life. METHODS: The study will use mixed sequential methods: quantitative pre-intervention and post-intervention survey and phenomenological qualitative study. Four health centers in Ada Districtof Oromia, Ethiopia will be purposively selected. A pre-intervention survey will measure coverage and content of postnatal checks and care-seeking behavior. Health centers will then implement family led postnatal care. Once FPNC is initiated, post-intervention quantitative data will be collected. Approximately 218 postnatal women are to be included in the quantitative survey.  Qualitative interviews with approximately 20 mothers, 20 partners, 20 families, eight health managers, 12 postnatal discharge counselors, 20 health extension workers, and eight home care kit custodians will be conducted. A quantitative measurement of sustainability six months after the endline will also be assessed. CONCLUSIONS: Optimally, the study will contribute evidence to inform decision makers locally and globally on whether FPNC is a feasible and acceptable service delivery model for postnatal care, and whether it improves women’s empowerment and/or increases men’s support and connection to women and newborns in the early postnatal period

A clustered randomized control trial to assess feasibility, acceptability, and impact of implementing the birth companion intervention package in Ethiopia, Kenya, and Nigeria: study protocol

BACKGROUND: A birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions. METHODS: This two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang'a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country. DISCUSSION: Ample evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings. TRIAL REGISTRATION: Trial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022