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Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania
Author(s) -
Patil Crystal L.,
Klima Carrie S.,
Steffen Alana D.,
Leshabari Sebalda C.,
Pauls Heather,
Norr Kathleen F.
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12324
Subject(s) - randomized controlled trial , tanzania , medicine , attendance , randomization , prenatal care , pregnancy , postnatal care , family medicine , physical therapy , obstetrics , population , environmental health , environmental planning , biology , economics , genetics , economic growth , environmental science
Objective To identify implementation challenges associated with conducting a randomized controlled trial ( RCT ) of group prenatal care ( PNC ) and report outcomes of the pilot. Methods A multi‐site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20–24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC . Structured interviews were conducted at baseline, in the third trimester and 6–8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6‐week postnatal visit. Results The pilot showed that an RCT with individual randomization can be conducted in these two low‐resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P< 0.001). Conclusion Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCT s to determine efficacy. ClinicalTrials.gov: NCT02999334